Surgery - Skin

Question 1

Where are melanocytes?

Answer 1

Epidermis

Question 2

Staging of melanoma

Answer 2

• T represents how thick the melanoma is, this will tell you prognostic factor
• Breslow was only depth (in mm) before (no ulceration or mets)
• Clark has lower predictive value and was used with Breslow’s depth but described where in anatomical invasion of skin
  o 1 = epidermis; 2 = papillary dermis; 3 = papillary-reticular dermis junction; 4 = reticular dermis; 5 = subQ fat

Question 3

Melanoma Stage IA

Answer 3

T1a, N0, M0

< 1mm, (-) ulceration

Question 4

Melanoma Stage IB

Answer 4

T1b, N0, M0 OR
T2a, N0, M0

< 1 mm + ulceration
OR
1-2 mm (-) ulceration

Question 5

Melanoma Stage IIA

Answer 5

T2b, N0, M0
OR
T3a, N0, M0

1-2 mm + ulceration
OR
2-4 mm (-) ulceration

Question 6

Melanoma Stage IIB

Answer 6

T3b, N0, M0
OR
T4a, N0, M0

2-4 mm + ulceration
OR
> 4 mm (-) ulceration

Question 7

Melanoma Stage IIC

Answer 7

T4b, N0, M0

> 4mm + ulceration

Question 8

Melanoma Stage III

Answer 8

+ nodes

Question 9

Melanoma Stage IV

Answer 9

Distant mets (lung, liver, bone, heart, brain…..loves small bowel mucosa)

Question 10

Dx SCC or Basal cell

Answer 10

Full thickness incisional bx done at edge of lesion including normal skin

Question 11

Preferred adjuvant systemic therapy for metastatic melanoma?

Answer 11

IFN beta

Question 12

Tx basal cell carcionma

Answer 12

Local excision

+ margins - reexcise to clear margins

Margins should be 2-4 mm

+ topical 5-FU or radiation

Question 13

Tx squamous cell carcinoma

Answer 13

More dangerous than basal

Excision w/ 1cm tumor-free margins
Lymph node excision is palpable

+ 5-FU or radiation

Question 14

What is most significant finding in addition to histo findings + TNM stage for melanoma?

Answer 14

Ulceration

Ulcerated lesions have 1/3 reduction in survival

Question 15

Lentigo maligna melanoma

Answer 15

Usually on face

Superficial spreading (not as invasive)

Favorable prognosis

Question 16

Hutchinson freckle

Answer 16

Precursor of lentigo malignant melanoma

Question 17

Acral melanoma

Answer 17

Usually in dark skinnier ppl

Tend to be thicker lesion

Assoc w/ poorer prognosis

Question 18

When do you bx or excise a soft tissue sarcoma?

Answer 18

Excisional bx for masses < 3cm

Question 19

Bx technique for sarcoma

Answer 19

Core biopsy

NOT FNA

Question 20

Sarcoma grading

Answer 20

Based on # of mitotic figures and degree of necrosis

Question 21

Mets of sarcomas to…

Answer 21

liver
lung
bone
brain

Question 22

If have recurrence of sarcoma, what is prognosis?

Answer 22

If have pulm mets, and excise, can have significant long term disease free intervavl