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Surgical MCQs > Mohs Micrographic Surgery and Cutaneous Oncology > Flashcards

Mohs Micrographic Surgery and Cutaneous Oncology Flashcards

1
Q

Mohs provides the highest cure rate for tumours that spread by direct extension.

A

T

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2
Q

MOHs has clearance approx 80% for recurrence rate

A

F >90%

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3
Q

Critical in the process is that the skin edge and deep surface are visualized in one plane on the glass slide, and thus the entire margin can be analysed

A

T

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4
Q

Mohs surgery originally involved the use of zinc chloride (as a fixative), combined with stibnite (as permeant) and bloodroot powder (Sanguinaria Canadensis) (as agglutinant).

A

T This is the same as black salve!

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5
Q

Conventional breadloaf sectioning of tumours allows for examination of 10% of the tumour’s margin.

A

F

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6
Q

Indications for MOHs micrographic surgery includes tumour larger than 2cm in diameter

A

T

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7
Q

Tumours of the skin of the upper lips are usually SCC, while those of the cutaneous lower lip are most commonly BCC.

A

F Other way round.

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8
Q

Most Mohs laboratories use routine hematoxylin and eosin staining for all specimens.

A

T

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9
Q

Technical errors are the most common cause of local recurrences after Mohs surgery.

A

T

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10
Q

Large or thick tumours may be debulked using a curette as this may further delineate margins and reduce the number of layers necessary to obtain clear margins

A

T

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11
Q

A saucer-shaped specimen with 45degree bevelled edges is ideal so that the specimen may be flattened

A

F 30 degrees. Flattening means that the bottom and margins can be sectioned by the Mohs technician in the same plane

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12
Q

The specimen has its non-epidermal edges stained to allow proper orientation. At least four colours are used for each specimen to allow for adequate orientation

A

F Two to three colours

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13
Q

In the laboratory, vertical sections are taken

A

F Specimen is placed bottom side up toward the microtome stage to allow horizontal sections

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14
Q

The tissue may be immediately frozen with tetrafluoroethylchloride or liquid nitrogen and then transferred to the cryostat for thorough freezing

A

T

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15
Q

Toluidine blue can be used for BCCs but has poor optical clarity

A

F Favoured by some for its optical clarity, but the process of immunostatins is impractical for routine use

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16
Q

Infiltrative BCC is not distinctive clinically, but histologically contains islands of tumour cells with a spiked appearance in narrow cords within a hyalinised stroma

A

T

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17
Q

BCCs with aggressive histology (ie. ulcerative, metatypical, morpheaform, infiltrative forms) require more Mohs layers to achieve tumour-free margins.

A

T

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18
Q

BCC tumour size does not affect the extent of subclinical spread.

A

F

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19
Q

Recurrent BCCs after radiotherapy often have morphoeaform or metatypical patterns.

A

T

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20
Q

Metastatic BCC occurs in less than 0.5% of cases.

A

T

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21
Q

Risk factors for metastatic BCC include tumour invasion into cartilage, bone, skeletal muscle or parotid gland, previous XRT and previous treatment with any modality.

A

T

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22
Q

The nose is the most common site from which metastatic spread of BCC occurs.

A

F The ear.

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23
Q

BCC metastasis occurs haematogenously only to lungs, bone&skin.

A

F Also through lymphatics.

24
Q

Biologically aggressive subtypes of SCC include cystic SCC, adenoid SCC, clear cell carcinoma and spindle cell carcinoma.

A

T

25
Q

SCCs arising in immunocompromised pts tend to be more aggressive and have higher metastatic rates.

A

T

26
Q

SCCs that are more likely to recur or metastasize should not be considered for Mohs.

A

F

27
Q

There is an increased risk for metastatic spread for SCCs that are histologically moderately to poorly differentiated, and for facial lesions, particularly temple, nose, lip, periocular, or periauricular.

