Week 1 Benign/Malignant Cutaneous Carcinomas

Question 1

Gorlin’s syndrome is an AD disorder linked to ___.

Answer 1

Gorlin’s syndrome is an AD disorder linked to chromosome 9.

Question 2

Gorlin’s syndrome is associated w/falx cerebral calcifications, multiple ___, ___, bifid ribs, scoliosis, intellectual disability, and frontal bossing.

Answer 2

Gorlin’s syndrome is associated w/falx cerebral calcifications, multiple cutaneous Basal Cell Carcinomas, Odontogenic Keratocysts, bifid ribs, scoliosis, intellectual disability, and frontal bossing.

Question 3

A gamma probe is used to evaluate the radioactivity of nodal basins during sentinel LN biopsy in the management of _____.

Answer 3

A gamma probe is used to evaluate the radioactivity of nodal basins during sentinel LN biopsy in the management of cutaneous melanoma.

Question 4

A gamma probe is used to evaluate the radioactivity of nodal basins during _____ in the management of cutaneous melanoma.

Answer 4

A gamma probe is used to evaluate the radioactivity of nodal basins during sentinel LN biopsy in the management of cutaneous melanoma.

Question 5

A LN that demonstrates ___% or greater counters/min compared w/the hottest node ex vivo should be considered a sentinel node and should be removed.

Answer 5

A LN that demonstrates 10% or greater counters/min compared w/the hottest node ex vivo should be considered a sentinel node and should be removed.

Question 6

A LN that demonstrates 10% or greater counters/min compared w/the hottest node ex vivo should be considered a sentinel node and should be removed.

Using thresholds > 10% will minimize the
_____ and decrease _____ associated w/the procedure.

Answer 6

A LN that demonstrates 10% or greater counters/min compared w/the hottest node ex vivo should be considered a sentinel node and should be removed.

Using thresholds > 10% will minimize extent of surgery and decrease costs associated w/the procedure.

Question 7

Frey syndrome is secondary to injury of which nerve and nerve fibers?

Answer 7

Post-ganglionic parasympathetic fibers from CN IX via the auriculotemporal nerve of CN V.

Question 8

Cutaneous SCCa of the H&N may metastasize in up to ___ % of patients (and ___ % in high risk patients), w/the parotid LNs the most frequent site for spread.

Answer 8

Cutaneous SCCa of the H&N may metastasize in up to 5% of patients (and 10% in high risk patients), w/the parotid LNs the most frequent site for spread.

Question 9

A cutaneous SCCa of the H&N that is:

• size ___
• neurotropism
• immunosuppression

Indicate a poorer prognosis

Answer 9

A cutaneous SCCa of the H&N that is:

• size >2cm
• neurotropism
• immunosuppression

Indicate a poorer prognosis

Question 10

A cutaneous SCCa of the H&N that is:

• size >2cm
• ___
• immunosuppression

Indicate a poorer prognosis

Answer 10

A cutaneous SCCa of the H&N that is:

• size >2cm
• neurotropism (perineural innervation)
• immunosuppression

Indicate a poorer prognosis

Question 11

A cutaneous SCCa of the H&N that is:

• size >2cm
• neurotropism
• ___

Indicate a poorer prognosis

Answer 11

A cutaneous SCCa of the H&N that is:

• size >2cm
• neurotropism
• immunosuppression

Indicate a poorer prognosis

Question 12

What locations of melanoma has the worst prognosis?

Answer 12

“BANS:
- upper Back
- posterior Arm
- posterior Neck
- posterior Scalp

Question 13

Sentinel lymph node biopsy should be considered for intermediate and thick melanomas with cN_ nodes, beginning at stage ___.

Answer 13

Sentinel lymph node biopsy should be considered for intermediate and thick melanomas with cN0 nodes, beginning at stage T1b.

Question 14

Here is a cartoon of the histopathology of 2 diff melanomas. If the lesions were located on the R forehead and had no clinical evidence of nodal metastasis, how would you treat them?

Answer 14

Wide local excision w/1-2cm margins + SLNB

(this image depicts a T2b or T3 melanoma)

Question 15

The Phase III MSLT-II and DeCOG-salt trials demonstrated at a median f/u of 43mos, melanoma-specific survival was ____ (disease-free survival was ____) among patients assigned to complete LN dissection vs. observation (which included U/S evaluation of appropriate LN bastions prior to lymphatic mapping and SLNB)

Answer 15

The Phase III MSLT-II and DeCOG-salt trials demonstrated at a median f/u of 43mos, melanoma-specific survival was the SAME (disease-free survival was IMPROVED) among patients assigned to complete LN dissection vs. observation (which included U/S evaluation of appropriate LN bastions prior to lymphatic mapping and SLNB)

Question 16

19M presents with a pigmented lesion above left eyebrow. It is excised and path shows superficial spreading melanoma w/DOI 1.09mm and no ulceration. A sentinel LN bx is performed confirming the presence of a 0.5mm deposit of melanoma in 1 LN. BRAF testing is negative. What treatment coarse is most appropriate?

Answer 16

Careful clinical observation w/US surveillance of the + nodal basin (preferred over immediate complete LN dissection in patients w/+ SLNB)

This is based on phase III MSLT-II and DeCOG-SLT trials

Question 17

Complete LN dissection of melanoma is indicated if there is evidence of _____ (but has not been shown to improve mortality).

Answer 17

Complete LN dissection of melanoma is indicated if there is evidence of:

Regional LN recurrence in the absence of distant mets

(but has not been shown to improve mortality).

Question 18

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Answer 18

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Question 19

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Answer 19

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Question 20

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Answer 20

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Question 21

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Answer 21

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Question 22

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Answer 22

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Question 23

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Answer 23

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Question 24

A melanoma is excised from the cheek of a 65M. It is NOT ulcerated and extends into the reticular dermis at the depth of 1.01 mm. What is the T-stage according to the 2017 AJCC staging guidelines?

Answer 24

T1b.
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(Staging according to Clark and Breslin are historic only. Though AJCC staging resembles Breslin staging, it is more detailed and includes information on mitotic rate).

(Thickness measurements should be rounded up/down to be recorded as a single digit after the decimal, and so a tumor w/a 1.01 mm thickness would be rounded down to 1.0 mm, and thus staged as a T1b).