Exam 1 - Principles of Surgical Oncology: Specific Skin/SQ Tumor Types

Question 1

before pursuing surgery, what should you always do in the case of suspected cancer?

Answer 1

STAGING!!!!!!! PLAN!!!!!! ALWAYS DO AN FNA EVEN IF IT FEELS LIKE A LIPOMA!!!

Question 2

if 1 represents a marginal excision & 2 represents a wide excision, what is the importance of this picture?

Answer 2

if you only did a marginal excision, you wouldn’t get the whole tumor

if you did a wide, you would get clean margins

Question 3

what is an example of a radical excision?

Answer 3

amputation of a limb

Question 4

what kind of excision should be done in the case of a benign skin tumor?

Answer 4

marginal excision

Question 5

what are some examples of a benign skin tumor?

Answer 5

epidermal/follicular cyst, & sebaceous gland adenoma

Question 6

what is the general type of tumor? how would you remove it?

Answer 6

benign skin tumor - marginal excision

Question 7

when removing a lipoma, what’s different about the incision made?

Answer 7

incise over the center

Question 8

how is a lipoma removed?

Answer 8

shell the lipoma out making sure to keep the capsule intact

Question 9

why are you more concerned about hemostasis in large lipomas?

Answer 9

they may have neovascularization

Question 10

if there is excess skin after a lipoma is removed, what can you do?

Answer 10

excise the skin

Question 11

what is this

Answer 11

giant lipoma

Question 12

what is different when removing an intramuscular lipoma?

Answer 12

may require an en bloc removal of a muscle belly

Question 13

what is this?

Answer 13

intramuscular lipoma

Question 14

what would you expect to see on a CT scan of a patient with an infiltrative lipoma?

Answer 14

linear striations throughout the mass

Question 15

how do you treat an infiltrative lipoma?

Answer 15

treat like a malignant skin mass - remove with margins & follow with radiation

Question 16

what is scary about infiltrative lipomas?

Answer 16

high rate of recurrence even with aggressive surgery

Question 17

what is this?

Answer 17

ct of a infiltrative lipoma - linear striations throughout the mass

Question 18

T/F: a liposarcoma is easy to diagnose pre-op

Answer 18

FALSE

Question 19

T/F: CT characteristics may be helpful in diagnosing a liposarcoma

Answer 19

true!

Question 20

what are some CT characteristics that may be helpful if you think your patient has a liposarcoma?

Answer 20

heterogenous, soft tissue opacity, nodular in appearance, mineralization, & regional lymphadenomegaly

Question 21

how do you treat a liposarcoma?

Answer 21

like other soft tissue sarcomas - wide surgical excision

Question 22

when removing a mast cell tumor, surgical dose depends on what?

Answer 22

grade of tumor!

Question 23

what do you do if you don’t have a biopsy of a mast cell tumor before surgical excision?

Answer 23

assume a higher grade

Question 24

if appropriate margins can’t be obtained in a mast cell tumor removal, what should be considered?

Answer 24

neoadjuvant therapies!

Question 25

what are examples of neoadjuvant therapies for mast cell tumors?

Answer 25

prednisone 1mg/kg - up to 80% reduction in tumor volume in 70% of cases radiation chemo

Question 26

when removing grades I-II mast cell tumors, what is appropriate for surgical excision?

Answer 26

2cm laterally & 1 fascial plane deep - adequate for most lower grade tumors

Question 27

what does proportional margins entail in mast cell tumor removal?

Answer 27

margin is equal to the widest diameter of the tumor - can be applied to smaller, low grade MCT

Question 28

what is an example of a proportional margin taken in a mast cell tumor removal?

Answer 28

1cm tumor = maximum lateral diameter is 1 cm

Question 29

what margins does this represent?

Answer 29

proportional

Question 30

this surgical excision type is appropriate for what types of mast cell tumors?

Answer 30

grades I-II 2 cm laterally & 1 fascial plane deep

Question 31

name the tumor

Answer 31

mast cell tumor

Question 32

when removing a grade III mast cell tumor, what are the appropriate margins?

Answer 32

3cm laterally & 1 fascial plane deep

Question 33

when you have a mast cell tumor, you may have a higher incidence of high grade if the tumor is located in what anatomical locations?

Answer 33

preputial, scrotal, subungal, oral, & perivulvar

Question 34

how do feline cutaneous mast cell tumors tend to behave like?

Answer 34

benign manner

Question 35

why are wide margins typically unnecessary in removing a feline cutaneous mast cell tumor?

Answer 35

typically behave in a benign manner & often not possible because they are frequently on the face

Question 36

T/F: subcutaneous mast cell tumors involve the cutaneous layer/skin

Answer 36

false!!!

