Skin, Bone, & Soft Tissue

Front 1

Epidermis

Back 1

The outermost layer of skin that forms the external surface of the skin

Front 2

The epidermis is made up of

__________ and is ___________.

Back 2

-Stratified squamous epithelium

-avascular (no blood supply)

Front 3

Keratinocytes

Back 3

Cells that produce keratin

Front 4

Keratinocytes of the stratum corneum are called:

Back 4

Squamous cells (because of their flat shape)

Front 5

Keratinocytes of the stratum basale are called:

Back 5

Basal cells

Front 6

Where are the majority of melanocytes found?

Back 6

In the stratum basale

Front 7

The primary function of a basement membrane is:

Back 7

To anchor an epithelial later to the loose connective tissue underneath

Front 8

The basement membrane of the skin acts as a ___________

__________, preventing malignant cells of the epidermis from invading the deeper tissue.

Back 8

Mechanical barrier

Front 9

Angiogenesis

Back 9

Development of new blood vessels

Front 10

The dermis is the _______ layer of the skin and contains:

Back 10

-middle

-the accessory organs and appendages of the skin

Front 11

Merkel's disc

Back 11

Clear, oval slowly adapting receptor that senses texture, discrimination of shape, and sustained pressure

Front 12

Merkel's disc is located in the:

Back 12

Dermis

Front 13

2 categories of skin cancer:

Back 13

-Non-melanomas

-Melanomas

•Arise from melanocytes

Front 14

Which layer of the epidermis are the melanocytes in?

Back 14

Stratum basale

Front 15

2 types of non-melanomas:

Back 15

-Basal Cell Carcinoma (BCC)

-Squamous Cell Carcinoma (SCC)

Front 16

Basal cell carcinoma arise in:

Back 16

The stem cells of the stratum basale

Front 17

Squamous cell carcinoma arise in:

Back 17

More mature keratinocytes in the upper layers of the epidermis

Front 18

The most common type of non-melanoma is:

Back 18

Basal cell carcinoma

Front 19

The most important etiologic factor associated with ALL skin cancers is:

Back 19

Exposure to Ultraviolet (UV) light

Front 20

Most dangerous type of ultraviolet light:

Back 20

Type A ultraviolet light (UV-A)

Front 21

Type A ultraviolet light is able to penetrate to the:

Back 21

Stratum basale

Front 22

Previous superficial/ orthovoltage radiation exposure is an etiologic factor for:

Back 22

Non-melanomas

Front 23

Precursor lesions for non-melanomas:

Back 23

-Actinic (solar) keratoses

-Arsenical keratoses

Front 24

Actinic (solar) keratoses

Back 24

Warty lesions or areas of red, scaly patches occurring on sun- exposed skin of face, arms, or hands

Front 25

Arsenical keratoses

Back 25

Multiple, hard, corn-like masses on the palms of the hands or soles of feet resulting from long-term arsenic ingestion

Front 26

Thermal or electric burns; chronic heat exposure is an etiologic factor specifically for:

Back 26

Squamous cell carcinoma

Front 27

Nevus

Back 27

Benign, slightly pigmented cutaneous lesion; commonly known as birthmark or mole

Front 28

Nevus is an etiologic factor for:

Back 28

Melanoma

Front 29

Benign nevi tend to:

Back 29

• Be symmetrical

• Possess clearly defined, smooth borders

• Be uniformly tan or brown

• Be less then 6mm in diameter (the size of a pencil eraser)

Front 30

70% of melanomas develop as a result of:

Back 30

A change in a pre-existing benign nevus

Front 31

De novo melanoma

Back 31

Melanomas that do not develop from a pre-existing benign nevus

Front 32

Dysplastic nevus

Back 32

A nevus whose appearance is atypical from other nevi

Front 33

These are precursor lesions for melanoma:

Back 33

Dysplastic nevi

Front 34

Common clinical presentation of non-melanomas:

Back 34

-Any new growth that persist or change in appearance

-A wart that bleeds or scabs and becomes itchy or tender

-A sore that takes longer than three weeks to heal

Front 35

Specific presentations of basal cell carcinoma:

