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Surgical Oncology > Melanoma > Flashcards

Melanoma Flashcards

1
Q

Citation for the first recommendation for elective lymph node dissection

A

Herbert Snow Lancet, 1892

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2
Q

What is the false negative rate of SLNB for melanoma?

A

5%

Sentinel-lymph-node biopsy for cutaneous melanoma.
AU Gershenwald JE, Ross MI N Engl J Med. 2011

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3
Q

PAthologic appearance of Merkel Cell Carcinoma

A

Small Round Blue Cell Tumor (hard to distinguish LNs)

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4
Q

Treatment for MCC

A

1-2 cm margins and SLNB

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5
Q

What MCCs don’t get radiation?

A

<1cm wide tumor with wide margins, no LVI and immuno-competent patient

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6
Q

MCC 5 year survival
node negative
node positive
distant mets

A

node negative - 75%
node positive - 59%
distant mets - 25%

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7
Q

What does SLNB for MCC help decide?

A

Helps decide to do regional lymph node radiation

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8
Q

Standard of care for subungual melanoma?

A

Distal digital amputation with SLN biopsy.

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9
Q

Pattern of invasion for desmoplastic melanoma?

A

neurotropic invasion

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10
Q

Possible indication for radiation for desmoplastic melanoma?

A

neurovascular invasion

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11
Q

margins for dermatofibrosarcoma protuberans (DFSP)?

A

2cm

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12
Q

radiation for DFSP?

A

only for positive margins in area where rexcision isn’t feasible

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13
Q

French Cooperative Group Trial

Swedish Melanoma Trial Group

A

compared 2 v 5 cm margins for melanoma < 2mm in depth (no difference)

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14
Q

WHO Melanoma trial #10

A

1 v 3 cm margins for melanoma <2mm (no difference in OS, but local control may be better with wider margins for melanoma >1 mm in depth)

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15
Q

Intergroup Melanoma Trial

A

2 v 4 cm margins with no difference in OS or local control. Did not officially address melanoma > 4mm in depth.

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16
Q

British Cooperative Group Trial (melanoma)

A

1 v 3 cm margins for melanoma >2mm with higher risk for smaller margins.

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17
Q

key flaw of British Cooperative Group Trial (melanoma)

A

didn’t perform SLNB and counted regional nodes as a “local recurrence”

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18
Q

treatment for anal canal melanoma

A

transanal wide local excision (retrospective evidence)

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19
Q

biopsy indication for a nailbed lesion

A

any pigmented band >3mm wide

any band with discoloration of the skin folds (Hutchinsons sign)

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20
Q

Margins for eccrine cancer?

A

at least 1 cm

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21
Q

risk factors for recurrence of eccrine cancer?

A

thickness > 7mm
lymphovascular invasion
>14 mitoses/HPF
dermal infiltration

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22
Q

Mohs for eccrine cancer?

A

acceptable for cosmetically sensitive areas

23
Q

SLNB for eccrine cancer?

A

controversial. LN mets are rare. Should consider it at tumor recurrence.

24
Q

Adjuvant therapies for eccrine cancer?

A

radiation and chemo have not demonstrated any significant benefit.

25
Q

What virus is present in 80% of MCC?

A

polyoma virus

26
Q

What percent of all MCC are node positive?

A

30%

27
Q

bland spindle cell neoplasm

A

desmoid

28
Q

desmoid immunohistochemistry

A

positive for
desmin and
beta-catenin

negative for
Dog-1
myo-D1
S100

29
Q

Five year survival after pulmonary metastasectomy for soft tissue sarcoma?

A

20-40%

30
Q

Therapy for small extremity low grade chondrosarcomas?

A

currettage with local chemical or cryotherapy

31
Q

external hemipelvectomy for sarcoma?

A

Not if you can do an internal one;

External necessitates an amputation

32
Q

Main chemo for Soft Tissue Sarcoma?

A

Doxorubicin/Ifosfamide

33
Q

Main chemo for leiomyosarcoma?

A

Gemcitabine

34
Q

Main chemo for angiosarcoma?

A

taxanes

35
Q

Most aggressive chemo for STS?

A 
MAID
mesna
doxorubicin
ifosfamide
dacarbazine
36
Q

What to include of physical exam for retroperitoneal sarcoma?

A

testicular exam to rule out metastatic disease.

37
Q

heterogeneity of a retroperitoneal sarcoma on CT?

A

suggest dedifferentiation; can recommend RT to improve local control

38
Q

consider brachytherapy plus XRT for recurrent extremity STS?

A

Maybe according to SOSAP Holloway CL ABS consensus statement for Sarcoma Brachytherapy Brachytherapy 2013

39
Q

Re-excise a desmoid for R1 margins?

A

No

40
Q

Radiaiton for desmoids?

A

No benefit

Ballo MT J Clin Oncol 1999

41
Q

Most common pediatric tumors with Li Fraumeni?

A

osteosarcoma
adrenocortical carcinoma
CNS cancer
soft tissue sarcoma

42
Q

Most common adult tumors with Li Fraumeni?

A

Breast and soft tissue sarcoma

43
Q

Other cancers seen with BRCA2 besides breast/ovarian?

A

pancreas
melanoma
prostate

44
Q

When can you do flow cytometry on peripheral blood for a lymphoma work-up?

A

When the absolute B-cell count is up on the peripheral smear.

45
Q

Previous ovarian cancer with new lesion in the spleen?

A

do the splenectomy, followed by systemic chemo.

46
Q

Most common cancers metastasizing to the spleen?

A

lung
colorectal
ovary
melanoma

47
Q

Initial antibiotics for suspected OPSI?

A

Ceftriaxone/Vancomycin

48
Q

First line of medical therapy at diagnosis of ITP?

A

Prednisone

can add iv IgG for severe cases/acute bleeding

49
Q

Size of spleen in ITP

A

normal

50
Q

Presentation of ITP

A

side effects of thrombocytopenia, bleeding, petechiae etc.

51
Q

diseases mimicking ITP

A 
HIV
SLE
Anti-phospholipid
hepatitis
hematologic malignancy
52
Q

drugs causing ITP

A 
cocaine
gold
heparin
quinidine
abciximab

also many common anti-inflammatory, hypertension and antibiotics.

53
Q

second line options for ITP?

A

After steroids:
splenectomy
rituximab
thrombopoietin agonists

54
Q

mechanism of ITP?

A

anti-platelet antibodies bind to platelets and cause them to get phagocytosed.

Surgical Oncology (23 decks)

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