Question 37

what is the prognosis for subcutaneous mast cell tumors?

Answer 37

good prognosis - behave like low grade cutaneous mast cell tumors

Question 38

what is this?

Answer 38

subcutaneous mast cell tumor - histopath

Question 39

these are examples of what?

Answer 39

feline cutaneous mast cell tumors

Question 40

how would you remove a feline cutaneous mast cell tumor?

Answer 40

proportional margins

Question 41

where are the most common locations for soft tissue sarcomas?

Answer 41

limbs & trunk

Question 42

how do soft tissue sarcomas feel?

Answer 42

firm & fixed on palpation

Question 43

what is prognosis of soft tissue sarcomas dependent on?

Answer 43

ability to achieve complete margins & the grade of the tumor

Question 44

what is the origin of soft tissue sarcomas?

Answer 44

mesenchymal - multiple subtypes

Question 45

what is this?

Answer 45

soft tissue sarcoma

Question 46

why not biopsy a soft tissue sarcoma?

Answer 46

only correct 60% of the time

Question 47

why is grading of soft tissue sarcomas very important?

Answer 47

prognosis, possible neoadjuvant/post-op treatment, & margins needed during surgical excision

Question 48

what are the guidelines for surgical removal of soft tissue sarcomas?

Answer 48

2-3cm laterally & 1 fascial plane deep recommended when achievable

Question 49

why is surgical removal of soft tissue sarcomas more difficult on limbs?

Answer 49

hard to get the necessary margins - need to consider neoadjuvant vs. post-op radiation & potentially radical excision (amputation)

Question 50

recommended margins for surgical removal?

Answer 50

2-3cm laterally & 1 fascial plane deep - soft tissue sarcoma

Question 51

how may you go about removing this soft tissue sarcoma?

Answer 51

radical excision - amputation of the limb

Question 52

what is this an example of?

Answer 52

soft tissue sarcoma that came back due to incomplete margins in 1st surgical removal

Question 53

why must you refer feline injection site sarcomas?

Answer 53

they are very locally aggressive & advanced imaging is necessary as the first surgery may be the only chance

Question 54

what are the recommended margins for surgical removal of a feline injection site sarcoma?

Answer 54

5cm laterally & 2 fascial planes deep

Question 55

what are the necessary margins needed for surgical excision?

Answer 55

5cm laterally & 2 fascial planes deep

Question 56

if a dog presents with a mammary tumor, what are the chances it is benign or malignant?

Answer 56

50/50

Question 57

if a cat presents with a mammary tumor, what are the chances it is malignant?

Answer 57

85%

Question 58

if a dog's mammary tumor is larger (2+cm) & ulcerated, it is more likely to be what?

Answer 58

malignant

Question 59

during removal of a mammary tumor, what is also recommended?

Answer 59

spay - impact on survival may be controversial

Question 60

when removing mammary tumors, when should you take the underlying fascia?

Answer 60

never - except for when the mass is adhered

Question 61

what is a lumpectomy?

Answer 61

removal of the mammary mass with ~1cm margin

Question 62

what is a single mastectomy?

Answer 62

removal of a single gland, with 1-2 cm margin around the tumor

Question 63

what is a regional mastectomy?

Answer 63

removal of glands 1-3, or glands 3-5 en bloc

Question 64

what is a unilateral mastectomy?

Answer 64

removal of an entire mammary chain

Question 65

what is a bilateral mastectomy?

Answer 65

removal of both mammary chains

Question 66

when removing a mammary tumor in the dog, surgical dose depends on what?

Answer 66

tumor behavior, tumor size, & number of tumors

Question 67

in cats, what is the current recommended treatment for mammary tumors?

Answer 67

bilateral chain mastectomy in all cases - may need to be staged

Question 68

what are the recommended margins for mammary tumors in cats for surgical excision?

Answer 68

1-2cm margins around tumor/tumors - otherwise smaller margins

Question 69

what is the goal of removing a mammary tumor in cats?

Answer 69

remove mammary tissue & lymphatics

Question 70

for digit tumors in dogs, are benign or malignant tumors more common?

Answer 70

malignant

Question 71

what are the most common malignant digit tumors in dogs?

Answer 71

SCC (50%) >> melanoma >> STS >> MCT >> osteosarcoma

Question 72

T/F: staging isn't important in digit tumors

Answer 72

false - it is very important

Question 73

how do you treat digit tumors?

Answer 73

digit amputation is indicated but you still need to consider margins

Question 74

how would you treat this?

Answer 74

digit amputation