| Question |
Answer |
| Tumor steps |
DX, extent disease, extent excision, recon, complications |
| Mel - prognosis relates to |
thickness of the lesion and presence of node mets |
| Mel - when is systemic eval done? |
prior to treatment |
| Mel -lesions handled with conserve mgmt? |
Less than 0.76 mm |
| Mel - when SLN? |
always except extreme circumstances. |
| Lip CA - risk factors |
smoking, sun exposure |
| Lip CA - central lymph drainage? |
submental nodes |
| Lip CA - lateral lymph drainage? |
jugular, digastric system |
| Lip CA - preceeded by? |
leukoplakia |
| Lip CA - Size can be closed primarily? |
1/3 |
| Lip CA - local flaps? |
Estlander, Abbe, Ashley, Webster |
| Hematoma predisposing factors? |
ASA, PT elev, rHTN, pain, anxiety, cough, strain, vomiting, neck flexion |
| Mel - risk factors |
UV exposure, immunosuppression, xeroderma, giant nevi, large # nevi, prev. CA, fair skin, |
| MEL-risk risk of melanoma in giant Nevus |
2.8% over about six years |
| Characteristics of nevus c/w melanoma |
change color, bleed, prolif, >6 mm diameter, irreg. border or texture |
| Accuracy of dermoscopy? |
70% |
| Four groups of Melanoma? |
Sup. Spreading, nodular, lentigo maligna, acral letiginous |
| Mel - % superficial spreading? |
60-70% |
| Mel - % nodular? |
15 - 20% |
| Mel - % lentigo maligna? |
5-10 % |
| Mel - % Acral Lentiginous |
2 - 5 % |
| Mel - demographics SSM? |
men (trunk), women (extr), Age 30-50 |
| Mel - demographics NM? |
men (head and neck, trunk), Age 60+ |
| Mel - demographics LMM? |
70+ age, |
| Mel - demographics AL? |
70% of african americans, |
| Mel - Amelanocytic |
Older males, H&N, lacks pigment, Fibrosis, rare LN mets, LUNG METS |
| Mel - Epidem - % with "localized dz" |
85% - stage I or II |
| Mel - Epidem - % with "regional dz" |
10% - nodal, in transit, Stage III |
| Mel - Epidem - % with "distant dz" |
5% - distant mets. |
| Mel - DDX List |
Dysplastic, BCCA, SCCA, Blue, Halo, Spitz, DFibroma, SK, Subung Hem |
| Mel - Nodular melanoma (15-30%) behavior |
rapid growth, may ulcerate, lacks typical ABCDE, may be amelanocytic |
| Mel - In situ pre-cursor Lentigo Maligna Mel |
> 3 cm diameter, 5-8% of lentigo |
| Hutchinson sign |
subungual pigment spreading to nail folds |
| Desmoplastic Melanoma |
<1% melanomas, 75% in H&N, amelanocytic |
| Amelanocytic Melanoma |
mimics BCCA SCCA, nodular or mets, pyogenic granuloma |
| Importance of Melanoma staging |
Prognosis, treatment, research, 2002 AJCC guidelines (changes in 2009) |
| Mel - most imp. factor for recurrence + surv |
Lymph node status |
| Mel - Number or Size more imp. for nodes |
number |
| Dysplasic Nevi - predictor or risk for mel? |
risk |
| Prophylactic removal of nevi ? |
not indicated unless suspicious |
| Mel - staging - Breslow DEPTH is most important |
New levels <1mm, 1-2mm, 2-4 mm, >4 mm |
| Mel - Stage IA |
T1a N0 M0 - no ulceration, no mitoses |
| Mel - Stage IB |
T1b NO MO - with ulceration or mitosesT2a NO MO - no ulceration or mitoses |
| Mel T2 |
1.01 - 2.00 mm. (a without ulc, b with ulc) |
| Mel - Stage IIA (NO MO) |
T2b - 1.01-2.00 with ulc
T3a - 2-4 no ulc |
| Mel - Stage IIB (NO MO) |
T3b - 2-4 with ulc
T4a - >4 no ulc |
| Mel - Stage IIC (NO MO) |
T4b - >4 with ulc |
| Mel - Stage IIIA |
(AnyT N1a-N2a) no ulc.
a = micro(IHC), b = macro(clinical) |
| Mel - unknown primary |
Stage III |
| Mel - Stage IIIB |
(AnyT N1a/N2a with ulc, N1b/2b no ulc)
a = micro(IHC), b = macro(clinical) |
| Mel - N2 |
2-3 nodes (a=micro, b=macro) |
| Mel - N3 |
>4 nodes, matted, nodes and in transit mets |
| Mel - Stage IV |
M1a,b,c |
| Mel - M1a |
distant skin, subcutaneous, nodal |
| Mel - M1b |
lung mets |
| Mel - M1c |
visceral mets or LDH with mets |
| Mel - screening if + SLNB |
CXR, LDH |
| Mel - IIIB/C or IV workup |
CXR, LDH, +/- CT, PET, Brain MRI |
| Mel - Folly of frozen section SLN |
cand contain dendritic cells and normal neval cells that look like melanoma |
| Mel - risk of melanoma if prior history |
4-8 X higher chance of new melanoma unrelated to first melanoma |
| Mel - Stains to confirm micro mets |
S-100, MART -1, mitoses per mm2 |
| SLNBx - ratio of ex vivo to bed count |
3:1 |
| SLN procedure steps |
Technetium 99 intradermal, dynamic scan 5mins, delay scan 2 hrs. |
| Vital blue dye |
Lymphazurin |
| Mel - Lymphadenectomy |
+SLN, CLND, prognosis, local control, some survival, IIIB/C |
| CLND survival advantage |
LM/SLB+ 71% 5 yr vs. 55% with delayed |
| Stage IV Melanoma Issues |
Surgery, XRT, Adjuvant rx for palliation, Interferon |
| Melanoma XRT |
Stage IIIC with extracapsular extension (oncologist guides) |
| Mel - recurrence |
re-excision, SLN if not previously, CLND if not previously |
| Mel - Nodal Recurrence |
Re-excise and XRT. |
| Mel - Distant Recurrence |
excise for control or palliation |
| IFN alpha 2 |
Only regimen that improves relapse free survival. |
| IFN Alpha 2 treatment characteristics |
year long treatment with significant side effects/toxicity |
| melanoma follow up |
lifetime annual, CXR CT PET MRI prn |
Poultry
