BCC: Slow-growing ulcerative lesion, mainly on face, raised Anatomy: Parotid Gland - divided by faciovenous plane

beaded margins, indurated base, scabbed floor, slight (Superficial & Deep). Boundaries: Mandible (ant), Mastoid Papilloma - Compact Summary
bleeding, no LN involvement. Dx via biopsy process (post), Digastric (inf), Zygomatic arch (sup). Duct: Definition: Benign epithelial tumor forming finger-like
(excisional/incisional/punch/curettage). Mgmt: Surgical Runs over masseter, pierces buccinator, opens opposite projections, often HPV-induced.
excision (5mm margin, depth per invasion), skin graft/flaps upper 2nd molar. Hypospadias - Compact Summary Types:
for closure. RT effective but avoided near eye. Cryo (small Vascular Relations: Veins - Retromandibular (divides into Case: 2M, urethral orifice on ventral penis since birth,  Cutaneous: Common warts (HPV).
lesions, liquid N2), 5-FU (superficial), curettage & diathermy ant/post → facial/ext. jugular). Arteries - External carotid narrow stream, soiling. Exam: Hypoplastic penis, distal
(<1cm, not over bone/cartilage). Types: Nodular (slow (gives superficial temporal, maxillary, posterior auricular). penile meatus, chordee (ventral bend), dorsal preputial
 Genital: Condyloma acuminata (HPV, oncogenic
ulcerative papule), Cystic (dark w/ venules), Pigmented Nerves - Facial (main), Auriculotemporal (secretomotor), risk).
hood, no other anomalies.  Oral: Soft palate, tongue, tonsils.
(brown-black), Superficial (erythematous scaly patches), Great auricular (sensory). Dx: Distal penile hypospadias w/ meatal stenosis. DDx:
Morphoeic/Sclerosing (red plaques, scarring). Spread: Direct Frey’s Syndrome: Gustatory sweating post-parotidectomy Undescended testis, inguinal hernia, hydrocele,  Conjunctival: Eye lesions.
(centrifugal, deep invasion); LN/blood rare. High recurrence: (auriculotemporal nerve injury → parasympathetic hydronephrosis.  Intraductal: Breast ducts (nipple discharge).
central face, postauricular, pinna, forehead. Variants: rerouting to sweat glands). Mgmt: No surgery, local Types (by meatal location): Symptoms: Painless growth, rough/smooth surface, may
Rodent ulcer (deep burrowing), Field fire (heals one side, antiperspirants, possible spontaneous recovery. ulcerate/bleed if irritated.
spreads other), Turban tumor (scalp, transparent cylinders). Parotid Secretomotor Pathway: Inferior salivary nucleus →
 Anterior (50%): Glandular, Coronal, Subcoronal Dx: Clinical exam, Dermoscopy, Biopsy (if suspicious for
Glossopharyngeal → Tympanic branch → Tympanic plexus  Middle (30%): Distal/Midshaft/Proximal Penile malignancy), HPV testing.
→ Lesser petrosal nerve → Otic ganglion →  Posterior (20%): Penoscrotal, Scrotal, Perineal (+ Mgmt:
Paraumbilical Hernia (PUH) - Compact Summary Auriculotemporal (V3) → Parotid gland. bifid scrotum)  Small/Superficial: Cryotherapy (liquid N₂),
Case: 45M, progressive umbilical swelling (3yrs), enlarges Problems: Abnormal meatus (often stenosed, wetting Topical agents (5-FU, Imiquimod, Salicylic acid).
w/ activity, reduces lying down, dull pain (6m), H/O open clothes), chordee (ventral bend worsens w/ erection),
cholecystectomy. Exam: Umbilical swelling, stretched Lipoma - Compact Summary deficient ventral prepuce, infertility (posterior types), sexual  Larger/Recurrent: Surgical excision, Laser
umbilicus, expansile cough impulse, reducible w/ gurgling, Case: 30M, slow-growing painless nape swelling (4yrs), now dysfunction. ablation, Electrocautery.
4cm linea alba gap. 5cm, no rapid growth, no other swellings. Exam: Soft, Etiology: Hormonal (↓Testosterone/DHT, maternal  HPV-related: Vaccination for prevention.
