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RO Clinical Boards > Skin > Flashcards

Skin Flashcards

1
Q

Function of CTLA-4

A

It is expressed on T-cells, binds to co-stimulatory domains on CD28 and DOWNREGULATES the T-cell response by outcompeting CD80/86

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2
Q

Appropriate doses for resected skin SCC with positive microscopic margins

A
  1. 50/20

2. 60-64 Gy in conventional fractions

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3
Q

SCC factors to recommend postop RT

A
  1. microscopically positive margins

2. substantial perineural invasion

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4
Q

Appropriate dose for resected basal SCC with positive microscopic margins

A
  1. 50/20

2. 60-64 Gy in conventional fractions

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5
Q

5 year DSS for Primary cutaneous DLBCL, leg type

A

75%

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6
Q

Most common form of PCBCL

A

primary cutaneous follicle center

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7
Q

Treatment of PC follicle center lymphoma

A

24-30 Gy, reserving systemic therapy for recurrent/large volume disease

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8
Q

Merkel cell carcinoma is what type of cell

A

neuroendocrine carcinoma

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9
Q

what do merkel cells do

A

mechanoreception and maybe neuroendocrine role

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10
Q

Merkel cell can be confused with which malignancy

A

metastatic SCLC

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11
Q

Thickness of lead to block e- energy

A

E/2 [i.e., 6 MeV –> 3 mm]

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12
Q

Risk factors for local recurrence of resected melanoma

A
  1. Depth of invasion
  2. Ulceration
  3. Anatomic site (distal leg, HN)
  4. Desmoplastic histology
  5. Node positive
  6. In-transit mets
  7. Positive margins
  8. Recurrent disease
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13
Q

What margin is safe for melanoma

A

2 cm

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14
Q

What is most significant predictor of local recurrence for melanoma

A

ulceration (6 fold increase)

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15
Q

Dose for gross residual Merkel cell

A

60-66 Gy (tumor or nodes)

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16
Q

Dose for nodal volumes that are clinically negative and not undergone a SLNB

A

46-50 Gy

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17
Q

Dose for Merkel nodal volumes with ECE or multiple resected nodes

A

50-56 Gy

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18
Q

Dose for Merkel with negative margins

A

50-56 Gy

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19
Q

Dose for Merkel with microscopic positive margins

A

56-60 Gy

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20
Q

What surgical margin is recommended for Merkel

A

1-2 cm

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21
Q

What % of metastatic melanoma are BRAF positive

A

50%

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22
Q

BRAF inhibitors

A

Vemurafenib
Dabrafenib
Encorafenib

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23
Q

MEK inhibitors

A

Trametinib
Cobimetinib
Binimetinib

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24
Q

Why is BRAF-MEK combo used instead of BRAF alone

A

Improved OS, PFS and response rates

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25
Q

TROG 0501 design

A

RCT of PORT vs. postop CRT (weekly carbo) for high risk cutaneous SCC.

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26
Q

Patients included in TROG 0501

A
  1. cutaneous SCC of HN
  2. Complete macroscopic resection
  3. High risk nodal disease
  4. Advanced primary tumor
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27
Q

Dose of RT used in TROG 0501

A

60-66 Gy

28
Q

Key finding of TROG 0501

A

No benefit for additional of chemo
2 year FFLF: 88% vs. 89% (NSS)
5 year FFLF: 83% vs 87%

29
Q

TROG 0201 design

A

RCT of adjuvant RT vs. observation following lymphadenectomy

30
Q

Dose of RT used in TROG 0201

A

48 Gy / 20

31
Q

Findings of TROG 0201

A

RT improves LRR, no diff in DFS or OS

32
Q

Which melanoma patients should get referred for consideration of adjuvant immunotherapy

A

Stage III/IV

Improvements in relapse free survival

33
Q

Margins utilized for skin SCC

A

1-1.5 cm

34
Q

RT for SCC of skin (<2 cm)

A
  1. 60-64 in conventional
  2. 50-55/20
  3. 40 / 10
  4. 30 / 5 (over two weeks)
35
Q

RT for SCC of skin (larger)

A

60-70 in conventional

36
Q

T1

A

<2cm

37
Q

T2

A

2-4 cm

38
Q

T3

A

> 4 cm or
minor bone erosion
or PNI
or deep invasion

39
Q

T4

A

Gross cortical bone invasion, skull base invasion

40
Q

Typical margins for BCC

A

1-1.5 if small, 1.5-2 if larger

41
Q

What radiation margin is recommended for Merkel

A

Very wide (5 cm)

42
Q

What dose should electrons be prescribed to?

A

90% IDL

43
Q

What clinical endpoints were improved with ipi/nivo for metastatic melanoma

A

OS, PFS and ORR for ipi/nivo or nivo alone vs. ipi alone

44
Q

2 year OS rate for stage IV melanoma patient getting ipi/nivo

A

65%

45
Q

Margins for leg type DLBCL

A

1-2 cm on pre-chemo GTV

46
Q

RT dose for leg type DLBCL

A

36-40 Gy

47
Q

What is size nerve involvement to count as PNI

A

> 0.1 mm in caliber or nerve deeper than dermis

48
Q

Indication for PORT in SCC (primary)

A

T3-T4 tumors
+PNI
Close or positive margins

49
Q

Indication for PORT in SCC (nodes)

A

Post lymphadenectomy unless single, small (<3 cm) without ECE

50
Q

Relationship between electron RBE and orthovoltage xray

A

electrons have lower RBE (15-20% lower) so electrons prescribed to 90% IDL = orthovoltage dosed to Dmax

51
Q

Role for IO in Merkel cell

A

metastatic or recurrent and non-operable

no role for adjuvant for locally advanced

52
Q

Margin status of patients included in TROG 05.01

A

Must be completely resected (microscopic margin ok)

53
Q

How was high risk defined for TROG 05.01

A

Intraparotid nodes
Higher burden cervical nodal disease (>/= 2 nodes, largest node >3cm, ECE)
T3/T4
In transit mets

54
Q

Area L skin cancer

A

Low risk - trunk, extremities

55
Q

What size does lesion need to be in area L for higher risk

A

2 cm

56
Q

Area M skin cancer

A

Moderate risk - cheeks, forehead, scalp, neck, pretibia

57
Q

What size does lesion need to be in area M for higher risk

A

1 cm

58
Q

Area H skin cancer

A

Mask area of the face (central face, eyelids, eyebrows, periorbital, nose, lips, chin, mandible, preauricular and postauricular skin

59
Q

What classification are genitalia, hands, feet

A

Area H

60
Q

What size do lesions need to be in area H to be considered high risk

A

any size

61
Q

Size of surgical margin for melanoma depends on

A

thickness

62
Q

in situ melanoma should have what surgical margin

A

0.5-1 cm

63
Q

<1 mm invasion melanoma should have what surgical margin

A

1 cm

This is T1 tumor

64
Q

1-2mm invasion melanoma should have what surgical margin

A

1-2 cm

This is a T2 tumor

65
Q

2-4 mm invasion melanoma should have what surgical margin

A

2 cm

66
Q

> 4 mm invasion melanoma should have what surgical margin

A

2 cm

67
Q

Most aggressive forms of BCC

A

Morpheaform
Infiltrative
Micronodular/basosquamous

RO Clinical Boards (13 decks)

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