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23 Cards in this Set
- Front
- Back
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What are the Breslow depths?
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I: 0-0.75mm
II: 0.76-1.5mm III: 1.51-4.0mm IV: >4.0mm |
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What are the risk factors for melanoma?
What are the 2 growth patterns of melanoma? |
1. age
2. sun/uv exposure - blistering sunburns, particularly in teen age years 3. multiple dysplastic nevi/atypical moles - location: trunk vs. extremity 4. family h/o melanoma 5. fair skin 6. immunosuppression 1. radial 2. vertical |
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What are the 5 subtypes of melanoma?
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1. superficial spreading
2. nodular 3. lentigo maligna 4. acral lentiginous 5. desmoplastic 6. amelanotic |
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What are the Clark's levels?
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I: epidermis
II: into but not filling the papillary dermis III: filling papillary dermis IV: reticular dermis V: subcutis |
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What is the only FDA-approved adjuvant therapy for melanoma?
Which melanoma subtype has the best prognosis? |
Interferon alpha-2B
Lentigo maligna |
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Which melanoma subtype presents on palms, soles and sublingual regions?
Which characteristics of melanoma are associated with poor prognosis? |
Acral lentiginous melanoma
1. ulceration 2. trunk 3. male gender |
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What charactestics of skin lesions asre associated with increased risk of melanoma?
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Skin characteristics a/w increased risk of melanoma (ABCD):
1. Asymmetry 2. irregular borders 3. variegated colors 4. diameter > 6 mm 5. ulceration |
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What is an essential part of evaluating skin lesions?
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All skin lesion should undergo full thickness skin biopsy:
1. punch biopsy at the thickest part of the lesion or the part with ulceration 2. full thickness excisional biopsy with 2 mm margin, oriented so the scar may be excised if wider margin is needed |
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How are subungual lesions evaluated? What is the treatment of subungual lesions?
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Subungual lesions require biopsy. This may be accomplished by unroofing nail If biopsy reveals melanoma then amputation of the proximal interphalangeal joint with reimplantation of the flexor and extensor digitorum tendond
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What are the accepted margins of resection for melanoma?
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Accepted margins of resection depend on the depth of invasion:
in situ, then 0.5 - 1 cm margin < 1mm, then 1 cm margin > or equal to 1mm, then 2 cm margin |
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What are the T classifications of melanoma? What is used to modify T stages?
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T classification of melanoma:
T1: < or equal to 1 mm T2: 1.01 mm to 2.0 mm T3: 2.01 mm to 4.0 mm T4: > 4 mm a. without ulceration or mitosis < 1 mm2 b. with ulceration or mitosis > 1 mm2 |
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What are the N classifications fro melanoma? What is used to modify to N stages?
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The N classification refers to the amount of nodes involved:
N0: no nodes N1: one N2: 2-3 N3: 4 or more, matted nodes, in transit a. micrometatsis b. macrometastasis |
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What is the M staging sytem for melanoma?
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M1a: skin, subcutaneous, distant lymph nodes with nomrmal LDH
M1b: lung with normal LDH M1c: any other site or elevated LDH |
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What is the difference between a satellite lesion and melanoma in transit?
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A satellite lesion occurs within 2 cm of the primary lesion. In-transit lesions occur greater than 2 cm from the primary lesion.
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What is your therapeutic approach to in transit lesions?
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Therapy for in transit melanoma:
1. excision 2. hyperthermic, isolated limb infusion with mephalan and actinomycin D. |
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what are the most common sites of melanoma metastasis?
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Most common sites of melanoma metastasis:
lung skin lymph nodes brain liver GI tract |
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What are the indications for sentinel lymph node biopsy for the treatment of melanoma?
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Indications for SLNB in melanoma:
1. lesion greater than 1 mm 2. any size with ulceration 3. any size with mitosis > 1 mm2 |
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How is SLNB performed?
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SLNB is perform using two techniques:
1. Infusion of technetium 99m-sulfor colloid 2. 2 mL of vital blue dye with 2 min of massage |
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In patients with melanoma of the anterior face, scalp or upper neck with clinically apparent cervical disease a _________ should also be performed.
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In patients with melanoma of the anterior face, scalp or upper neck with clinically apparent cervical disease a superifical parotidectomy should also be performed.
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How does an axillary lymph node dissection for melanoma differ from an ALND performed for breast cancer.
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ALND for melanoma requires removal of all levels (I, II, and III) of axillary lymph nodes with skeletonization of the axillary vein.
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Superficial inguinal lymph node dissection is also called _______. Deep inguinal lymph node dissection is also called _______.
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Superficial inguinal lymph node dissection is also called an ingiunal femoral lymph node dissection. Deep inguinal lymph node dissection is also called an iliac/obturator lymph node dissection.
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What are the indications for a iliac/obturator lymph node dissection?
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Indications for iliac/obturator lymph node dissection:
1. positive Cloquet's node 2. preop evaluation indicates involvement 3. four or more positive nodes on superficial lymph node dissection. |
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What is the recommended number of lymph nodes harvested from each of the following nodal basins:
axillary, inguinofemoral, iliac/obturator, anterior cervical, posterior cervical, supraclavicular, suprahyoid, parotid, popliteal. |
Recommended lymph node harvest:
axillary 9, inguinofemoral 8, iliac/obturator 6, anterior cervical 15 , posterior cervical 15, supraclavicular 6 suprahyoid, 4 parotid 3, popliteal 2-3 |