Dx: PUH (adults—through linea alba, not umbilical scar). lobulated, well-defined, mobile, slip sign (+), pseudo- progesterone), Enzyme defect (3β-HSD deficiency), Complications: Recurrence, Ulceration, Malignant
Contents: Mostly omentum, ±small intestine, transverse fluctuation (+), transillumination (-), skin free, prominent on Arrested local development. transformation (rare, high-risk HPV types).
colon, bladder. More common in females (obesity, trapezius contraction. Investigations: CBC, USG-KUB, Voiding Cystourethrogram
pregnancy). Dx: Subcutaneous lipoma. DDx: Neurofibroma, fibroma, (if needed). Non-Healing Ulcer - Compact Summary
Complications: Irreducibility (narrow neck/adhesions), sebaceous cyst, rhabdomyoma. Surgical Goals: 1) Meatus at glans tip, 2) Chordee Case: Chronic ulcer (>6wks), non-resolving despite
obstruction (gut adhesion/constriction), strangulation, Tests: Lobulation check (firm pressure at margin), Slip sign correction, 3) Normal urinary flow, 4) Good cosmesis. Ideal treatment, may have pain, discharge, bleeding.
intertrigo (skin ulceration in obese). (displaces w/ palpation), Pseudo-fluctuation (yields to Age: 6-12 months. Exam: Site, size, shape, margins, base, edges, depth,
Mgmt: Weight loss, anesthesia fitness, USG abdomen. pressure w/o true fluid shift), Transillumination (sometimes Surgical Principles: surrounding skin, tenderness, discharge (serous/purulent),
Surgery (if large/symptomatic): Mesh repair (preperitoneal + in large lipomas).  Orthoplasty (Chordee correction): Heineke- induration, bleeding, LN status.
placement). Mgmt: Excision (local anesthesia unless large, Langer’s line Mikulicz (tunica incisions closed longitudinally), Types (by etiology):
 Transverse elliptical incision, dissect to rectus sheath, incision, capsular dissection, hemostasis, interrupted Plication (Baskin & Duckett), Dermal Graft  Traumatic: Mechanical (pressure sores, bites),
open sac, reduce contents, excise redundant sac, close sutures). (Devine & Horton for severe cases). Thermal (burns), Radiation.
neck, place polypropylene mesh (4cm coverage), fix Lipoma: Benign tumor from mature fat cells, most common
soft tissue tumor (Universal Tumor). Common sites: Trunk,
 Urethroplasty (Neourethra creation): Duckett’s  Infective: Tuberculosis, Syphilis, Leprosy, Fungal.
w/ interrupted sutures, close rectus sheath, drain TPIF (preputial flap), Asopa’s technique  Vascular: Arterial (PVD, Buerger’s), Venous
placed, skin closure. neck, limbs. (tubularized prepuce). (Varicose ulcers), Diabetic.
 Anatomical repair (<3cm defect): No mesh, fascia Complications: Cosmetic (large size), Saponification,
calcification, myxomatous change, infection, hemorrhage,  Meatoplasty/Glanuloplasty: Meatus reshaped  Neoplastic: SCC (Marjolin’s ulcer), BCC,
closed w/ interrupted sutures. at glans tip. Melanoma.
Strangulation Dx: Irreducible, severe pain, obstruction rare malignant change (liposarcoma). Complications: Bleeding, Meatal stenosis,  Autoimmune: Pyoderma gangrenosum,
signs (vomiting, distension, constipation), tachycardia, Malignant Change Suspicion: Rapid growth, pain, distant Urethrocutaneous fistula, Stricture, Diverticulum, Wound Vasculitis.
dehydration, tenderness, rebound tenderness. mets, raised temp, dilated veins, deep fixation. High-risk breakdown.
locations: Retroperitoneum, thigh, shoulder. Red Flags (Malignancy Suspicion): Induration, everted
Strangulation Mgmt: Resus (IV fluids, NG aspiration, ABx, Two-Stage Repair: Severe chordee/scrotal-perineal types edges, rapid growth, bleeding, fixity, LN involvement.
catheter). Emergency surgery: Open sac, drain toxic fluid, Anatomical Types: → 1st stage: Orthoplasty & prepuce repositioning, 2nd Investigations: CBC, ESR, Biopsy (edge—malignancy, base
resect gangrenous bowel (small intestine—anastomosis, 1. Subcutaneous (most common) stage (6m later): Neourethra formation. —infection), Gram stain, AFB stain, Culture, Doppler
large intestine—colostomy + mucous fistula), widen sac 2. Subfascial (deep fat) (vascular), Biopsy (vasculitis workup).
neck, defer formal repair. 3. Intramuscular (between muscle fibers) Mgmt:
4. Subserous (gut) Peripheral Vascular Disease (PVD) - Compact Summary
5. Submucous (respiratory/GIT) Case: 55M, progressive calf pain on walking (claudication),  Cause-Specific: Treat underlying etiology
Mixed Parotid Tumor (Pleomorphic Adenoma) - Compact 6. Subsynovial (joints) relieved by rest, cold feet, numbness, skin changes. Exam: (vascular, infection, neoplasm, autoimmune).
