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Oral Boards > Skin > Flashcards

Skin Flashcards

1
Q

What is the risk of PNI, LN, DM for BCC

A

very low

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2
Q

What is the risk of PNI, LN, DM for SCC

A

PNI is 2-15%

Well diff SCC LN+ 1%

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3
Q

Risk factors for greater LN+ for SCC

A

>3 cm

>4 mm depth

Lips

Temporal lesions

SCC from burn scars or osteomyelitis

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4
Q

What syndrome increases risk of BCC and medulloblastoma

A

Gorlin syndrome

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5
Q

What is etiology of Merkel cell

A

Merkel polyoma virus

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6
Q

What imaging is needed for Merkel cell

A

PET CT

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7
Q

When should MRI be ordered for skin cancers

A

Concern for PNI

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8
Q

T1 SCC/BCC

A

<2 cm

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9
Q

T2 skin

A

2-4 cm

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10
Q

T3 skin

A

>4 cm and/or

PNI and/or

Deep invasion or minor bone erosion

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11
Q

T4a skin

A

cortical bone or marrow invasion

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12
Q

T4b skin

A

BOS or foramen involvement

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13
Q

What is preferred managment of BCC or SCC

A

Moh’s surgery

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14
Q

What are the indications for post-op RT for SCC or BCC

A
  • Positive margin
  • Extensive PNI or large nerve involvement
  • Skeletal muscle, bone/cartilage invasion or other high risk features
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15
Q

What is large nerve involvement for skin cancer

A

>0.1 mm

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16
Q

What are indicates for RT to nodes for SCC/BCC

A

N+ disease or ECE

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17
Q

What levels are treated for skin cancers

A

IB to III

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18
Q

Which skin lesions should be offered definitive RT

A

Central lesions > 5 mm

eyelids, tip of nose, lip commissure

Large lesions with poor comesis after Moh’s

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19
Q

If incurable skin cancer, what is another treatment option

A

cemiplimab

PD1 inhibitor

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20
Q

What is the preferred RT approach for SCC/BCC

A

Electron beam therapy

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21
Q

Doses of SC for definitive SCC

A

70 Gy in 2 fractions

55 Gy in 20 fractions

Prescribe electrons to 90%IDL

22
Q

Dose of RT for postop SCC

A

60 Gy in 30 fractions

23
Q

What is electron setup for SCC

A

custom electron cutout with bolus and 1-2 cm margin on lesion

24
Q

Specific steps for periorbital treatment

A

Lead sheild

Place anesthetic drops prior to placement of lead shield and then do eye patch afterward due to impaired corneal reflex

25
Q

Specific steps for nose

A

Wax bolus over node to convert to box like contour

Lead plugs in nostrils

26
Q

Special steps for lips

A

Lead shield between gingiva and lips

27
Q

When to start RT if skin graft

A

6-8 weeks

28
Q

If there is a graft what should be in the field?

A

FUll graft

29
Q

What is 90% electron range

A

E/4

30
Q

What is 80% electron range

A

E/3

31
Q

What is preferred treatment for Merkel cell

A

WLE + LND if cN+ or SLNB+

Then typically adjuvant RT for MOST PATIENTS

32
Q

RT target for Merkel if WLE and neg SLNB

A

Primary site itself

tumor bed + 5 cm margins (scalp but non HN)

tumor bed + 2 cm margins (HN primary)

33
Q

What is Merkel adjuvant RT plan if N+

A

Adjuvant RT to primary and nodal basin

34
Q

Dose for Merkel if R0

A

50 Gy

35
Q

Dose for Merkel cell if R1

A

56 Gy

36
Q

Dose for Merkel if R2 or definitive

A

60 Gy

37
Q

Most common form of melanoma

A

Superficial spreading

38
Q

Imaging needed for melanoma

A

CT CAP or PET for stage III/IV

39
Q

How is T stage determined for melanoma

A

Thickness

40
Q

T2 melanoma is what thickness

A

1-2 mm

41
Q

T3 melanoma

A

2-4 mm

42
Q

T4 melanoma

A

>4 mm

43
Q

What is stage I/II melanoma

A

T1-T4N0

44
Q

What is preferred treatment for stage I or II melanoma

A

WLE and LN evaluation

45
Q

What is the required surgical margin for melanoma

A

1 cm if superficial T1

2 cm margin if T3+

46
Q

Which melanoma patients need SLNB

A

cN0 and >0.8 mm

47
Q

If melanoma patient is cN+, next step

A

LND

48
Q

Indications for postop RT to primary for melanoma

A

Close or + margin (though re-excision preferred)

Desmoplastic

Thickeness > 4 mm

Recurrence

Extensive PNI

49
Q

What are the indications for postop RT to nodes for melanoma

A

1+ parotid nodes, 2+ cervical or axillary, 3+ groin

ECE

LN>3 cm

50
Q

WHat is the adjuvant RT dose for melanoma

A

48 in 20 fractions (2.4 per fraction)

Oral Boards (12 decks)

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