111-- MMaalliiggnnaanntt TTuummoorrss ooff tthhee SSkkiinn1-BCC:

From basal layer, it is locally malignant tumor, not metastasize mainly in the face above line of angel of mouth to lobule of ear. It spread by local infiltration and so called "Rodent Ulcer"

PF: - UV rays, common in white races- Commonest in albinism (no pigment)- Sweepers - Xeroderma pigmentosa- Brown disease (red papule)- Erythroplsi of zyrate- Senile keratosis

NB if +++ LNs infection or turn to SCC Macro: papule, itchy, ulcerate raised, inverted rolled in edge) Micro: palisade appearance Clinical Types:

1- Ulcerative.2- Cystic.3- Turbane type.4- Field fire.5- Pigmented6- Nodular.

TTT: radiation then surgery

2-SCC:More aggressive, metastasis (local, lymph, blood)

PDF: as above + margiolin ulcer (on top of long-standing scar) Site

- It arises anywhere with squamous epithelium.- Up (smokers) esophagus, oral cavity, lower anus mouth- PDF for carcinoma of tongue- $ ? Spirits smoking sharp tooth spicy food bengin tumors e.g. papilloma

Micro: cell nests. TTT: resection

3-Melanoma: Types:

- Intradermal, junctional, compound- (Last 2 precanerous esp. in friction sites) so excision is a must

Any change in melanoma (increase or decrease in size, change of odor suspect malignancy so biopsy is a must.

Appears as:1- Lentigo.2- Frechles.3- Giant hairy navus.

Any ulcerated pigmented lesion in the body is considered malignant melanoma except if above the line fromto . It is BCC

2 Malignant melanoma is an aggressive tumor, spread by local, blood (live heart,

LNs Any metastasis in unexplained site suspect melanoma TTT: surgery and chemotherapy (it is radio-resistant)

( organ ) enuculation)

Types: nodular, sbuangual, acral lentigus Any black lesion in limbs malignant melanoma

Slides1- Burn with ulceration SCC & PDF burn2- Black lesion in side of foot malignant melanoma (DD Others SCC &

BCC)3- Tongue with white patches -> leucoplakia (EX LNS, PDF for

malignancy)4- Pigmented face + dryness + ulcer with raised everted edge SCC on top

of xeroderma pigmentosa5- Ulcer on lower eyelid and rolled-in edges pigmented BCC (if LN

infection or turn to SCC)

22-- TTuummoorrss ooff mmaaxxiillllooffaacciiaall bboonneessIt arises from maxillary sinus, tooth or gum

A- Gum tumors: called epiulus it is 5 types1- Fibrous (fibroma)2- Myloid (osteoclastoma of alceolar bones)3- Granulomatous (granuloma)4- Sarcomatours (fibrosarcoma)5- Carcinomatous (SCC)

TTT: wide local excision with bone graftsB- Tooth tumors (odontomes)

From paradenbtal epithelia debris1- Dental cysts: cysts related to fully erupted tooth 2- Dentagerous unerpted tooth

- Presentation: tooth pain, fracture mandible, facial swelling3- Adamentenoma: locally malignant tumor of angel of manbile in femal mainly

DD of adamentenooma is osteoclastoma occurs at symphisis mentiC- Maxillary sinus:

1- Cancer of maxilla () big mass occuping maxillary sinus and displace teeth2- Fibrous dysplasia not displace teeth (no manifestations of ulceration or invasion),

no LNs metastasis, no bony destruction.- Presentation may be: dystopia, diplopia

Slides1- Panoramic view on mandible cystic, radiolucent swelling involve angel and

ramus of mandible DD cystic swelling of mandible2- Tumors arising from maxilla affects and displace teeth, destruction of bones of face

with ulceration and obliterated sinus cavity DD cancer maxilla3- Gum swelling epiulus (ex of LNs, diagnosis by biopsy)4- Maxillary swelling by CT obliterate maxillary sinus + healthy oral cavity DD

fibrousdyplasia5- Cystic swelling in mandible with tooth inside dentagerous cyst

333-- UUllcceerrssUUllcceerrss ooff tthhee lleegg

Types:1- Neoplastic: SCC, BCC, marjiolin, melanoma2- Vascular

- Arterial S & S of ischemia- Lymphatic lymphatic- Venous in guuter area surrounded by pigment

3- traumatic: follow trauma, bed sores4- Infective

- Specific TB, leshmania- Non specific

5- Neuropathic () with nerve injuries deep, non sensation around itCornifying the skin occurs in abnormal positionTreatment: should be treated by muscle flap.