Back 35

-Arise as smooth, red or milky lumps

•A few may contain melanin

and may appear black

-Have a pearly border

-Have multiple telangiectasis

-May be shiny or pale

*Most common site for BCC is head and neck

Front 36

Telangiectasis

Back 36

Spider veins

Front 37

Specific presentations of squamous cell carcinoma:

Back 37

-Have a scaly, crust, slightly elevated lesion that may have a cutaneous horn

-Most common site: Arms

Front 38

Clinical presentation of melanomas:

Back 38

-Asymmetrical

-Notched uneven borders

-Contain different shades of black, brown, or tan

-Diameter > 6mm

Front 39

The most common site of occurrence for melanoma in MEN is on the:

Back 39

Trunk and face

Front 40

The most common site of occurrence for melanoma in WOMEN is on the:

Back 40

Legs

Front 41

"ABCD" rules for early detection of melanomas:

Back 41

A-asymmetry

B-border

C-color

D-diameter

Front 42

Detection and Diagnosis

•Suspected BCCs

Back 42

Shave biopsy or curettage

Front 43

Detection and Diagnosis:

•Suspected SCCs or melanomas

Back 43

Excisional biopsy

Front 44

Non-melanoma metastasis

Back 44

Direct extension

Front 45

BCCs vs. SCCs

Back 45

BCC- extremely slow growing

SCC- faster growing, more aggressive, and have a higher risk of metastasis then BCC

Front 46

What has the highest risk of metastasis of all skin cancers?

Back 46

Melanomas

Front 47

Melanoma metastasis

Back 47

-Direct extension (most common)

*If they do metastasize via blood, they go to the LUNG

Front 48

Melanomas may be "microstaged" using 2 systems, which are critically important prognostic indicators. They are:

Back 48

1. Clark's level

2. Breslow's depth

Front 49

Clark's level

Back 49

Categorizes melanomas based on their level of invasion through the epidermis and layers of the dermis

Front 50

Breslow's depth

Back 50

Categorizes melanomas based on tumor thickness

*More accurate indicator of the metastatic risk and prognosis than the Clark's level

Front 51

Most common histologic type of basal cell carcinoma

Back 51

Nodular BCC

Front 52

Nodular BCC appearance

Back 52

Smooth, shiny and translucent accompanied by telangiectasis

Front 53

Rodent Ulcer

Back 53

-Type of BCC

:Large nodular lesion with central necrosis

Front 54

The two most common histologic types of SCC are:

Back 54

Bowen's disease

Keratoacanthoma

Front 55

Bowen's disease

Back 55

Considered SCC in situ; characterized by pink or brown papules covered with a thickened, horny layer

Front 56

Keratoacanthoma

Back 56

Considered a well-differentiated, *low grade SCC*, characterized by a rapid-growing lesion that can appear suddenly as a *dome-shaped mass* on a sun-exposed area

Front 57

Most common histologic type of melanoma

Back 57

Superficial Spreading Melanoma (SSM)

Front 58

Superficial Spreading Melanoma frequently arises from:

Back 58

A precursor lesion (previously benign)

Front 59

Most aggressive form of melanoma

Back 59

Nodular Melanoma

Front 60

Treatment of choice for small non-melanomas

Back 60

Surgery

Front 61

Treatment of choice for melanomas

Back 61

Surgery

Front 62

Melanomas are considered __________, but __________ with high doses per fraction.

Back 62

-radioresistant

-radioresponsive

Front 63

Hypofractionated EBRT for Melanomas

Back 63

High dose (6000cGy) delivered twice per week for 5 fractions

*increase in daily dose, decrease in protraction (# of fractions)

Front 64

Mycosis Fungoides

Back 64

A type of Non-Hodgkin's Lymphoma that affects the skin

*AKA: cutaneous T-cell lymphoma

Front 65

Treatment for Mycosis Fungoides

Back 65

Total skin electron therapy (TSET)

Front 66

Kaposi's Sarcoma most common presenting symptoms:

Back 66

Nodules or blotches that may be red, purple, brown, or black, and are usually palpable or raised

Front 67

Kaposi's Sarcoma metastasis

Back 67

Hematogenous

Front 68

Kaposi's Sarcoma is radio______, but not ______.

