skin cancer and sarcoma Flashcards
what cell markers are positive in merkel cell cancer?
CK-20, negative for thyroid transcription factor (TTF-1);
unlike small cell lung cancer which is positive for CK-20 AND TTF-1
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
true
treatment for actinic keratosis:
multiple options - topic 5FU, photodynamic therapy, topical imiquimod; cautery and destruction
margin for excision of cutaneous squamous cell carcinoma
0.5-1.0cm; 4mm for low risk, high risk needs 6mm
most common nonskin melanoma
eye melanoma
true or false. strawberry hemangioma appears at birth and is characterized by slow growth and rapid involution
false. rapid growth followed by involution
treatment of strawberry hemangioma
observation. usually involute by age 7-8; treat complicated ones with propanolol
vascular tumors that occur primarily in breast parenchyma or secondarily in the dermis of the breast after radiation for breast cancer
angiosarcoma
treatment of secondary angiosarcoma
total mastectomy plus chemo (taxane based)
histologic findings of SCC:
atypical cells, intracellular bridging and nodules of eosinophilic keratinized cells with ghost nuclei (aka keratin pearls)
acceptable excision margin for basal cell carcinoma:
3mm; usually 0.5cm
chronic nonhealing wound that progresses to squamous cell carcinoma
Marjolin ulcer
most important prognostic indicator in soft tissue sarcomas of the extremity
histologic grade
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
true
soft tissue tumor that arises from fibroblstasts; CD-34 positive and spindle-like
dermatofibrosarcoma
what margins are needed for dermatofibrosarcoma?
2cm; adequate WLE is important to prevent recurrence b/c these tumors are characterized by microscopic lateral extensions
Merkel Cell carcinoma histologic features:
bx shows small blue cells that stain positive for CK-20
uncommon neuroendocrine tumor of the skin that occurs mostly over sun exposed areas and metastasizes to locoregional lymph node basins:
Merkel Cell carcinoma
most common site of recurrence of melanoma
skin
generally soft tissue sarcomas do not spread to lymph nodes, however several kinds that can include:
rhabdomyosarcoma, epitheloid sarcoma, clear cell sarcoma, vascular sarcoma, and synovial sarcoma
skin cancer characterized by pearly papules/nodules with telangiectasias; can have center ulceration with peripheral “rolled” borders
basal cell carcinoma
histopathologic features of basal cell carcinoma
polygonal cells with granular eosinophilic cytoplasm (basaloid) arising from the epidermis with peripheral palisading nuclei and stromal retraction
most common type of skin cancer
basal cell carcinoma
acceptable margin: melanoma <1mm thick
1cm margin
acceptable margin: melanoma 1-2mm thick
1-2cm margins
acceptable margin: melanoma >2mm thick
2cm margins
acceptable margin: melanoma in situ
0.5cm margin
most common subtype of melanoma; grows in a radial fashion initially
superficial spreading melanoma
subtype of melanoma more common in elderly sun-exposed patients; slow growth and overall best prognosis
lentigo maligna melanoma
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)
Ehler Danlos syndrome
genetic disorder characterized by defect in fibrillin protein; characterized by tall stature, arachnodactyly, ligamentous laxity, myopia, scoliosis, pectus excavatum, and ascending aortic aneurysms
Marfan syndrome
genetic disorder characterized by brittle bones from defect/mutation in type 1 collagen
osteogenesis imperfecta
When is sentinel lymph node biospy warranted for melanoma?
when depth is at least 1 mm
or when there are adverse parameters like ulceration, increased mitotic rate, young age, or positive deep margin
Staining of dermatofibrosarcoma protuberans:
CD34
Treatment of dermatofibrosarcoma protuberans:
excise with 2 cm margin; sensitive to radiation tx; imatinib can be used for locally advanced or metastatic disease
True or false. Dermatofibrosarcoma protuberans metastasizes to lymph nodes.
false
Findings of MSLT-II trial:
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)
Association and features of Merkel Cell carcinoma:
associated with immunosuppression and polyomavirus; cutaneous neuroendocrine tumor
Treatment of Merkel cell carcinoma:
wide local excision (1-2cm margins) with SNLB followed by radiation; no role for chemo
Strongest predictor of disease recurrence and death from melanoma
sentinel lymph node status
Standard surgical margins for BCC and SCC of the skin
excision to clear margins or 4-10mm
What primary tumor metastasizes to skin most often?
breast adenocarcinoma
Standard neoadjuvant radiation dose for soft tissue sarcomas:
50 Gy over 25 fractions
True or false. Dermatofibrosarcoma protuberans without fibrosarcomatous change rarely metastasizes.
True. usually recurs locally; those with fibrosarcomatous change have increase risk of metastases to the lungs
What type of surgical resection improves survival for liposarcoma?
resection to grossly negative margins
Which retroperitoneal liposarcoma patients should receive adjuvant chemotherapy?
reserved for metastatic patients
Immunohistochemical markers for melanoma:
HMB-45, Melan-A, S100 protein, MITF, SOX-10
