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Surgical Oncology > Melanoma > Flashcards

Flashcards in Melanoma Deck (54)
1

Citation for the first recommendation for elective lymph node dissection

Herbert Snow Lancet, 1892

2

What is the false negative rate of SLNB for melanoma?

5%

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

3

PAthologic appearance of Merkel Cell Carcinoma

Small Round Blue Cell Tumor (hard to distinguish LNs)

4

Treatment for MCC

1-2 cm margins and SLNB

5

What MCCs don't get radiation?

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

6

MCC 5 year survival
node negative
node positive
distant mets

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

7

What does SLNB for MCC help decide?

Helps decide to do regional lymph node radiation

8

Standard of care for subungual melanoma?

Distal digital amputation with SLN biopsy.

9

Pattern of invasion for desmoplastic melanoma?

neurotropic invasion

10

Possible indication for radiation for desmoplastic melanoma?

neurovascular invasion

11

margins for dermatofibrosarcoma protuberans (DFSP)?

2cm

12

radiation for DFSP?

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

13

French Cooperative Group Trial
Swedish Melanoma Trial Group

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

14

WHO Melanoma trial #10

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)

15

Intergroup Melanoma Trial

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

16

British Cooperative Group Trial (melanoma)

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

17

key flaw of British Cooperative Group Trial (melanoma)

didn't perform SLNB and counted regional nodes as a "local recurrence"

18

treatment for anal canal melanoma

transanal wide local excision (retrospective evidence)

19

biopsy indication for a nailbed lesion

any pigmented band >3mm wide
any band with discoloration of the skin folds (Hutchinsons sign)

20

Margins for eccrine cancer?

at least 1 cm

21

risk factors for recurrence of eccrine cancer?

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

22

Mohs for eccrine cancer?

acceptable for cosmetically sensitive areas

23

SLNB for eccrine cancer?

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

24

Adjuvant therapies for eccrine cancer?

radiation and chemo have not demonstrated any significant benefit.

25

What virus is present in 80% of MCC?

polyoma virus

26

What percent of all MCC are node positive?

30%

27

bland spindle cell neoplasm

desmoid

28

desmoid immunohistochemistry

positive for
desmin and
beta-catenin

negative for
Dog-1
myo-D1
S100

29

Five year survival after pulmonary metastasectomy for soft tissue sarcoma?

20-40%

30

Therapy for small extremity low grade chondrosarcomas?

currettage with local chemical or cryotherapy

31

external hemipelvectomy for sarcoma?

Not if you can do an internal one;
External necessitates an amputation

32

Main chemo for Soft Tissue Sarcoma?

Doxorubicin/Ifosfamide

33

Main chemo for leiomyosarcoma?

Gemcitabine

34

Main chemo for angiosarcoma?

taxanes

35

Most aggressive chemo for STS?

MAID
mesna
doxorubicin
ifosfamide
dacarbazine

36

What to include of physical exam for retroperitoneal sarcoma?

testicular exam to rule out metastatic disease.

37

heterogeneity of a retroperitoneal sarcoma on CT?

suggest dedifferentiation; can recommend RT to improve local control

38

consider brachytherapy plus XRT for recurrent extremity STS?

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

39

Re-excise a desmoid for R1 margins?

No

40

Radiaiton for desmoids?

No benefit

Ballo MT J Clin Oncol 1999

41

Most common pediatric tumors with Li Fraumeni?

osteosarcoma
adrenocortical carcinoma
CNS cancer
soft tissue sarcoma

42

Most common adult tumors with Li Fraumeni?

Breast and soft tissue sarcoma

43

Other cancers seen with BRCA2 besides breast/ovarian?

pancreas
melanoma
prostate

44

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

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

45

Previous ovarian cancer with new lesion in the spleen?

do the splenectomy, followed by systemic chemo.

46

Most common cancers metastasizing to the spleen?

lung
colorectal
ovary
melanoma

47

Initial antibiotics for suspected OPSI?

Ceftriaxone/Vancomycin

48

First line of medical therapy at diagnosis of ITP?

Prednisone
can add iv IgG for severe cases/acute bleeding

49

Size of spleen in ITP

normal

50

Presentation of ITP

side effects of thrombocytopenia, bleeding, petechiae etc.

51

diseases mimicking ITP

HIV
SLE
Anti-phospholipid
hepatitis
hematologic malignancy

52

drugs causing ITP

cocaine
gold
heparin
quinidine
abciximab

also many common anti-inflammatory, hypertension and antibiotics.

53

second line options for ITP?

After steroids:
splenectomy
rituximab
thrombopoietin agonists

54

mechanism of ITP?

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