Back 68

-Sensitive

-Curable

Front 69

What type of tumor is Merkel's Cell Carcinoma?

Back 69

Neuroendocrine

*Associated with a virus

Front 70

Merkel's Cell carcinoma develops where?

Back 70

In Merkel cells, just beneath the skin and in hair follicles

Front 71

Merkel's Cell Carcinoma metastasis

Back 71

Lymphogenous

*not curable

Front 72

Treatment of choice for Merkel's Cell Carcinoma

Back 72

Surgery

Front 73

Keloids

Back 73

A type of scar which results from an overgrowth of collagen at the site of a healed skin injury or wound

Front 74

Keloids appearance

Back 74

-Firm, rubbery lesions or shiny, fibrous nodules

-Can vary from pink to flesh-colored or red to dark brown

- May be itchy or tender to the touch

Front 75

Keloids in females occur most commonly in the:

Back 75

Earlobes (due to piercing)

Front 76

Keloids in males occur most commonly on:

Back 76

The face (due to shaving injury)

Front 77

Keloids are most common in dark-pigmented individuals.

Back 77

15 times higher risk in persons of African descent

Front 78

Hematopoiesis

Back 78

The process of formation and development of the various types of blood cells

Front 79

Where does Hematopoiesis occur?

Back 79

Red bone marrow

Front 80

Ossification

Back 80

The process by which hyaline cartilage and connective tissue membranes are replaced by bone

Front 81

Osteoblasts

Back 81

Immature bone-forming cells that produce hormones and alkaline phosphate which assist with bone formation

Front 82

Alkaline phosphate

Back 82

An enzyme that helps mineralize bone

Front 83

Epiphyseal plate

Back 83

A flat plate of hyaline cartilage responsible for the lengthwise growth of long bones in children

Front 84

Primary site of ossification

Back 84

Middle of the diaphysis

Front 85

Osteoclasts

Back 85

Phagocytic bone cells that assist with absorption and removal of bone; release calcium into the blood

Front 86

Malignant tumors that arise from the mesenchyme are referred to as:

Back 86

Sarcomas

Front 87

The two most common sites of occurrence of primary bone cancer are in the:

Back 87

-Distal femur

-Proximal tibia

Front 88

Ischemia

Back 88

Absent of blood, oxygen, nutrient supply

Front 89

2 basic types of osseous tissue:

Back 89

-Compact

-Spongy

Front 90

Iatrogenic

Back 90

Cancers that are the result of medical treatment; induced by the treatment itself

Front 91

Iatrogenic cancers are most commonly associated with:

Back 91

-Previous external beam irradiation

-Internal bone-seeking radionuclides from medical occupational exposures and medical procedures

Front 92

The most common presenting symptom of most bone cancers/tumors is:

Back 92

Pain in the area of the tumor

Front 93

Bone cancers associated with a pathological fracture

Back 93

-Metastatic bone cancer

-Multiple Myeloma

Front 94

What is the most important diagnostic tool prior to biopsy in bone cancer?

Back 94

Conventional radiographs

Front 95

Bone cancers/tumors may be lytic or blastic. What is lytic?

Back 95

To break-up, disintegrate or destroy bone

Front 96

Bone cancers/tumors may be lytic or blastic. What is blastic?

Back 96

To build-up, form or produce bone

Front 97

This appearance implies *aggressive* cancer/tumor with bone invasion:

Back 97

Moth-eaten or punched-out appearance

*Associated with: Metastatic bone cancer and Multiple Myeloma

Front 98

Ewing's Sarcoma radiographic appearance:

Back 98

"Onion" pattern

Front 99

Elevated Prostate Specific Antigen (PSA) can indicate:

Back 99

Metastatic bone cancer

Front 100

Epiphyses

Back 100

The ends of long bones that consists of spongy bones sandwiched between a thin layer of compact bone

Front 101

A blood chemistry study showing elevated alkaline phosphatase (ALP) can indicate:

Back 101

-Metastatic bone cancer

-Osteosarcoma

Front 102

Biopsy techniques for bone cancers/tumors may include:

Back 102

Incisional biopsy (most common)

Front 103

The 2 staging systems specifically for Multiple Myeloma:

