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Skin & Soft Tissue > skin cancer and sarcoma > Flashcards

skin cancer and sarcoma Flashcards

1
Q

what cell markers are positive in merkel cell cancer?

A

CK-20, negative for thyroid transcription factor (TTF-1);

unlike small cell lung cancer which is positive for CK-20 AND TTF-1

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2
Q

true or false. primary melanoma greater than or equal to 0.8mm thick and clinically negative nodes should be considered for sentinel lymph node bx

A

true

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3
Q

treatment for actinic keratosis:

A

multiple options - topic 5FU, photodynamic therapy, topical imiquimod; cautery and destruction

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4
Q

margin for excision of cutaneous squamous cell carcinoma

A

0.5-1.0cm; 4mm for low risk, high risk needs 6mm

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5
Q

most common nonskin melanoma

A

eye melanoma

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6
Q

true or false. strawberry hemangioma appears at birth and is characterized by slow growth and rapid involution

A

false. rapid growth followed by involution

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7
Q

treatment of strawberry hemangioma

A

observation. usually involute by age 7-8; treat complicated ones with propanolol

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8
Q

vascular tumors that occur primarily in breast parenchyma or secondarily in the dermis of the breast after radiation for breast cancer

A

angiosarcoma

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9
Q

treatment of secondary angiosarcoma

A

total mastectomy plus chemo (taxane based)

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10
Q

histologic findings of SCC:

A

atypical cells, intracellular bridging and nodules of eosinophilic keratinized cells with ghost nuclei (aka keratin pearls)

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11
Q

acceptable excision margin for basal cell carcinoma:

A

3mm; usually 0.5cm

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12
Q

chronic nonhealing wound that progresses to squamous cell carcinoma

A

Marjolin ulcer

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13
Q

most important prognostic indicator in soft tissue sarcomas of the extremity

A

histologic grade

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14
Q

true or false. for melanoma patients with clinical stage 1 or 2 disease, no additional preoperative workup for metastatic disease is indicated after hx and PE prior to excision

A

true

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15
Q

soft tissue tumor that arises from fibroblstasts; CD-34 positive and spindle-like

A

dermatofibrosarcoma

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16
Q

what margins are needed for dermatofibrosarcoma?

A

2cm; adequate WLE is important to prevent recurrence b/c these tumors are characterized by microscopic lateral extensions

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17
Q

Merkel Cell carcinoma histologic features:

A

bx shows small blue cells that stain positive for CK-20

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18
Q

uncommon neuroendocrine tumor of the skin that occurs mostly over sun exposed areas and metastasizes to locoregional lymph node basins:

A

Merkel Cell carcinoma

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19
Q

most common site of recurrence of melanoma

A

skin

20
Q

generally soft tissue sarcomas do not spread to lymph nodes, however several kinds that can include:

A

rhabdomyosarcoma, epitheloid sarcoma, clear cell sarcoma, vascular sarcoma, and synovial sarcoma

21
Q

skin cancer characterized by pearly papules/nodules with telangiectasias; can have center ulceration with peripheral “rolled” borders

A

basal cell carcinoma

22
Q

histopathologic features of basal cell carcinoma

A

polygonal cells with granular eosinophilic cytoplasm (basaloid) arising from the epidermis with peripheral palisading nuclei and stromal retraction

23
Q

most common type of skin cancer

A

basal cell carcinoma

24
Q

acceptable margin: melanoma <1mm thick

A

1cm margin

25
Q

acceptable margin: melanoma 1-2mm thick

A

1-2cm margins

26
Q

acceptable margin: melanoma >2mm thick

A

2cm margins

27
Q

acceptable margin: melanoma in situ

A

0.5cm margin

28
Q

most common subtype of melanoma; grows in a radial fashion initially

A

superficial spreading melanoma

29
Q

subtype of melanoma more common in elderly sun-exposed patients; slow growth and overall best prognosis

A

lentigo maligna melanoma

30
Q

genetic disorder characterized by defect in production of collagen type III; have hypermobile joints, fragile skin, and fragile blood vessels; prone to aortic root aneursysm and Osgood Schlatter (inflamed tibial tubercle)

A

Ehler Danlos syndrome

31
Q

genetic disorder characterized by defect in fibrillin protein; characterized by tall stature, arachnodactyly, ligamentous laxity, myopia, scoliosis, pectus excavatum, and ascending aortic aneurysms

A

Marfan syndrome

32
Q

genetic disorder characterized by brittle bones from defect/mutation in type 1 collagen

A

osteogenesis imperfecta

33
Q

When is sentinel lymph node biospy warranted for melanoma?

A

when depth is at least 1 mm

or when there are adverse parameters like ulceration, increased mitotic rate, young age, or positive deep margin

34
Q

Staining of dermatofibrosarcoma protuberans:

A

CD34

35
Q

Treatment of dermatofibrosarcoma protuberans:

A

excise with 2 cm margin; sensitive to radiation tx; imatinib can be used for locally advanced or metastatic disease

36
Q

True or false. Dermatofibrosarcoma protuberans metastasizes to lymph nodes.

A

false

37
Q

Findings of MSLT-II trial:

A

for melanoma, completion lymph node dissection was associated with improved disease free survival but equivalent melanoma specific survival (i.e. decreased nodal relapse but no improvement in overall survival)

38
Q

Association and features of Merkel Cell carcinoma:

A

associated with immunosuppression and polyomavirus; cutaneous neuroendocrine tumor

39
Q

Treatment of Merkel cell carcinoma:

A

wide local excision (1-2cm margins) with SNLB followed by radiation; no role for chemo

40
Q

Strongest predictor of disease recurrence and death from melanoma

A

sentinel lymph node status

41
Q

Standard surgical margins for BCC and SCC of the skin

A

excision to clear margins or 4-10mm

42
Q

What primary tumor metastasizes to skin most often?

A

breast adenocarcinoma

43
Q

Standard neoadjuvant radiation dose for soft tissue sarcomas:

A

50 Gy over 25 fractions

44
Q

True or false. Dermatofibrosarcoma protuberans without fibrosarcomatous change rarely metastasizes.

A

True. usually recurs locally; those with fibrosarcomatous change have increase risk of metastases to the lungs

45
Q

What type of surgical resection improves survival for liposarcoma?

A

resection to grossly negative margins

46
Q

Which retroperitoneal liposarcoma patients should receive adjuvant chemotherapy?

A

reserved for metastatic patients

47
Q

Immunohistochemical markers for melanoma:

A

HMB-45, Melan-A, S100 protein, MITF, SOX-10

Skin & Soft Tissue (2 decks)

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