Skin neoplasia

Question 1

9. Melanoma with Breslow 11 on thigh
   a. What are your margins
   b. What are two important technical points of your biopsy.
   c. What is your management (4 lines)

Answer 1

a. 2cm
b. Longitudinal excision, excision with 1-3mm margins, no shave biopsy
c.
H&P, looking for lymph node
CT or PET
Wide local excision
SLNB

Question 2

1.5cm lesion of cheek, SCC
a. What are your margins

b. What 3 things on physical exam you evaluate

c. Draw a Limberg on picture

d. What are 3 things on pathology report that are risk factors for recurrence.

Answer 2

a. Wider (around 6mm)
b.
- presence of lympth nodes
-mobile vs. fixed
-complete skin exam
c. x
d. perineural infiltration, agressive subtype (metaplasic), lymphatic/vascular invasion, depth >2mm high risk, >6mm very high risk, degree of differentiation