Summary Case: 45F, slow-growing painless right parotid 7. Parosteal (bone surface) Absent dorsalis pedis/posterior tibial pulses, pale/cyanotic  Local Care: Debridement, dressings
swelling (8yrs), no facial palsy, no LN involvement. Exam: 8. Intra-articular (joint) toes, dry skin, hair loss, ulcers/gangrene possible. (hydrocolloid, NPWT), infection control.
Firm, well-defined 6×4 cm swelling in parotid region, 9. Extradural (spinal, not cranial) Dx: PVD (likely due to atherosclerosis). DDx: Buerger’s  Surgical: Excision (if malignant), Grafts/flaps (if
smooth surface, free from skin/underlying structures, deep 10. Intraglandular (breast, salivary). disease, Raynaud’s, diabetic vasculopathy, chronic venous large defect).
lobe not enlarged. Variants: insufficiency.  Adjuncts: Antibiotics (if infected), Hyperbaric O₂
Dx: Likely mixed parotid tumor (most common benign  Fibrolipoma (fat + fibrous tissue) Types: (vascular ulcers).
parotid tumor). DDx: Adenolymphoma, chronic sialadenitis,  Nevolipoma (fat + hemangioma, compressible)  Functional: Temporary vasospasm (e.g.,
carcinoma, cervical LN, lipoma, fibroma, Raynaud’s).
rhabdomyosarcoma.  Neurolipoma (fat + nerve, multiple/painful =
Facial Nerve Palsy Tests: Orbicularis oculi (eye closure), neurolipomatosis)  Organic: Structural damage (e.g.,
 Dercum’s Disease (Adiposis Dolorosa): Painful atherosclerosis, thromboangiitis obliterans).
Frontalis (forehead furrows), Corrugator supercilii Risk Factors: Smoking, diabetes, HTN, hyperlipidemia,
(frowning), Buccinator (cheek tone), Orbicularis oris (whistle fat deposits (trunk/thighs, mainly women, no
capsule = false lipoma). obesity, sedentary lifestyle.
blowing), Levator anguli oris (mouth deviation), Platysma Investigations: ABPI (<0.9), Duplex USG, CT/MR
(neck stretch). angiography, Doppler waveform analysis.
Mgmt: FNAC (safe, no implantation risk). If benign → Stages (Fontaine):
Superficial Parotidectomy (removal of superficial lobe w/ 1. Asymptomatic
tumor). Incisional biopsy contraindicated (risk of 2. Claudication
recurrence due to tumor capsule breach). 3. Rest pain
Surgical Steps: Incision from zygomatic process → in front 4. Ulcers/Gangrene
of tragus → around earlobe → along SCM. Identify facial Mgmt:
nerve (at stylomastoid foramen, near digastric origin).  Lifestyle: Stop smoking, exercise therapy, BP &
Facial Nerve Branches: Temporal, Zygomatic, Upper Buccal, glucose control.
Lower Buccal, Mandibular, Cervical.  Meds: Antiplatelets (aspirin/clopidogrel),
Malignant Change Indicators: Rapid growth, pain, hardness, statins, vasodilators (cilostazol), anticoagulants
fixation, facial palsy, ulceration, prominent veins, TMJ (if needed).
restriction, cervical LN.
Recurrence Risk: Tumor finger-like extensions penetrate  Interventions: Angioplasty ± stent, bypass
pseudocapsule; simple enucleation leaves residual tumor. grafting (severe cases), amputation (if
Other Parotid Tumors: Adenomas (pleomorphic, gangrene).
adenolymphoma, oxyphilic), Carcinomas (acinic, Complications: Non-healing ulcers, gangrene, infection,
mucoepidermoid, adenoid cystic, adenocarcinoma, SCC, critical limb ischemia → amputation.
undifferentiated), Non-epithelial (hemangioma,
lymphangioma, neurofibroma), Lymphomas.