A 63 year-old man is scheduled to undergo a liver biopsy for multiple liver lesions he developed 5 years after undergoing a wedge resection of a gastrointestinal stromal tumor (GIST) of the stomach. The pathology returns hepatic metastases consistent with a GIST primary. To guide therapy, you should request the pathologist also stain the tumor for:
A 64 year-old woman recently underwent a wide local excision and sentinel lymph node biopsy for a melanoma of her left calf. The final pathology reveals an ulcerated melanoma that is 1.0mm in depth and the sentinel lymph node is tumor free. The patient’s tumor, node, metastasis (TNM) staging is:
A 74 year-old woman is referred with a biopsy-proven melanoma of her right forearm that is 1.4 mm in depth. She has no family history of skin cancer. She has a history of hypertension for which she takes a diuretic. Her physical examination reveals a 2.0-cm healing incision on her right forearm with no other skin lesions of lymphadenopathy. The next most appropriate step in management is:
Wide local excision of the forearm scar with sentinel lymph node biopsy
A 70-year old man presents with an enlarging, nontender mass in his left thigh. The mass has been present for 4 months and he denies any history of trauma. Physical examination reveals an 8.0-cm firm mass in the anterior compartment of the left thigh. An MRI reveals a heterogeneous mass in the quadriceps muscle suspicious for a possible sarcoma. The next most appropriate step in management is:
A 36-year-old woman is seen in clinic to discuss options to decrease her risk for developing cancer. She has a strong family history of breast cancer on her mother’s side. Her paternal grandfather died of colon cancer, and a paternal aunt had thyroid cancer. The patient has tested positive for the BRCA1 gene. Which of the following surgical procedures is the most appropriate to decrease her risk for developing cancer?
A 42 year-old woman is seen in clinic because of a basal cell carcinoma located o the bridge of her nose. Mohr’s therapy is recommended. The following statement best describes Mohr’s therapy for skin cancer:
A specialized surgical technique used to excise skin cancers in areas where there is a need to preserve normal tissue.
A 54-year-old man is referred for a 1.0-cm skin lesion on his upper back that his wife noticed while he was getting out of the shower. His past medical history is unremarkable. He has no other suspicious lesions of lymphadenopathy. The most appropriate next step in diagnosis is:
Excisional biopsy with a 1 to 2-mm margin of normal skin
A 64 year-old man is seen in clinic because of a chest radiograph revealing a new solitary lesion in his left upper lobe. He has a history of melanoma of his left flank resected 5 years ago. He is otherwise healthy and has no other symptoms. He has never smoked. Physical examination reveals a well-healed scar where the flank melanoma was removed and no evidence of local recurrence. He has no new skin lesions or lymphadenopathy. A positron emission tomography-computed tomography (PET/CT) scan shows a 1.0-cm PET-avid lesion in the left upper lobe with no other suspicious lesions. The next most appropriate step in management is:
Video-assisted thoracoscopic (VATS) resection of the lesion
A 55 year-old woman is seen in clinic two weeks after completing 5 cycles of chemotherapy for a 6.0-cm cancer of her left breast. The tumor is now 2.0 cm in size. She elects to undergo a lumpectomy. The use of chemotherapy in this setting is described as:
A 67 year-old man presents to clinic with a 3-month history of a left neck mass. He has a history of squamous cell cancer of the left cheek removed 2 years ago. He denies any other symptoms and he has never smoked. His physical examination reveals a 2.0-cm firm mass in the mid portion of his left neck; the rest of his examination is unremarkable. A positron emission tomography-computed tomography (PET/CT) scan shows a 2.0 cm PET-avid lesion in the left neck with no other suspicious lesions. The next most appropriate step in management is:
Fine-needle aspiration biopsy of the neck lesion