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|ExamType=USMLE Step 2 CK
|ExamType=USMLE Step 2 CK
|MainCategory=Surgery
|MainCategory=Surgery
|SubCategory=Dermatology
|SubCategory=Dermatology, Dermatology
|MainCategory=Surgery
|MainCategory=Surgery
|SubCategory=Dermatology
|SubCategory=Dermatology, Dermatology
|MainCategory=Surgery
|MainCategory=Surgery
|SubCategory=Dermatology
|SubCategory=Dermatology, Dermatology
|MainCategory=Surgery
|MainCategory=Surgery
|MainCategory=Surgery
|MainCategory=Surgery
|SubCategory=Dermatology
|SubCategory=Dermatology, Dermatology
|MainCategory=Surgery
|MainCategory=Surgery
|SubCategory=Dermatology
|SubCategory=Dermatology, Dermatology
|MainCategory=Surgery
|MainCategory=Surgery
|SubCategory=Dermatology
|SubCategory=Dermatology, Dermatology
|MainCategory=Surgery
|MainCategory=Surgery
|SubCategory=Dermatology
|SubCategory=Dermatology, Dermatology
|MainCategory=Surgery
|MainCategory=Surgery
|MainCategory=Surgery
|MainCategory=Surgery
|SubCategory=Dermatology
|SubCategory=Dermatology, Dermatology
|Prompt=A 42-year-old blond man originally from Portland at age 17 and has been working as a fisherman in the Caribbean. He comes to the clinic complaining of multiple nevi. He recently noticed that one of them has changed in appearance and is enlarging.  The nevus has multiple colors within the lesion, irregular borders and measures 1.9 cm.  A picture of the lesion is shown below.  Which of the following is the most important prognostic predictor?
|Prompt=A 42-year-old blond man originally from Portland at age 17 and has been working as a fisherman in the Caribbean. He comes to the clinic complaining of multiple nevi. He recently noticed that one of them has changed in appearance and is enlarging.  The nevus has multiple colors within the lesion, irregular borders and measures 1.9 cm.  A picture of the lesion is shown below.  Which of the following is the most important prognostic predictor?
<br>
<br>
[[File:Melanoma_malignum.jpg|300px|center]]
[[File:Melanoma_malignum.jpg|300px|center]]
|Explanation=<font color="MediumBlue"><font size="4">'''Educational Objective:''' </font></font>
|Explanation=Features that affect prognosis are tumor thickness in millimeters (Breslow's depth), depth related to skin structures (Clark level), type of melanoma, presence of ulceration, presence of lymphatic/perineural invasion, presence of tumor infiltrating lymphocytes (if present, prognosis is better), location of lesion, presence of satellite lesions, and presence of regional or distant metastasis.<ref>{{cite journal | author = Homsi J, Kashani-Sabet M, Messina J, Daud A | title = Cutaneous melanoma: prognostic factors. | journal = Cancer Control | volume = 12 | issue = 4 | pages = 223-9 | year = 2005 | id = PMID 16258493}}''[https://www.moffitt.usf.edu/pubs/ccj/v12n4/pdf/223.pdf Full text (PDF)]''</ref>
#  
 
#
Certain types of melanoma have worse prognoses but this is explained by their thickness. Interestingly, less invasive melanomas even with lymph node metastases carry a better prognosis than deep melanomas without regional metastasis at time of staging. Local recurrences tend to behave similarly to a primary unless they are at the site of a wide local excision (as opposed to a staged excision or punch/shave excision) since these recurrences tend to indicate lymphatic invasion.
{{See also|Melanoma}}
<font color="MediumBlue"><font size="4">'''Educational Objective:''' </font></font>
# Breslow's depth is used as a prognostic factor in melanoma of the skin. It is a description of how deeply tumor cells have invaded.
{{See also|Melanoma|Breslow's depth}}
|AnswerA=Diameter
|AnswerA=Diameter
 
|AnswerAExp=<font color="red">'''Incorrect.'''</font>
 
|AnswerAExp=<font color="red">'''Incorrect.'''</font>  
|AnswerB=Color
|AnswerB=Color
 
|AnswerBExp=<font color="red">'''Incorrect.'''</font>
|AnswerBExp=<font color="red">'''Incorrect.'''</font>  
|AnswerC=Depth of invasion
|AnswerC=Depth of invasion
|AnswerCExp=<font color="Green">'''Correct.'''</font>
|AnswerCExp=<font color="Green">'''Correct.'''</font>
|AnswerD=Multiple nevi
|AnswerD=Multiple nevi
 
|AnswerDExp=<font color="red">'''Incorrect.'''</font>
|AnswerDExp=<font color="red">'''Incorrect.'''</font>  
|AnswerE=Location
|AnswerE=Location
|AnswerEExp=<font color="red">'''Incorrect.'''</font>  
|AnswerEExp=<font color="red">'''Incorrect.'''</font>
|RightAnswer=C
|RightAnswer=C
|WBRKeyword=melanoma, skin cancer,  
|WBRKeyword=melanoma, skin cancer,
|Approved=No
|Approved=No
}}
}}

Revision as of 18:59, 7 October 2013

 
Author [[PageAuthor::Gonzalo A. Romero, M.D. [1]]]
Exam Type ExamType::USMLE Step 2 CK
Main Category MainCategory::Surgery
Sub Category SubCategory::Dermatology, SubCategory::Dermatology
Prompt [[Prompt::A 42-year-old blond man originally from Portland at age 17 and has been working as a fisherman in the Caribbean. He comes to the clinic complaining of multiple nevi. He recently noticed that one of them has changed in appearance and is enlarging. The nevus has multiple colors within the lesion, irregular borders and measures 1.9 cm. A picture of the lesion is shown below. Which of the following is the most important prognostic predictor?


]]
Answer A AnswerA::Diameter
Answer A Explanation [[AnswerAExp::Incorrect.]]
Answer B AnswerB::Color
Answer B Explanation [[AnswerBExp::Incorrect.]]
Answer C AnswerC::Depth of invasion
Answer C Explanation [[AnswerCExp::Correct.]]
Answer D AnswerD::Multiple nevi
Answer D Explanation [[AnswerDExp::Incorrect.]]
Answer E AnswerE::Location
Answer E Explanation [[AnswerEExp::Incorrect.]]
Right Answer RightAnswer::C
Explanation [[Explanation::Features that affect prognosis are tumor thickness in millimeters (Breslow's depth), depth related to skin structures (Clark level), type of melanoma, presence of ulceration, presence of lymphatic/perineural invasion, presence of tumor infiltrating lymphocytes (if present, prognosis is better), location of lesion, presence of satellite lesions, and presence of regional or distant metastasis.[1]

Certain types of melanoma have worse prognoses but this is explained by their thickness. Interestingly, less invasive melanomas even with lymph node metastases carry a better prognosis than deep melanomas without regional metastasis at time of staging. Local recurrences tend to behave similarly to a primary unless they are at the site of a wide local excision (as opposed to a staged excision or punch/shave excision) since these recurrences tend to indicate lymphatic invasion. Educational Objective:

  1. Breslow's depth is used as a prognostic factor in melanoma of the skin. It is a description of how deeply tumor cells have invaded.

Educational Objective:
References: ]]

Approved Approved::No
Keyword WBRKeyword::melanoma, WBRKeyword::skin cancer
Linked Question Linked::
Order in Linked Questions LinkedOrder::
  1. Homsi J, Kashani-Sabet M, Messina J, Daud A (2005). "Cutaneous melanoma: prognostic factors". Cancer Control. 12 (4): 223–9. PMID 16258493.Full text (PDF)