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Section II General Surgery P203Surgical Recall Sixth > Melanoma, C64 P471-476 > Flashcards

Melanoma, C64 P471-476 Flashcards

1
Q

What is it?

P471

A

Neoplastic disorder produced by
malignant transformation of the
melanocyte; melanocytes are derived
from neural crest cells

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2
Q

Which patients are at
greatest risk?
P471

A 
White patients with blonde/red hair, fair
skin, freckling, a history of blistering
sunburns, blue/green eyes, actinic
keratosis
Male > female
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3
Q

What are the most common
sites (3)?
P471

A
  1. Skin
  2. Eyes
  3. Anus
    (Think: SEA = Skin, Eyes, Anus)
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4
Q

What is the most common
site in African Americans?
P472

A

Palms of the hands, soles of the feet

acral lentiginous melanoma

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5
Q

What characteristics are
suggestive of melanoma?
P472

A 
Usually a pigmented lesion with an
    irregular border, irregular surface, or
    irregular coloration
Other clues: darkening of a pigmented
    lesion, development of pigmented
    satellite lesions, irregular margins or
    surface elevations, notching, recent
    or rapid enlargement, erosion or
    ulceration of surface, pruritus
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6
Q

What are the “ABCDs” of
melanoma?
P472

A

Asymmetry
Border irregularity
Color variation
Diameter >6 mm and Dark lesion

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7
Q

What are the associated risk
factors?
P472

A

Severe sunburn before age 18, giant
congenital nevi, family history, race
(White), ultraviolet radiation (sun),
multiple dysplastic nevi

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8
Q

How does location differ in
men and women?
P472

A

Men get more lesions on the trunk;

women on the extremities

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9
Q

Which locations are
unusual?
P472

A

Noncutaneous regions, such as mucous
membranes of the vulva/vagina, anorectum,
esophagus, and choroidal layer of the eye

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10
Q

What is the most common
site of melanoma in men?
P472

A

Back (33%)

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11
Q

What is the most common
site of melanoma in women?
P472

A

Legs (33%)

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12
Q

What are the four major
histologic types?
P472

A
  1. Superficial spreading
  2. Lentigo maligna
  3. Acral lentiginous
  4. Nodular
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13
Q

Define the following terms:
Superficial spreading melanoma
P472

A

Occurs in both sun-exposed and
non-exposed areas; most common
of all melanomas (75%)

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14
Q

Define the following terms:
Lentigo maligna melanoma
P473

A 
Malignant cells that are superficial, found
    usually in elderly patients on the head
    or neck
Called “Hutchinson’s freckle” if
    noninvasive
Least aggressive type; very good
    prognosis
Accounts for < 10% of all melanomas
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15
Q

Define the following terms:
Acral lentiginous melanoma
P473

A 
Occurs on the palms, soles, subungual
    areas, and mucous membranes
Accounts for ≈5% of all melanomas
    (most common melanoma in
    African American patients; ≈50%)
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16
Q

Define the following terms:
Nodular melanoma
P473

A

Vertical growth predominates
Lesions are usually dark
Most aggressive type/worst prognosis
Accounts for ≈15% of all melanomas

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17
Q

Define the following terms:
Amelanotic melanoma
P473

A

Melanoma from melanocytes but with

obvious lack of pigment

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18
Q

What is the most common
type of melanoma?
P473

A 
Superficial spreading (≈75%) (Think:
SUPERficial = SUPERior)
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19
Q

What type of melanoma
arises in Hutchinson’s
freckle?
P473

A

Lentigo maligna melanoma

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20
Q

What is Hutchinson’s
freckle?
P473

A

Lentigo maligna melanoma in the radial
growth phase without vertical extension
(noninvasive); usually occurs on the
faces of elderly women

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21
Q 
STAGING
What are the American Joint Committee on Cancer
(AJCC) stages simplified:
IA?
P473
A

<1 mm without ulceration

22
Q 
STAGING
What are the American Joint Committee on Cancer
(AJCC) stages simplified:
IR?
P473
A

<1 mm with ulceration or 1–2 mm

without ulceration

23
Q

STAGING
What are the American Joint Committee on Cancer
(AJCC) stages simplified:

