Flashcards in Melanoma Deck (54)
Citation for the first recommendation for elective lymph node dissection
Herbert Snow Lancet, 1892
What is the false negative rate of SLNB for melanoma?
Sentinel-lymph-node biopsy for cutaneous melanoma.
AU Gershenwald JE, Ross MI N Engl J Med. 2011
PAthologic appearance of Merkel Cell Carcinoma
Small Round Blue Cell Tumor (hard to distinguish LNs)
Treatment for MCC
1-2 cm margins and SLNB
What MCCs don't get radiation?
<1cm wide tumor with wide margins, no LVI and immuno-competent patient
MCC 5 year survival
node negative - 75%
node positive - 59%
distant mets - 25%
What does SLNB for MCC help decide?
Helps decide to do regional lymph node radiation
Standard of care for subungual melanoma?
Distal digital amputation with SLN biopsy.
Pattern of invasion for desmoplastic melanoma?
Possible indication for radiation for desmoplastic melanoma?
margins for dermatofibrosarcoma protuberans (DFSP)?
radiation for DFSP?
only for positive margins in area where rexcision isn't feasible
French Cooperative Group Trial
Swedish Melanoma Trial Group
compared 2 v 5 cm margins for melanoma < 2mm in depth (no difference)
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)
Intergroup Melanoma Trial
2 v 4 cm margins with no difference in OS or local control. Did not officially address melanoma > 4mm in depth.
British Cooperative Group Trial (melanoma)
1 v 3 cm margins for melanoma >2mm with higher risk for smaller margins.
key flaw of British Cooperative Group Trial (melanoma)
didn't perform SLNB and counted regional nodes as a "local recurrence"
treatment for anal canal melanoma
transanal wide local excision (retrospective evidence)
biopsy indication for a nailbed lesion
any pigmented band >3mm wide
any band with discoloration of the skin folds (Hutchinsons sign)
Margins for eccrine cancer?
at least 1 cm
risk factors for recurrence of eccrine cancer?
thickness > 7mm
Mohs for eccrine cancer?
acceptable for cosmetically sensitive areas
SLNB for eccrine cancer?
controversial. LN mets are rare. Should consider it at tumor recurrence.
Adjuvant therapies for eccrine cancer?
radiation and chemo have not demonstrated any significant benefit.
What virus is present in 80% of MCC?
What percent of all MCC are node positive?
bland spindle cell neoplasm
Five year survival after pulmonary metastasectomy for soft tissue sarcoma?
Therapy for small extremity low grade chondrosarcomas?
currettage with local chemical or cryotherapy
external hemipelvectomy for sarcoma?
Not if you can do an internal one;
External necessitates an amputation
Main chemo for Soft Tissue Sarcoma?
Main chemo for leiomyosarcoma?
Main chemo for angiosarcoma?
Most aggressive chemo for STS?
What to include of physical exam for retroperitoneal sarcoma?
testicular exam to rule out metastatic disease.
heterogeneity of a retroperitoneal sarcoma on CT?
suggest dedifferentiation; can recommend RT to improve local control
consider brachytherapy plus XRT for recurrent extremity STS?
Maybe according to SOSAP Holloway CL ABS consensus statement for Sarcoma Brachytherapy Brachytherapy 2013
Re-excise a desmoid for R1 margins?
Radiaiton for desmoids?
Ballo MT J Clin Oncol 1999
Most common pediatric tumors with Li Fraumeni?
soft tissue sarcoma
Most common adult tumors with Li Fraumeni?
Breast and soft tissue sarcoma
Other cancers seen with BRCA2 besides breast/ovarian?
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.
Previous ovarian cancer with new lesion in the spleen?
do the splenectomy, followed by systemic chemo.
Most common cancers metastasizing to the spleen?
Initial antibiotics for suspected OPSI?
First line of medical therapy at diagnosis of ITP?
can add iv IgG for severe cases/acute bleeding
Size of spleen in ITP
Presentation of ITP
side effects of thrombocytopenia, bleeding, petechiae etc.
diseases mimicking ITP
drugs causing ITP
also many common anti-inflammatory, hypertension and antibiotics.
second line options for ITP?