Back 103

-Durie-Salmon

-International Staging System (ISS) for Multiple Myeloma

Front 104

The most common route of metastasis for primary bone cancer is:

Back 104

Hematogenous

Front 105

Skip metastasis

Back 105

A second site of metastasis that is smaller than the first and is located in the same bone or in a bone on the opposing side of a joint space (i.e. Femur and tibia)

*usually means cancer is in the medullary cavity

Front 106

Treatment of choice of most primary bone tumors:

Back 106

Surgery

Front 107

Diaphysis

Back 107

The long shaft of the bone

Front 108

Metaphysis

Back 108

The widest portion of the diaphysis that is adjacent to the epiphysis

Front 109

Epiphyseal line

Back 109

A thin line of bony tissue between the Epiphyses and diaphysis that is noticeably different from surrounding bone

*Is a remnant of what used to be the epiphyseal plate or "growth plate" in children

*Epiphyseal plates are located in the metaphysis region

Front 110

Medullary cavity

Back 110

The cavity found within the shaft of the bones

Front 111

Osteocyte

Back 111

Mature bone-forming cells

Front 112

Two types of bone marrow:

Back 112

Yellow

Red

Front 113

Treatment of choice of most primary bone tumors:

Back 113

Surgery

Front 114

Limb salvage surgery

Back 114

Wide en bloc resection; only take out what you need

Front 115

Symptoms of malignant spinal cord compression:

Back 115

-Relentless and progressive back pain

-Paralysis (partial or total)

-Sensory loss

-Urinary and fecal incontinence

Front 116

Goal of treatment for metastatic bone cancers:

Back 116

Palliation

Front 117

Most common radioisotope used to treat metastatic bone cancers:

Back 117

Strontium 89 (T1/2 is 50.5 days or 1212 hours

Front 118

Most common type of primary bone cancer:

Back 118

Osteosarcoma

Front 119

Osteosarcomas arise from:

Back 119

Osteoblasts

Front 120

Most common histology of primary bone tumors in adolescents:

Back 120

Osteosarcoma

Front 121

Osteosarcoma most often develops in the:

Back 121

-Metaphysis- children

-Diaphysis- adults

Front 122

Most common site of occurrence for osteosarcoma is:

Back 122

The knee joint

Front 123

98% of Osteosarcomas metastasize to the:

Back 123

Lung

Front 124

Most common histopathology of a radiation induced bone sarcoma is:

Back 124

Osteosarcoma

Front 125

Cyclophosphamide

Back 125

Cystotoxicity: hemorrhagic cystitis

Front 126

Osteosarcomas are chemo_______ and radio_________.

Back 126

-sensitive

-resistant

(Usually do chemo and surgery)

Front 127

2nd most common type of primary bone cancer in adults:

Back 127

Chondrosarcoma

Front 128

Chondrosarcoma develops most often in the:

Back 128

Epiphyses

Front 129

The most common site of occurrence for chondrosarcoma is in the:

Back 129

Pelvis

Front 130

Chondrosarcomas are chemo_________ and radio________.

Back 130

-resistant

-resistant

Front 131

A chondrosarcoma has a ________ prognosis than an osteosarcoma.

Back 131

Better

Front 132

Most common histology of Fibrosarcoma is:

Back 132

Malignant Fibrous Histiocytoma (MFH)

Front 133

Most common site of occurrence for both Fibrosarcoma and MFH is the:

Back 133

Femur

Front 134

2nd most common primary bone cancer in children is:

Back 134

Ewing's Sarcoma

Front 135

Ewing's sarcoma develops most often in the:

Back 135

Diaphysis

Front 136

Methotrexate

Back 136

Gastrointestinal toxicity: stomatitis and mucositis

Front 137

Most common site of occurrence for Ewing's Sarcoma is the:

Back 137

Lower extremities

Front 138

Ewing's sarcomas have a unique microscopic appearance. They are composed of cells with:

Back 138

Hyperchromatic bluish nuclei and very little cytoplasm that are arrayed in sheets

Front 139

Malignant Spinal Cord Compression is commonly associated with:

Back 139

Ewing's sarcoma

Front 140

Ewing's sarcoma are very chemo_________ and radio________.

