skin cancer and sarcoma

Question 1

what cell markers are positive in merkel cell cancer?

Answer 1

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

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

Question 2

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

Answer 2

true

Question 3

treatment for actinic keratosis:

Answer 3

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

Question 4

margin for excision of cutaneous squamous cell carcinoma

Answer 4

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

Question 5

most common nonskin melanoma

Answer 5

eye melanoma

Question 6

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

Answer 6

false. rapid growth followed by involution

Question 7

treatment of strawberry hemangioma

Answer 7

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

Question 8

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

Answer 8

angiosarcoma

Question 9

treatment of secondary angiosarcoma

Answer 9

total mastectomy plus chemo (taxane based)

Question 10

histologic findings of SCC:

Answer 10

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

Question 11

acceptable excision margin for basal cell carcinoma:

Answer 11

3mm; usually 0.5cm

Question 12

chronic nonhealing wound that progresses to squamous cell carcinoma

Answer 12

Marjolin ulcer

Question 13

most important prognostic indicator in soft tissue sarcomas of the extremity

Answer 13

histologic grade

Question 14

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

Answer 14

true

Question 15

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

Answer 15

dermatofibrosarcoma

Question 16

what margins are needed for dermatofibrosarcoma?

Answer 16

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

Question 17

Merkel Cell carcinoma histologic features:

Answer 17

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

Question 18

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

Answer 18

Merkel Cell carcinoma

Question 19

most common site of recurrence of melanoma

Answer 19

skin

Question 20

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

Answer 20

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

Question 21

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

Answer 21

basal cell carcinoma

Question 22

histopathologic features of basal cell carcinoma

Answer 22

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

Question 23

most common type of skin cancer

Answer 23

basal cell carcinoma

Question 24

acceptable margin: melanoma <1mm thick

Answer 24

1cm margin

Question 25

acceptable margin: melanoma 1-2mm thick

Answer 25

1-2cm margins

Question 26

acceptable margin: melanoma >2mm thick

Answer 26

2cm margins

Question 27

acceptable margin: melanoma in situ

Answer 27

0.5cm margin

Question 28

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

Answer 28

superficial spreading melanoma

Question 29

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

Answer 29

lentigo maligna melanoma

Question 30

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)

Answer 30

Ehler Danlos syndrome

Question 31

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

Answer 31

Marfan syndrome

Question 32

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

Answer 32

osteogenesis imperfecta

Question 33

When is sentinel lymph node biospy warranted for melanoma?

Answer 33

when depth is at least 1 mm | or when there are adverse parameters like ulceration, increased mitotic rate, young age, or positive deep margin

Question 34

Staining of dermatofibrosarcoma protuberans:

Answer 34

CD34

Question 35

Treatment of dermatofibrosarcoma protuberans:

Answer 35

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

Question 36

True or false. Dermatofibrosarcoma protuberans metastasizes to lymph nodes.

Answer 36

false

Question 37

Findings of MSLT-II trial:

Answer 37

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)

Question 38

Association and features of Merkel Cell carcinoma:

Answer 38

associated with immunosuppression and polyomavirus; cutaneous neuroendocrine tumor

Question 39

Treatment of Merkel cell carcinoma:

Answer 39

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

Question 40

Strongest predictor of disease recurrence and death from melanoma

Answer 40

sentinel lymph node status

Question 41

Standard surgical margins for BCC and SCC of the skin

Answer 41

excision to clear margins or 4-10mm

Question 42

What primary tumor metastasizes to skin most often?

Answer 42

breast adenocarcinoma

Question 43

Standard neoadjuvant radiation dose for soft tissue sarcomas:

Answer 43

50 Gy over 25 fractions

Question 44

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

Answer 44

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

Question 45

What type of surgical resection improves survival for liposarcoma?

Answer 45

resection to grossly negative margins

Question 46

Which retroperitoneal liposarcoma patients should receive adjuvant chemotherapy?

Answer 46

reserved for metastatic patients

Question 47

Immunohistochemical markers for melanoma:

Answer 47

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