A

T

28
Q

SCCs with perineural invasion do not have an increased risk of recurrence.

A

F

29
Q

Mohs for recurrent SCC can provide local cure rates of 94% or greater.

A

T

30
Q

For SCC the combination of chemotherapy agents cisplatin, 5-FU and bleomycin had an overall response rate of 79%

A

T

31
Q

For advanced head and neck SCC cetuximab, a monoclonal antibody inhibitor of epidermal growth factor receptor, has been shown to have effect

A

T

32
Q

Induction chemotherapy with docetaxel, cisplatin and flurorouracil offers increased median time survival for locally advanced SCC of head and neck when used alone

A

F When used with concurrent chemoradiotherapy

33
Q

Incidence of nodal mets greatly increases with Breslow depth

A

T Used for invasive melanomas intermediate in depth between 1 and 4mm

34
Q

Radiotherapy is the treatment of choice for verrucous carcinoma.

A

F Becomes more aggressive after XRT.

35
Q

Mohs micrographic surgery has been successfully used to treat Merkel cell carcinoma, a neuroendocrine tumour of the skin

A

T

36
Q

The pathogenesis of Merkel cell carcinoma is linked to a virus in some cases

A

T Merkel cell polymavirus

37
Q

Merkel cell carcinoma has local recurrence rates of 30%, regional node involvement rates of up to 50%, and metastatic rates of 40%.

A

T

38
Q

Survival rates for Merkel cell carcinoma statistically correlate with nodal status.

A

T

39
Q

A 2cm margin is recommended for primary excision of Merkel cell carcinoma.

A

F 3cm.

40
Q

Although the optimal treatment of Merkel cell carcinoma is unknown, radiation therapy is a commonly used adjunct to surgery to improve local control

A

T

41
Q

Adjunctive chemo for Merkel cell has been proven to improve survival

A

F No chemotherapy protocol has been shown to improve survival

42
Q

Adjuvant XRT is recommended for large, recurrent or incompletely excised Merkel cell carcinomas.

A

T

43
Q

Dermatofibrosarcoma protuberans is characteristically a rapid growing, locally aggressive malignant tumour of the skin

A

F A slow growing tumour

44
Q

Dermatofibrosarcoma protuberans is most common on the distal extremity.

A

F Trunk, upper thighs, groin.

45
Q

Recurrence rates after wide excision of DFSP can be as high as 60%.

A

T

46
Q

DFSP rarely metastasize.

A

T

47
Q

DFSP tumours over 2cm in dimaeter need a margin of 1.5cm

A

F
1.5cm margin for DFSP less than 2cm diameter
Larger tumours – 2.5cm margin

48
Q

DFSP stains positively with CD34

A

T

49
Q

Atypical fibroxanthoma (AFX) usually presents as an ulcerated, erythematous nodule or plaque on heavily actinically damaged skin of the head and neck in older men

A

T

50
Q

Malignant fibrous histiocytoma has a worse prognosis than atypical fibroxanthoma.

A

T

51
Q

Malignant fibrous histiocytoma is a soft tissue sarcoma with a better prognosis with than AFX

A

F Less favourable

52
Q

In malignant fibrous histiocytoma special stains may be of value with CD74 positive in 90% of patients

A

T

53
Q

Microcystic adnexal carcinoma (MAC) occurs most commonly on the periorbital region of elderly men.

A

F Upper lip in middle-aged women.

54
Q

MAC frequently invade into skeletal muscle, and perineural invasion is often seen.

A

T

55
Q

Local recurrence rate for MAC excised with standard excision is 10%.

A

F Almost 50%. Mohs is 10%.

56
Q

Primary eccrine adenocarcinoma (eccrine porocarcinoma) is radioresistant.

A

T

57
Q

Sebaceous carcinoma most frequently occurs on the eyelids and has a tendency for local invasion and metastases

A

T

Surgical MCQs (44 decks)

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