P474

A

1–2 mm with ulceration or 2–4 mm

without ulceration

24
Q 
STAGING
What are the American Joint Committee on Cancer
(AJCC) stages simplified:
IIB?
P474
A

2–4 mm with ulceration or >4 mm

without ulceration

25
Q 
STAGING
What are the American Joint Committee on Cancer
(AJCC) stages simplified:
IIC?
P474
A

>4 mm with ulceration

26
Q 
STAGING
What are the American Joint Committee on Cancer
(AJCC) stages simplified:
III?
P474
A

Positive nodes

27
Q 
STAGING
What are the American Joint Committee on Cancer
(AJCC) stages simplified:
IV?
P474
A

Distant metastases

28
Q

STAGING
What are the common sites
of metastasis?
P474

A 
Nodes (local)
Distant: lung, liver, bone, heart, and
    brain
Melanoma has a specific attraction for
    small bowel mucosa and distant
    cutaneous sites
Brain metastases are a common cause of
    death
29
Q

STAGING
What are the metastatic
routes?
P474

A

Both lymphatic and hematogenous

30
Q

STAGING
How is the diagnosis made?
P474

A

Excisional biopsy (complete removal
leaving only normal tissue) or incisioned
biopsy for very large lesions
(Note: Early diagnosis is crucial)

31
Q

STAGING
What is the role of shave
biopsy?
P474

A

No role

32
Q

STAGING
What is the “sentinel node”
biopsy?
P474

A

Inject Lymphazurin® blue dye, colloid
with a radiolabel, or both around the
melanoma; the first LN in the draining
chain is identified as the “sentinel lymph
node” and reflects the metastatic status of
the group of lymph nodes

33
Q

STAGING
When is elective lymph node
dissection recommended?
P474

A

Controversial—possible advantage in
melanomas 1 to 2 mm in depth but jury
still out; sentinel node biopsy if >1 mm
is becoming very common

34
Q

STAGING
What is the recommended size of the surgical margin
for depth of invasion:
Melanoma in situ?

P475

A

0.5-cm margin

35
Q 
STAGING
What is the recommended size of the surgical margin
for depth of invasion:
≤1 mm thick?
P475
A

1-cm margin

36
Q 
STAGING
What is the recommended size of the surgical margin
for depth of invasion:
1–4 mm thick?
P475
A

2-cm margin

37
Q 
STAGING
What is the recommended size of the surgical margin
for depth of invasion:
>4 mm thick?
P475
A

3-cm margin

38
Q

STAGING
What is the treatment for
digital melanoma?
P475

A

Amputation

39
Q 
STAGING
What is the treatment of
palpable lymph node
metastasis?
P475
A

Lymphadenectomy

40
Q

STAGING
What factors determine the
prognosis?
P475

A 
Depth of invasion and metastasis are
the most important factors (Superficial
spreading and lentigo maligna have a
better prognosis because they have a
longer horizontal phase of growth and
are thus diagnosed at an earlier stage;
nodular has the worst prognosis because
it grows predominantly vertically and
metastasizes earlier)
41
Q 
STAGING
What is the workup to
survey for metastasis in the
patient with melanoma?
P475
A

Physical exam, LFTs, CXR (bone

scan/CT/MRI reserved for symptoms)

42
Q

STAGING
What is the treatment of
intestinal metastasis?
P475

A

Surgical resection to prevent

bleeding/obstruction

43
Q 
STAGING
Which malignancy is most
likely to metastasize to the
bowel?
P475
A

Melanoma

44
Q 
STAGING
What is the surgical
treatment of nodal
metastasis?
P475
A

Lymphadenectomy

45
Q

STAGING
What is FDA-approved
adjuvant therapy?
P475

A

Interferon alpha-2b (for stages IIB/III)

46
Q

STAGING
What is the treatment of
unresectable brain metastasis?
P476

A

Radiation

47
Q

STAGING
What is the treatment of
isolated adrenal metastasis?
P476

A

Surgical resection

48
Q

STAGING
What is the treatment of
isolated lung metastasis?
P476

A

Surgical resection

49
Q

STAGING
What is the most common
symptom of anal melanoma?
P476

A

Bleeding

50
Q

STAGING
What is the treatment of
anal melanoma?
P476

A

APR or wide excision (no survival benefit

from APR, but better local control)

51
Q 
STAGING
What other experimental
therapy is available for
metastatic disease?
P476
A
  1. Monoclonal antibodies
  2. Chemotherapy (e.g., dacarbazine)
  3. Vaccinations
52
Q

STAGING
What is the median survival
with distant metastasis?
P476

A

≈6 months

Section II General Surgery P203Surgical Recall Sixth (33 decks)

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