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Skin Flashcards

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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

Study These Flashcards
A

70 Gy in 2 fractions

55 Gy in 20 fractions

Prescribe electrons to 90%IDL

22
Q

Dose of RT for postop SCC

Study These Flashcards
A

60 Gy in 30 fractions

23
Q

What is electron setup for SCC

Study These Flashcards
A

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

24
Q

Specific steps for periorbital treatment

Study These Flashcards
A

Lead sheild

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

25
Specific steps for nose
Wax bolus over node to convert to box like contour Lead plugs in nostrils
26
Special steps for lips
Lead shield between gingiva and lips
27
When to start RT if skin graft
6-8 weeks
28
If there is a graft what should be in the field?
FUll graft
29
What is 90% electron range
E/4
30
What is 80% electron range
E/3
31
What is preferred treatment for Merkel cell
WLE + LND if cN+ or SLNB+ Then typically adjuvant RT for MOST PATIENTS
32
RT target for Merkel if WLE and neg SLNB
Primary site itself tumor bed + 5 cm margins (scalp but non HN) tumor bed + 2 cm margins (HN primary)
33
What is Merkel adjuvant RT plan if N+
Adjuvant RT to primary and nodal basin
34
Dose for Merkel if R0
50 Gy
35
Dose for Merkel cell if R1
56 Gy
36
Dose for Merkel if R2 or definitive
60 Gy
37
Most common form of melanoma
Superficial spreading
38
Imaging needed for melanoma
CT CAP or PET for stage III/IV
39
How is T stage determined for melanoma
Thickness
40
T2 melanoma is what thickness
1-2 mm
41
T3 melanoma
2-4 mm
42
T4 melanoma
\>4 mm
43
What is stage I/II melanoma
T1-T4N0
44
What is preferred treatment for stage I or II melanoma
WLE and LN evaluation
45
What is the required surgical margin for melanoma
1 cm if superficial T1 2 cm margin if T3+
46
Which melanoma patients need SLNB
cN0 and \>0.8 mm
47
If melanoma patient is cN+, next step
LND
48
Indications for postop RT to primary for melanoma
Close or + margin (though re-excision preferred) Desmoplastic Thickeness \> 4 mm Recurrence Extensive PNI
49
What are the indications for postop RT to nodes for melanoma
1+ parotid nodes, 2+ cervical or axillary, 3+ groin ECE LN\>3 cm
50
WHat is the adjuvant RT dose for melanoma
48 in 20 fractions (2.4 per fraction)

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