Slides:1- Traumatic ulcer with sloping edge in leg2- venous ulcer necrotic floor, surrounded by pigmentation3- ischemic ulcer patient with claudication pain and weak pulsation4- Neuropathic ulcer in sole with characteristic teritstic chhs

44-- CClleefftt LLiipp aanndd PPaallaattee Face develops 6-9 weeks induration Commonest on clip lip

1- Upper or lower.2- Unilateral or bilateral3- Complete or incomplete4- Alevolar or prealveolar5- Complicated or not (associated with cleft palate)

TTT:- Repair at 3 months of age in Zigzag line to avoid fibrosis and recurrence with

preservation of wt line - But cleft palate at 10 months as it is major surgery (by mucoperosal flap)

Complications: cosmetic (lip mainly), problems indentation, phonation (B P T D K J Slides:1- Complete bilateral cleft lip and palate2- Simple unilateral incomplete cleft lip3- Cleft soft palate4- Incomplete unilateral cleft lip

Most important Q: time of repair

More details: See special surgery part II plastic surgery

455-- FFrraaccttuurree ooff mmaannddiibblloo--mmaaxxiillllaarryy ffaacciiaallrreeggiioonn

Most weak points in mandible:1- The site of the 3rd molar.2- Canines.3- COndyles.

Treatment:1- Para-sympheseal fracture treatment by mandibulomaxillary fixation for 6

weeks.2- Fracture condyle it must be fixed by a rigid plate and screw.

Slides:- 10 Fracture zygoma with sub-conjunctival hemorrhage- Fracture of body of mandible- Zygomatic fracture and nasal fracture with marked fascial deformity- Panoramic X-ray fracture in body of mandible.

66-- BBeedd SSoorreess 1st region is fixed erythrema. Grading of bed sores:

Grade 1:- Non-blanchable erythema of intact skin. Discoloration of the skin,

warmth, edema, induration or hardness may also be used as indicators,particularly on individuals with darker skin in whom it may appear blue or purple.

Grade 2:- Partial thickness loss involving epidermis, dermis, or both. The ulcer is

superficial and presents clinically as an abrasion or blister. Surrounding skin may be red or purple.

Grade 3:- Full thickness skin loss involving damage o or necrosis of SC tissue that

may extend down to, but not through underlying fascia. Grade 4:

- Extensive destruction, tissue necrosis, or damage to muscle, bone or supporting structure with or without full thickness loss, Extremely difficult to heal and predispose to fatal infection

TTT: - Closure and debridement by myocutaneous flap because it is thick vascular

flap cover bed sores Slides:

- Trochanteric bed sore- Bilateral ischeal bed sores- Sacral bed sores.

577-- HHyyppoossppaaddiieeuuss aanndd eeppiissppaaddiiuuss See Special surgery Book part 2 plastic surgery for more details.

Slides:1. Glanular hypospadius2. Distal penile hypospadius3. Adult + hypospadius + circumcision4. Urinary diversion (post operative)5. Urethral fistula ( )

Ideal time for repair is 2 years by prepius or buccal mucosa6. Epispedius7. Ectopia vesica.

88-- BBuurrnn Complications:

1- Laryngeal edema in face burn TTT tracheostomy.2- Sepsis.3- Eschar contraction nerve and vascular compression.

Slides1. Facial burn 1st and 2nd degree TTT escharotomy

Q= First aid ? Care of respiration 2. Burn on calf (wide patches) 3rd degree (red granular or white patches)3. Burn with vesciles due to hot fluids 2nd degree. (scaled)4. Necrotic tissue with burn 3rd degree.5. Circumferntial eschar TTT escharotomy

99-- HHeemmaannggiioommaa Vascular malformations

Afterbirth hemangioma strawberry

Proliferative stage involutive stage

Vascular malformations

Capillary(port wine) red macule not raised)

LymphaticCystic hygroma in flexruis (partially compressible)

VenousCompressible

A-V fistula(Pulsating)

Treatment:Conservative waiting for involution

Treatment:Excision or embolization

6Q: Complications

Bleeding on trauma, thrombosis, hemanigosarcoma, impairment of organ according to site, infection

How to examine consistency: > 2 cm fluctuating test. < 2 cm paget's test

1100-- HHaanndd eexxaammiinnaattiioonn- See Special surgery Book part 2 plastic surgery for more details.

Allen test to know predominant vessel.