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Z - SURGERY

Skin

QuestionAnswer
How to evaluate pigmented skin lesions? ABCDE: Asymmetry, Border irreg, Color change, Diameter increase, Enlargement or elevation
What is malignant melanoma? CA of the pigmented cells of the skin (melanocytes)
What factors used to stage malignant melanoma? (3) Depth of invasion, ulceration, LN status
Where on the body is malignant melanoma most likely to occur? Evenly distributed among head, neck, trunk, and upper and lower extremities
Genetic risk factors for development of malignant melanoma, in decreasing order (8) prior hx, fam hx, white, easily burn/unable to tan, blue eyes, >20 nevi on body, red hair, fair skin
Environmental risk factors for development of malignant melanoma (3) Sunlight (esp UVB), near equator, 1st sunburn at young age
Other risk factors for development of malignant melanoma (not genetic, not environmental) - (7) tanning lamps, UVA exposure, higher SES, immunosuppression, halogenated compounds, alcohol/tobacco, coffee/tea
Name the 4 types of melanoma 1. superficial spreading, 2. nodular sclerosis, 3. lentigo maligna, 4. acral lentiginous
What is the most common type of melanoma? superficial spreading (70% of cases)
Malignant melanoma - superficial spreading female predominance, prolonged radial growth phase (1 to 10 y), late vertical growth phase, good prognosis
Malignant melanoma - nodular sclerosis second most common, 15-30%, aggressive vertical growth phase, poor prognosis
Malignant melanoma - lentigo maligna 4-10%, long radial growth phase (5-15 y), good prognosis
Malignant melanoma - acral lentiginous 35-60% in AA, Asian, Hispanic; primarily on palms and soles and in nail beds; aggressive vertical growth phase, poor prognosis
5y survival for stage I melanoma with thickness of <0.75mm >96%
which is more accurate prognostic indicator - depth of invasion or level of invasion? Depth (Breslow) - overall 5y survival correlates with tumor thickness
How does ulceration of lesion affect cancer staging? stage is increased
Minimum surgical margin width for 1. melanoma in situ, 2. <1.5mm tickness, 3. 1.5-4mm, 4. >4mm 0.5cm, 1 cm, 2 cm, at least 2 cm
for pts with malignant melanoma, what is the tx if they have palpable adenopathy? complete lymphadenectomy of the involved LN basin
which malignant melanoma pts would benefit from prophylactic LN dissection? intermediate depth - 0.75mm to 4mm; prophylactic LN dissection in this population associated with longer survival
Is adjuvant therapy recommended for melanoma? Minimal benefits for stage I and II, limited for stage III
prognosis for stage 4 melanoma 6 to 9 mo
tx for stage 4 melanoma high-dose IL2 (9% durable response, 8% partial response)
Created by: christinapham
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