Mock37 Hand SCC

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64 years old man is referred by GP with a large 25mm nonbleeding RT arm skin ulcer punch biopsy is performed
The skin lesion is reported as showing squamous cell carcinoma.

What is carcinoma?

Malignant epithelial Neoplasm.

Patient undergoes surgical excision of the region. What tumour characteristic in histopathology report might indicate an aggressive tumour Potential?

Deep penetration
Lymphatic or blood vessel invasion
High mitotic activity or high proliferation fracture
Poor Differentiations

What two treatments are appropriate for an incompletely excision of the tumour at the site?

Re-excision to achieve clearance
Radiotherapy to sterilizes the field of tumour cells in tumour

For incompletely excised tumours, how may frozen section histology assist surgical clearances?

It's help to assist the margins.

Aside from frozen section, what is a common method that a histopathology department process pathology samples through glass stain dissections?

Sections are made from Formalin fixed and paraffin embedded blocks.

What is the benefits of formalin?

Preservation of tissue.

10 days following further excision and wound the grafting surgery. The operation site is noted to have partial about 50 percentage broken down and is now leaking fluid. The laboratory report is MRSA positive from wound swab, why is identification of MRSA is important?
MRSA (Methicillin-Resistant Staphylococcus Aureus) is a drug-resistant, subtype of Staphylococcus Aureus and likely to have problems in terms of claudication.

Given the tissue breakdown with MRSA positive and partial graft filler, what is the appropriate treatment?

Local wound care and decolonization
Systemic antibiotics may be needed if patient have sepsis, guided by microbiologist advice.

What other microbiological investigations are appropriate at this point?

Screening for patient organism from all wounds by swab
Considering MRSA eradication therapy based on screening results

The wound develops granulation tissue, what is granulation tissue, and what is its role in secondary intention healing?

Granulation tissue is vascularized loose connective tissue.
Its growth into the space or defect and detects with its fibroblast and some inflammatory cells.
Sclerosis into a scar later.
Then it permits the surface revitalization

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Stem 2
46-year-old man is referred by GP with a large 25 mm non-bleeding right arm skin ulcer. Punch biopsy is performed.
From biopsy report, what are the criteria of malignancy?
See 'Parotid tumours' station – Cytological features of malignant neoplasms

Six months later, patient developed cervical lymphadenopathy. How does cancer spread to lymph nodes?
See 'BCC' station and 'Parotid tumours' station

Excision done but not enough, what you will do?
See 'BCC' station

What is the advantage of frozen section?
See 'Peptic Ulcer Disease + Hyperparathyroidism' station
Frozen section technique shortens the time to preliminary diagnosis significantly from traditional tissue biopsy preparation.

What other alternatives to frozen section?

Fine Needle Aspiration Cytology (FNAC)
Imprint Cytology (IC)

After excision and grafting, graft became infected and sloughed. Swab shows MRSA. What will you do?
See 'BCC' station & 'Breast Cancer' station

Define granulation tissue?

Combination of proliferating fibroblasts, loose connective tissue, new blood vessels and scattered chronic inflammatory cells, forms a type of tissue that is unique to healing wounds and is called granulation tissue.

Fate of granulation tissue?

Remodelling - The connective tissue that has been deposited by fibroblasts is reorganized to produce the stable fibrous scar. This process begins 2 to 3 weeks after injury.

isurg

Mock37 Hand SCC