Surgical Oncology, Skin Cancer, and Sarcoma

Question 1

what does the TNM system stand for?

Answer 1

Tumor size and characteristics
regional lymph node involvement
Distant Metastases

Question 2

what would an in situ carcinoma be staged as?

Answer 2

Stage 0

Question 3

what stage would be advanced dz w/ distant metastasis?

Answer 3

Stage 4

Question 4

to actually diagnose cancer what do you need?

Answer 4

a tissue diagnosis

Question 5

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

Answer 5

marginline ulcers

Question 6

what are some red flags for skin lesions?

Answer 6

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

Question 7

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.

Answer 7

Adnexal tumors

Question 8

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

Answer 8

transplantation

SCCs

Question 9

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

Answer 9

Basal Cell Carcinoma

Question 10

where do most BCCs occur?

Answer 10

head and neck

some on exposed limbs and trunks

Question 11

what is believed to be the precipitating factor for BCC?

Answer 11

UVB

Question 12

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

Answer 12

nevoid BCC syndrome

Question 13

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.

Answer 13

BCC

Question 14

how do you tx a BCC <1 cm?

Answer 14

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

Question 15

how do you tx a BCC >1 cm

Answer 15

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

Question 16

second most common skin cancer?

Answer 16

squamous cell carcinoma

Question 17

what causes SCCs

Answer 17

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

Question 18

where are SCCs seen?

Answer 18

face, ears, lip, and exposed trunk and extremities

Question 19

what do most SCCs arise from?

Answer 19

premalignant lesiosn called actinic keratoses (AKS)

Question 20

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

Answer 20

actinic keratoses (AKs)

Question 21

are BCCs or SCCs more likely to metastasize?

Answer 21

SCCs

Question 22

Tx for AKs?

Answer 22

topical cytotoxic creams
cryosurgery
electrodessication

Question 23

Tx of SCC

Answer 23

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

Question 24

when do you use radiotherapy for SCCs?

Answer 24

not suitable for surgery

Question 25

Tx of adnexal tumors

Answer 25

excision, possibly w/ sentinel node sampling

Question 26

what are examples of adnexal tumors.

Answer 26

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

Question 27

what cause melanoma?

Answer 27

chronic UVB radiation fair-skinned lives closer to the equator

Question 28

most melanomas arise from what?

Answer 28

from or near benign nevi

Question 29

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

Answer 29

FAM-M | familial atypical mole and melanoma syndrome

Question 30

what are the 4 types of melanomas?

Answer 30

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

Question 31

what is one promising treatment for malignant melanoma

Answer 31

interferon for a year

Question 32

what are the ABCDEs of melanoma

Answer 32

``` Asymmetry Border irregularity Color variability Diameter, > 6 mm Erythema or enlargement ```

Question 33

what are lentigo maligna melanomas

Answer 33

bad cells w/o invasion in basement membrane | often quite diffuse (hard to clear surgically)

Question 34

how do you biopsy a melanoma.

Answer 34

full thickness biopsy or punch | want a tab of fat w/ it

Question 35

where should you do a punch biopsy?

Answer 35

on the most suspicious part

Question 36

what do you do after a punch biopsy

Answer 36

leave it open w/ triple abx ointment | and cover w/ bandage

Question 37

how should you orient biopsies?

Answer 37

Orient biopsy so it is compatible with wide excision

Question 38

how should a biopsy on the Extremities be?

Answer 38

longitudinal or oblique

Question 39

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

Answer 39

orient perpendicular to underlying fibers

Question 40

what is the primary staging of melanoma crieteria?

Answer 40

depth of invasion in mm (Breslow classification)

Question 41

for melanoma in situ what margins do you need?

Answer 41

5 mm

Question 42

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

Answer 42

1 cm

Question 43

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

Answer 43

2 cm

Question 44

what does regression tell you?

Answer 44

where melanoma was and may have regressed. | still need to treat this where the tumor was at any point

Question 45

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

Answer 45

>2cm

Question 46

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

Answer 46

rotation flap (or skin graft)

Question 47

when do you need a sentinel lymph node biopsy?

Answer 47

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

Question 48

how can surgeons know what the sentinel lymph node is?

Answer 48

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

Question 49

when do you do a SLN biopsy?

Answer 49

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

Question 50

rare malignant soft tissue tumors that arise from mesenchymal tissue.

Answer 50

soft tissue sarcomas

Question 51

what is the median age for a sarcoma?

Answer 51

55

Question 52

where are the most common sites of sarcomas?

Answer 52

extremities | intraabdominal and retroperitoneal

Question 53

sarcomas that occur most frequently in children

Answer 53

rhabdomyosarcomas

Question 54

sarcomas that occur more frequently in the elderly.

Answer 54

malignant fibrous histiocytomas

Question 55

characteristics that indicate a lipomas might actually be a liposarcoma.

Answer 55

firm texture rapid growth embedded in muscle (not SubQ)

Question 56

what causes sarcomas

Answer 56

don't really know | thought to be a problem at the genetic level

Question 57

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

Answer 57

lymphangiosarcoma

Question 58

do sarcomas often metastasize to lymph nodes?

Answer 58

No, primarily spread hematogenously

Question 59

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

Answer 59

lung

Question 60

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

Answer 60

liver

Question 61

how do sarcomas usually present?

Answer 61

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

Question 62

what is the main imaging for sarcomas?

Answer 62

MRIs

Question 63

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

Answer 63

CT and CXR

Question 64

tx for sarcomas

Answer 64

surgery w/ 1-2 cm margins

Question 65

what are some symptoms of lymphoma

Answer 65

weight loss, night sweats

Question 66

what is a GIST tumor?

Answer 66

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

Question 67

where are GIST tumors found?

Answer 67

stomach and small bowel