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*OldSurgery > Surgical Oncology, Skin Cancer, and Sarcoma > Flashcards

Surgical Oncology, Skin Cancer, and Sarcoma Flashcards

1
Q

what does the TNM system stand for?

A

Tumor size and characteristics
regional lymph node involvement
Distant Metastases

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2
Q

what would an in situ carcinoma be staged as?

A

Stage 0

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3
Q

what stage would be advanced dz w/ distant metastasis?

A

Stage 4

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4
Q

to actually diagnose cancer what do you need?

A

a tissue diagnosis

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5
Q

aggressive ulcerating squamous cell carcinoma presenting in an area of previously traumatized chronically inflamed or scarred skin.

A

marginline ulcers

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6
Q

what are some red flags for skin lesions?

A 
change in pidmentation
rapid growth
bleeding
crusting
serious exudate
loss of skin appendages
satellite lesions
regional LAD
raised borders
ulcerations
inflammatory areolae
firm or rubbery texture
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7
Q

tumors arise from cells of the appendages of the skin, i.e., hair follicles, sweat and oil glands, and fibrous and neural tissue in the skin.

A

Adnexal tumors

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8
Q

Skin cancers are increased in individuals who have undergone _____________ and who are immunosuppressed and these cancers tend to be more frequently ______ and more aggressive.
Skin cancers increase with age reflecting chronic

A

transplantation

SCCs

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9
Q

what are the most common skin cancers and often found in fair skin patients >40

A

Basal Cell Carcinoma

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10
Q

where do most BCCs occur?

A

head and neck

some on exposed limbs and trunks

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11
Q

what is believed to be the precipitating factor for BCC?

A

UVB

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12
Q

where BCC occurs in childhood, often in non-sun-exposed areas, and in association with medulloblastoma and reproductive tumors.

A

nevoid BCC syndrome

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13
Q

waxy, translucent nodule with a thin overlying epithelium and a fine network of vessels traversing the margins. Central regression may lead to depressions in the center of the lesion and may progress to ulceration.

A

BCC

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14
Q

how do you tx a BCC <1 cm?

A

removed by curettage, electro-desiccation, cryotherapy, or excision.

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15
Q

how do you tx a BCC >1 cm

A

should be removed with excision with a minimum of 1mm margins laterally and deep.

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16
Q

second most common skin cancer?

A

squamous cell carcinoma

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17
Q

what causes SCCs

A

chronic exposure to UV light, environmental carcinogens, and by malignant degeneration in chronic, non-healing wounds and scars.

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18
Q

where are SCCs seen?

A

face, ears, lip, and exposed trunk and extremities

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19
Q

what do most SCCs arise from?

A

premalignant lesiosn called actinic keratoses (AKS)

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20
Q

which are dysplastic lesions involving the dermis and epidermis secondary to chronic sun exposure

A

actinic keratoses (AKs)

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21
Q

are BCCs or SCCs more likely to metastasize?

A

SCCs

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22
Q

Tx for AKs?

A

topical cytotoxic creams
cryosurgery
electrodessication

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23
Q

Tx of SCC

A

primarily surgical with excision to a margin of at least 5mm deep and laterally.

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24
Q

when do you use radiotherapy for SCCs?

A

not suitable for surgery

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25
Q

Tx of adnexal tumors

A

excision, possibly w/ sentinel node sampling

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26
Q

what are examples of adnexal tumors.

A

Sebaceous carcinoma
cylindroma
Merkel cell carcinoma (sensory- light touch)

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27
Q

what cause melanoma?

A

chronic UVB radiation
fair-skinned
lives closer to the equator

28
Q

most melanomas arise from what?

A

from or near benign nevi

29
Q

what is a genetic condition where individual get atypical moles and melanoma

A

FAM-M

familial atypical mole and melanoma syndrome

30
Q

what are the 4 types of melanomas?