Back 140

-sensitive

-sensitive

Front 141

Giant Cell Tumors of the bone (GCTB) has both:

Back 141

Benign and malignant forms

Front 142

Giant cell tumors of the bone develops most often in the:

Back 142

Metaphysis and epiphyses

Front 143

Most common site of occurrence for GCTB is the:

Back 143

Knee joints

Front 144

Multiple Myeloma is not a bone tumor. It is classified as a:

Back 144

B-cell lymphoma that is capable of forming tumors in the bone

Front 145

Multiple myeloma arises from _______ ___ that are produced in the bone marrow and transported through the ____________ __________.

Back 145

-plasma cells

-lymphatic system

Front 146

Multiple Myeloma is the most common lymphoreticular tumor in:

Back 146

Non-Caucasians

Front 147

Adriamycin

Back 147

Cardiotoxicity: cardiac failure

Front 148

Multiple myeloma has an increased incidence in:

Back 148

-survivors of atomic bomb in Hiroshima and Nagasaki

-African Americans

-First degree relatives (FDR)

Front 149

Multiple Myeloma increases the activity of:

Back 149

Osteoclasts

Front 150

Multiple myeloma's most common site of occurrence is the:

Back 150

Skull

Front 151

Multiple myeloma is also commonly associated with:

Back 151

Malignant spinal cord compression (MSCC)

Front 152

Goal of treatment for multiple myeloma is:

Back 152

Palliation

Front 153

Multiple myeloma is chemo_______ and radio_________.

Back 153

-sensitive

-sensitive

No surgery-too wide spread

Front 154

Benign bone tumor:

Heterotopic Bone Formation-

Back 154

A benign condition associated with abnormal bone formation outside the skeleton (specifically in the muscle)

AKA: Hypertropic ossification (HO)

Front 155

The most common place for Hypertropic bone formation is in the:

Back 155

Hip

Front 156

Benign bone tumors typically occur as:

Back 156

Bumps on the external surface of the periosteum or inside the medullary cavity

Front 157

Common side effects of radiation therapy for bone cancers:

Back 157

-Lymphedema

-Pathological fracture

-Increased risk of bone infections

-Avascular necrosis

Front 158

Vincristine

Back 158

Neurotoxicity: peripheral neuropathy

Front 159

Radiation therapy side effects from treating bone cancer in children:

Back 159

-Bone shortening/stunted growth

-Slipped capital femoral epiphysis

-Iatrogenic or "second" malignancies

Front 160

Slipped capitols femoral epiphysis-

Back 160

A fracture through the epiphyseal "growth" plate of the proximal femur that results in the slippage of the overlying epiphysis

Front 161

Cisplatin

Back 161

Nephrotoxicity: renal failure

Front 162

Primary bone tumors are relatively radio______:

Back 162

resistant

Front 163

Radiosensitive bone cancers

Back 163

-Metastatic bone tumors

-Ewing's sarcoma

Front 164

Most common site of metastatic bone cancer:

Back 164

Vertebrae

-pedicle

Front 165

Primary tumors that have a propensity to metastasize to the bone:

Back 165

Men- Prostate cancer

Women- Breast cancer

Front 166

Soft tissue sarcoma:

Malignant Fibrous Histiocytoma (MFH)-

Back 166

Mixed tissues

Front 167

Soft tissue is ____ encapsulated.

Back 167

Not

Front 168

Most common site of occurrence of soft tissue sarcoma in the extremities is

Back 168

Proximal posterior portion of the thigh and buttocks

Front 169

Angiosarcoma may develop as a result of Stewart-Treves Syndrome-

Back 169

A condition associated with chronic lymphedema

Front 170

Most common presenting symptom of soft tissue cancer:

Back 170

Painless mass or swelling

Front 171

Parenthesis-

Back 171

An abnormal sensation, such as burning, pricking, tickling, or tingling

Front 172

Constitutional symptom of heat in the tumor-

Back 172

Calor

Front 173

Most common route of metastasis in soft tissue sarcomas-

Back 173

Direct extension-

•fingerlike projections extend

through and beyond the

pseudocapsule and may

form "satellite" tumors

independent from the

primary mass

Front 174

Most common site of hematogenous metastasis in soft tissue cancer is-

Back 174

Lungs

Front 175

The most important prognostic factor for soft tissue sarcomas:

