Melanoma

Question 1

Citation for the first recommendation for elective lymph node dissection

Answer 1

Herbert Snow Lancet, 1892

Question 2

What is the false negative rate of SLNB for melanoma?

Answer 2

5%

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

Question 3

PAthologic appearance of Merkel Cell Carcinoma

Answer 3

Small Round Blue Cell Tumor (hard to distinguish LNs)

Question 4

Treatment for MCC

Answer 4

1-2 cm margins and SLNB

Question 5

What MCCs don’t get radiation?

Answer 5

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

Question 6

MCC 5 year survival
node negative
node positive
distant mets

Answer 6

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

Question 7

What does SLNB for MCC help decide?

Answer 7

Helps decide to do regional lymph node radiation

Question 8

Standard of care for subungual melanoma?

Answer 8

Distal digital amputation with SLN biopsy.

Question 9

Pattern of invasion for desmoplastic melanoma?

Answer 9

neurotropic invasion

Question 10

Possible indication for radiation for desmoplastic melanoma?

Answer 10

neurovascular invasion

Question 11

margins for dermatofibrosarcoma protuberans (DFSP)?

Answer 11

2cm

Question 12

radiation for DFSP?

Answer 12

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

Question 13

French Cooperative Group Trial

Swedish Melanoma Trial Group

Answer 13

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

Question 14

WHO Melanoma trial #10

Answer 14

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)

Question 15

Intergroup Melanoma Trial

Answer 15

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

Question 16

British Cooperative Group Trial (melanoma)

Answer 16

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

Question 17

key flaw of British Cooperative Group Trial (melanoma)

Answer 17

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

Question 18

treatment for anal canal melanoma

Answer 18

transanal wide local excision (retrospective evidence)

Question 19

biopsy indication for a nailbed lesion

Answer 19

any pigmented band >3mm wide

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

Question 20

Margins for eccrine cancer?

Answer 20

at least 1 cm

Question 21

risk factors for recurrence of eccrine cancer?

Answer 21

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

Question 22

Mohs for eccrine cancer?

Answer 22

acceptable for cosmetically sensitive areas

Question 23

SLNB for eccrine cancer?

Answer 23

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

Question 24

Adjuvant therapies for eccrine cancer?

Answer 24

radiation and chemo have not demonstrated any significant benefit.

Question 25

What virus is present in 80% of MCC?

Answer 25

polyoma virus

Question 26

What percent of all MCC are node positive?

Answer 26

30%

Question 27

bland spindle cell neoplasm

Answer 27

desmoid

Question 28

desmoid immunohistochemistry

Answer 28

positive for desmin and beta-catenin negative for Dog-1 myo-D1 S100

Question 29

Five year survival after pulmonary metastasectomy for soft tissue sarcoma?

Answer 29

20-40%

Question 30

Therapy for small extremity low grade chondrosarcomas?

Answer 30

currettage with local chemical or cryotherapy

Question 31

external hemipelvectomy for sarcoma?

Answer 31

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

Question 32

Main chemo for Soft Tissue Sarcoma?

Answer 32

Doxorubicin/Ifosfamide

Question 33

Main chemo for leiomyosarcoma?

Answer 33

Gemcitabine

Question 34

Main chemo for angiosarcoma?

Answer 34

taxanes

Question 35

Most aggressive chemo for STS?

Answer 35

``` MAID mesna doxorubicin ifosfamide dacarbazine ```

Question 36

What to include of physical exam for retroperitoneal sarcoma?

Answer 36

testicular exam to rule out metastatic disease.

Question 37

heterogeneity of a retroperitoneal sarcoma on CT?

Answer 37

suggest dedifferentiation; can recommend RT to improve local control

Question 38

consider brachytherapy plus XRT for recurrent extremity STS?

Answer 38

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

Question 39

Re-excise a desmoid for R1 margins?

Answer 39

No

Question 40

Radiaiton for desmoids?

Answer 40

No benefit Ballo MT J Clin Oncol 1999

Question 41

Most common pediatric tumors with Li Fraumeni?

Answer 41

osteosarcoma adrenocortical carcinoma CNS cancer soft tissue sarcoma

Question 42

Most common adult tumors with Li Fraumeni?

Answer 42

Breast and soft tissue sarcoma

Question 43

Other cancers seen with BRCA2 besides breast/ovarian?

Answer 43

pancreas melanoma prostate

Question 44

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

Answer 44

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

Question 45

Previous ovarian cancer with new lesion in the spleen?

Answer 45

do the splenectomy, followed by systemic chemo.

Question 46

Most common cancers metastasizing to the spleen?

Answer 46

lung colorectal ovary melanoma

Question 47

Initial antibiotics for suspected OPSI?

Answer 47

Ceftriaxone/Vancomycin

Question 48

First line of medical therapy at diagnosis of ITP?

Answer 48

Prednisone | can add iv IgG for severe cases/acute bleeding

Question 49

Size of spleen in ITP

Answer 49

normal

Question 50

Presentation of ITP

Answer 50

side effects of thrombocytopenia, bleeding, petechiae etc.

Question 51

diseases mimicking ITP

Answer 51

``` HIV SLE Anti-phospholipid hepatitis hematologic malignancy ```

Question 52

drugs causing ITP

Answer 52

``` cocaine gold heparin quinidine abciximab ``` also many common anti-inflammatory, hypertension and antibiotics.

Question 53

second line options for ITP?

Answer 53

After steroids: splenectomy rituximab thrombopoietin agonists

Question 54

mechanism of ITP?

Answer 54

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