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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
TROG 0501 design
RCT of PORT vs. postop CRT (weekly carbo) for high risk cutaneous SCC.
26
Patients included in TROG 0501
1. cutaneous SCC of HN 2. Complete macroscopic resection 3. High risk nodal disease 4. Advanced primary tumor
27
Dose of RT used in TROG 0501
60-66 Gy
28
Key finding of TROG 0501
No benefit for additional of chemo 2 year FFLF: 88% vs. 89% (NSS) 5 year FFLF: 83% vs 87%
29
TROG 0201 design
RCT of adjuvant RT vs. observation following lymphadenectomy
30
Dose of RT used in TROG 0201
48 Gy / 20
31
Findings of TROG 0201
RT improves LRR, no diff in DFS or OS
32
Which melanoma patients should get referred for consideration of adjuvant immunotherapy
Stage III/IV | Improvements in relapse free survival
33
Margins utilized for skin SCC
1-1.5 cm
34
RT for SCC of skin (<2 cm)
1. 60-64 in conventional 2. 50-55/20 3. 40 / 10 3. 30 / 5 (over two weeks)
35
RT for SCC of skin (larger)
60-70 in conventional
36
T1
<2cm
37
T2
2-4 cm
38
T3
>4 cm or minor bone erosion or PNI or deep invasion
39
T4
Gross cortical bone invasion, skull base invasion
40
Typical margins for BCC
1-1.5 if small, 1.5-2 if larger
41
What radiation margin is recommended for Merkel
Very wide (5 cm)
42
What dose should electrons be prescribed to?
90% IDL
43
What clinical endpoints were improved with ipi/nivo for metastatic melanoma
OS, PFS and ORR for ipi/nivo or nivo alone vs. ipi alone
44
2 year OS rate for stage IV melanoma patient getting ipi/nivo
65%
45
Margins for leg type DLBCL
1-2 cm on pre-chemo GTV
46
RT dose for leg type DLBCL
36-40 Gy
47
What is size nerve involvement to count as PNI
>0.1 mm in caliber or nerve deeper than dermis
48
Indication for PORT in SCC (primary)
T3-T4 tumors +PNI Close or positive margins
49
Indication for PORT in SCC (nodes)
Post lymphadenectomy unless single, small (<3 cm) without ECE
50
Relationship between electron RBE and orthovoltage xray
electrons have lower RBE (15-20% lower) so electrons prescribed to 90% IDL = orthovoltage dosed to Dmax
51
Role for IO in Merkel cell
metastatic or recurrent and non-operable | no role for adjuvant for locally advanced
52
Margin status of patients included in TROG 05.01
Must be completely resected (microscopic margin ok)
53
How was high risk defined for TROG 05.01
Intraparotid nodes Higher burden cervical nodal disease (>/= 2 nodes, largest node >3cm, ECE) T3/T4 In transit mets
54
Area L skin cancer
Low risk - trunk, extremities
55
What size does lesion need to be in area L for higher risk
2 cm
56
Area M skin cancer
Moderate risk - cheeks, forehead, scalp, neck, pretibia
57
What size does lesion need to be in area M for higher risk
1 cm
58
Area H skin cancer
Mask area of the face (central face, eyelids, eyebrows, periorbital, nose, lips, chin, mandible, preauricular and postauricular skin
59
What classification are genitalia, hands, feet
Area H
60
What size do lesions need to be in area H to be considered high risk
any size
61
Size of surgical margin for melanoma depends on
thickness
62
in situ melanoma should have what surgical margin
0.5-1 cm
63
<1 mm invasion melanoma should have what surgical margin
1 cm This is T1 tumor
64
1-2mm invasion melanoma should have what surgical margin
1-2 cm This is a T2 tumor
65
2-4 mm invasion melanoma should have what surgical margin
2 cm
66
>4 mm invasion melanoma should have what surgical margin
2 cm
67
Most aggressive forms of BCC
Morpheaform Infiltrative Micronodular/basosquamous

RO Clinical Boards (13 decks)

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