Back 175

Grade

Front 176

Treatment of choice for most soft tissue sarcomas:

Back 176

Surgery

Front 177

Most common histologic subtype of soft tissue sarcoma in adults:

Back 177

Malignant Fibrous Histiocytoma

Front 178

Soft tissue cancer surgery: if used with adjuvant radiation therapy, the surgical incision should be placed:

Back 178

Laterally

-the surgeon should identify the tumor bed and suspected margins with radiopaque surgical clips in case post-op radiation therapy is required

Front 179

Soft tissue cancer:

Rhabdomyosarcomas are the most-

Back 179

Chemosensitive

Front 180

Soft tissue cancers are considered highly radio_______

Back 180

Resistant

Front 181

Soft tissue cancer:

Liposarcomas are the most

Back 181

Radiosensitive

Front 182

Limb salvage techniques include: Sparing a strip of soft tissue on the medial aspect of the extremity treatment field from irradiation to preserve:

Back 182

Lymphatic drainage

Front 183

Intraoperative Radiation Therapy (IORT)

Back 183

A technique the involved irradiation of the tumor during a surgical procedure

Front 184

Radiation therapy is used most often in soft tissue cancers for

Back 184

Retroperitoneal and pelvic sarcomas

Front 185

The most common site of local recurrence in soft tissue cancer:

Back 185

Pseudocapsule

Front 186

Most common benign soft tissue tumor of the uterus-

Back 186

Leiomyoma

Front 187

Most common benign soft tissue tumor:

Back 187

Lipoma

Front 188

Soft tissue sarcoma:

Liposarcoma-

Back 188

Adipose (fat) tissue

Front 189

Second most common histology subtype of soft tissue sarcoma in adults:

Back 189

Liposarcoma

Front 190

Most common soft tissue sarcoma of the retroperitoneum:

Back 190

Liposarcoma

Front 191

Intraoperative Radiation Therapy (IORT)

Back 191

A technique that involves irradiation of the tumor during a surgical procedure

Front 192

Soft tissue sarcoma:

Rhabdomyosarcoma-

Back 192

Striated muscle tissue, these muscles are voluntary

Front 193

Malignant Schwannoma-

Back 193

Peripheral nerve sheath tissues

Front 194

Malignant Schwannoma is also know as-

Back 194

Neurofibrosarcoma

Front 195

As soft tissue sarcomas grow, they form a zone of reactive tissue called a "pseudocapsule"-

Back 195

A false capsule around the muscle compartment that is composed of compressed tumor cells and fibrotic tissue

Front 196

The 2 most effective chemotherapy drugs for soft tissue sarcomas are:

Back 196

Ifosfamide

Doxorubicin

Front 197

Ifosfamide chemotoxicity:

Back 197

Hemorrhagic cystitis toxicity

Front 198

Dioxyrubicin (Adriamycin) chemotoxicity:

Back 198

Cardiomyopathy toxicity

Front 199

Vincristine chemotoxicity:

Back 199

Neuropathy toxicity

Front 200

Cyclophosphamide chemotoxicity:

Back 200

Hemorrhagic cystitis toxicity

Front 201

Bleomycin chemotoxicity:

Back 201

Pulmonary toxicity

Front 202

Type of cancer most commonly linked to precursor lesions-

Back 202

Squamous cell carcinoma

Front 203

Skin cancer: epidemiology

Back 203

-Light skinned people who tend to tan poorly and sunburn easily

-More common in those who live near the equator

-More common in those who live at high altitudes

-Higher risk of recurrence or 2nd primary in persons with a prior skin cancer

Front 204

Skeletal survey

Back 204

Used to diagnose Multiple Myeloma

Front 205

Chondrosarcoma grade:

Back 205

Low grade

Front 206

Fibrosarcoma and MFH grade:

Back 206

High grade

Front 207

Giant cell tumors grade:

Back 207

Low grade

Front 208

What kind of surgery is used for Giant Cell Tumors?

Back 208

Curettage surgery

Front 209

Most common site of occurrence for BCC

Back 209

Head and neck