A

lentigo maligna
superficial spreading (most common)
nodular
acral lentiginous (soles of feet or palm, nails)

31
Q

what is one promising treatment for malignant melanoma

A

interferon for a year

32
Q

what are the ABCDEs of melanoma

A 
Asymmetry
Border irregularity
Color variability
Diameter, > 6 mm
Erythema or enlargement
33
Q

what are lentigo maligna melanomas

A

bad cells w/o invasion in basement membrane

often quite diffuse (hard to clear surgically)

34
Q

how do you biopsy a melanoma.

A

full thickness biopsy or punch

want a tab of fat w/ it

35
Q

where should you do a punch biopsy?

A

on the most suspicious part

36
Q

what do you do after a punch biopsy

A

leave it open w/ triple abx ointment

and cover w/ bandage

37
Q

how should you orient biopsies?

A

Orient biopsy so it is compatible with wide excision

38
Q

how should a biopsy on the Extremities be?

A

longitudinal or oblique

39
Q

for a head and neck biopsy how should you orient it?

A

orient perpendicular to underlying fibers

40
Q

what is the primary staging of melanoma crieteria?

A

depth of invasion in mm (Breslow classification)

41
Q

for melanoma in situ what margins do you need?

A

5 mm

42
Q

if a melanoma is <1 mm thick what margins do you need?

A

1 cm

43
Q

if a melanoma is 1-4 mm thick what size margins do you need?

A

2 cm

44
Q

what does regression tell you?

A

where melanoma was and may have regressed.

still need to treat this where the tumor was at any point

45
Q

If a melanoma is >4 mm what margins do you need?

A

> 2cm

46
Q

what is the ideal way to cover openings from surgical excision of melanoma?

A

rotation flap (or skin graft)

47
Q

when do you need a sentinel lymph node biopsy?

A 
tumors >0.76-1mm thick OR
ulceration OR
positive deep margin OR
w/ mitosis OR
Clarks IV
48
Q

how can surgeons know what the sentinel lymph node is?

A

lymphocentogram- tumor was injected then lymph nodes that drain that lesion will be shown

49
Q

when do you do a SLN biopsy?

A

along with wide excision- allows for better mapping then doing it after

50
Q

rare malignant soft tissue tumors that arise from mesenchymal tissue.

A

soft tissue sarcomas

51
Q

what is the median age for a sarcoma?

A

55

52
Q

where are the most common sites of sarcomas?

A

extremities

intraabdominal and retroperitoneal

53
Q

sarcomas that occur most frequently in children

A

rhabdomyosarcomas

54
Q

sarcomas that occur more frequently in the elderly.

A

malignant fibrous histiocytomas

55
Q

characteristics that indicate a lipomas might actually be a liposarcoma.

A

firm texture
rapid growth
embedded in muscle (not SubQ)

56
Q

what causes sarcomas

A

don’t really know

thought to be a problem at the genetic level

57
Q

what sarcoma are peopel following surgery and radiation therapy for breast cancer

A

lymphangiosarcoma

58
Q

do sarcomas often metastasize to lymph nodes?

A

No, primarily spread hematogenously

59
Q

what is the primary site of metastasis be for sarcomas of the extremities?

A

lung

60
Q

where is the primary site of metastasis of a patient w/ a sarcoma in the intraabdomen?

A

liver

61
Q

how do sarcomas usually present?

A

painless mass
can be associated w/ vague symptoms of pain, weight loss, nausea, chronic anemia, and intestinal obstruction if intraabdominal

62
Q

what is the main imaging for sarcomas?

A

MRIs

63
Q

what is used to monitor for metastatic dz w/ sarcomas?

A

CT and CXR

64
Q

tx for sarcomas

A

surgery w/ 1-2 cm margins

65
Q

what are some symptoms of lymphoma

A

weight loss, night sweats

66
Q

what is a GIST tumor?

A

Gastrointestinal Stromal Tumor
subtype of sarcoma
can be treated w/ an oral chemo agent

67
Q

where are GIST tumors found?

A

stomach and small bowel

*OldSurgery (22 decks)

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