Skin and Soft Tissue

Question 1

risk factors for melanoma

Answer 1

dysplastic/atypical congenital levi (10% lifetime risk for melanoma), familial BK mole syndrome 100% lifetime risk, xeroderma pigmentosum, 10% are familial; fair complexion, easy sunburn, intermittent sunburns, previous skin Ca, previous XRT

Question 2

where are melanocytes from?

Answer 2

neural crest cells in basal layer of epidermis

Question 3

most common location for distant melanoma metastasis

Answer 3

lung

Question 4

most common metastasis to small bowel

Answer 4

melanoma

Question 5

most common type of melanoma? most aggressive?

Answer 5

most common type is superficial spreading melanoma, most aggressive is nodular

Question 6

recommended margins for melanoma?

Answer 6

in situ 0.5-1cm, <1 mm = 1 cm, 1-2mm = 1-2 cm margins, >2mm = 2 cm margins

Question 7

what is the difference between an in transit lesion and satellite?

Answer 7

intransit lesions are > 2 cm from primary lesion but not beyond the nodal basin, satellite lesions are <2 cm

Question 8

what are the boundaries of a pelvic lymph node dissection

Answer 8

superiorly inguinal ligament, medially the fem vessels and adductor longus, laterally sartorius, inferiorly the adductor hiatus

Question 9

indication for SLNBx in melanoma?

Answer 9

for all melanoma >1mm deep or with overlying ulceration regardless of depth

Question 10

what is an important step for all anterior head/neck melanomas >1mm deep?

Answer 10

superficial parotidectomy

Question 11

most common malignancy in the US?

Answer 11

basal cell ca; 4x more common than squamous cell ca

Question 12

skin bx shows peripheral palisading nuclei and stromal reaction

Answer 12

basal cell ca

Question 13

most common soft tissue sarcoma

Answer 13

malignant fibrous histiosarcoma&raquo_space; liposarcoma

Question 14

staging of sarcoma is based on…?

Answer 14

grade

Question 15

what chemo agents used in sarcoma?

Answer 15

doxorubicin based

Question 16

most common soft tissue sarcoma in children? most common type? worst prognosis?

Answer 16

rhabdomyosarcoma; most common type is embryonal (has good prognosis), worst prognosis is the alveolar type

Question 17

CNS tumors, peripheral sheath tumors, pheochromocytoma

Answer 17

neurofibromatosis

Question 18

merkel cell carcinoma: features and tx

Answer 18

rare neuroendocrine skin ca, pink nodule that progresses to blue color w/ or w/o ulceration, occurs in elderly light skinned pt w/ sun exposure or immunosuppression: AEIOU - asymptomatic, expanding rapidly, immunosuppression, over 50, UV exposed area – Merkel cell polyomavirus, WLE with 1-2 cm negative margins + SLNBx and adjuvant XRT

Question 19

most common location of a desmoid tumor

Answer 19

anterior abdominal wall

Question 20

Bowen’s disease?

Answer 20

SCCA in situ of perianal margin, 10% turn to invasive SCCA, associated with HPV 16 and 18, tx w/ Imiquimod, cautery ablation, topical 5FU, avoid WLE

Question 21

lab value used in melanoma staging?

Answer 21

LDH

Question 22

most common cutaneous soft tissue sarcomas? #1? #2?

Answer 22

Kaposi sarcoma > dermatofibrosarcoma protuberans (DFSP)

Question 23

result of the MSLT-1 trial

Answer 23

no survival benefit in patients w/ positive SLNBx who underwent completion lymphadenectomy vs observation

Question 24

slow growing soft tissue mass subscapular/infrascapular region: dx, imaging findings, tx

Answer 24

elastofibroma dorsi, MRI shows mass w/ streaks of fibrous and fatty tissue located beneath scapula; symptomatic pt undergo simple excision (otherwise observe, no malig potential)

Question 25

which is more common, primary or secondary lymphedema? what’s the most common form of primary lymphedema? what’s the most common form of secondary lymphedema (world? US?)

Answer 25

primary lymphedema can be congenital, praecox, and tarda; praecox most common (praecox is primary) accounts for 80-90%, occurs in women; most common worldwide is filariasis, in US most commonly due to post axillary node dissection

Question 26

can you see hyperpigmentation of the skin in lymphedema?

Answer 26

usually not, usually due to hemosiderin deposition from venous insufficiencies, not usually w/ lymphedema