Multiple Choice Questions MCQ

Question 39# Print Question

The following is true regarding melanoma:

A. It is more common in women

B. Has a better prognosis in patients with black skin

C. A Spitz naevus is synonymous with juvenile melanoma

D. Is more common in brunettes than blondes

E. There is a 50% lifetime risk in giant hairy naevi

Question 36# Which of the following statements regarding sentinel lymph node biopsy in melanoma is false?
A. It is the best prognostic indicator for overall survival
B. It allows improved staging
C. It allows identification of patients to enter clinical trials
D. It leads to a definite increase in overall survival
E. There is a probable increase in disease-free survival
It leads to a definite increase in overall survival. D is false. Sentinel node biopsy remains a controversial topic. It has not reached the status of a universal gold standard, and current evidence has not yet proven an increased overall survival to date. It is a powerful prognostic indicator and allows improved staging, and is incorporated into the 2002 AJCC melanoma staging. Readers are recommended to keep up-to-date with progress with regard to this topic. The evidence and research may soon change in the near future and this is a hot topic for debate in examinations. References: 1. Stone C, Ed. The evidence for plastic surgery. Shrewsbury, UK: tfm publishing Ltd, 2008.

Question 37# The following is true regarding melanoma:
A. A margin of 3cm must be taken for a 2.2mm lesion
B. A better prognosis exists for a stage IIIA melanoma than for a IIC melanoma at 5 years
C. Back lesions have the best prognosis
D. Suspicious lesions should be best sampled with a punch biopsy forcep
E. It never metastasizes to the thyroid
A better prognosis exists for a stage IIIA melanoma than for a IIC melanoma at 5 years. A better prognosis exists for a stage IIIA melanoma than for a IIC melanoma. The AJCC classification 2001 ¹ gives 5-year survival for IIC tumours as 45% and IIIA as 69%. Based on 2008 AJCC data, the figures are 53% and 78%, respectively ². The 2009 AJCC guidelines are due for publication shortly. This highlights the prognostic significance of tumour thickness and ulceration. References: Balch CM, Buzaid AC, Soong SJ, Atkins MB, Cascinelli N, Coit DG, Fleming ID, Gershenwald JE, Houghton A Jr, Kirkwood JM, McMasters KM, Mihm MF, Morton DL, Reintgen DS, Ross MI, Sober A, Thompson JA, Thompson JF. Final version of the American Joint Committee on Cancer Staging system for cutaneous melanoma. J Clin Oncol 2001; 19(16): 3635-48. Balch CM, et al. In: Cutaneous melanoma, 5th ed. Balch, Houghton, Sober, Soong, Atkins & Thompson, Eds. St. Louis, USA: Quality Medical Publishing Inc, 2008; Chapter 4: 75.

Question 38# The following is true regarding melanoma:
A. A patient with a 0.7mm lesion has at least a 10% risk of death by 10 years
B. MM250 is the most sensitive immunohistological marker
C. HNB75 is the most sensitive immunohistological marker
D. In situ lesions have a Breslow thickness less than 0.15mm
E. In situ melanomas are the same lesions as solar lentigo in all but name
A patient with a 0.7mm lesion has at least a 10% risk of death by 10 years. The 10-year survival for a T1a (stage 1A) melanoma is 88%, the 5-year survival being 95%. References: 1. Balch CM, Buzaid AC, Soong SJ, Atkins MB, Cascinelli N, Coit DG, Fleming ID, Gershenwald JE, Houghton A Jr, Kirkwood JM, McMasters KM, Mihm MF, Morton DL, Reintgen DS, Ross MI, Sober A, Thompson JA, Thompson JF. Final version of the American Joint Committee on Cancer Staging system for cutaneous melanoma. J Clin Oncol 2001; 19(16): 3635-48.

Question 40# The following is true regarding melanoma:
A. Nodular is the commonest subtype
B. Is most commonly found on the scalp of men and the backs of women
C. Is most commonly found on the legs of men and the backs of women
D. It has an 88% 10-year survival if <1mm Breslow thickness
E. In situ melanoma has a 95% 10-year survival
It has an 88% 10-year survival if <1mm Breslow thickness. Superficial spreading melanoma is the commonest subtype. In situ melanoma has a 100% survival. It is most commonly found on the trunk and head of men and the lower extremity of women. In general it is commoner in men. References: 1. Balch CM, Buzaid AC, Soong SJ, Atkins MB, Cascinelli N, Coit DG, Fleming ID, Gershenwald JE, Houghton A Jr, Kirkwood JM, McMasters KM, Mihm MF, Morton DL, Reintgen DS, Ross MI, Sober A, Thompson JA, Thompson JF. Final version of the American Joint Committee on Cancer Staging system for cutaneous melanoma. J Clin Oncol 2001; 19(16): 3635-48.

Question 39# The following is true regarding melanoma:
A. It is more common in women
B. Has a better prognosis in patients with black skin
C. A Spitz naevus is synonymous with juvenile melanoma
D. Is more common in brunettes than blondes
E. There is a 50% lifetime risk in giant hairy naevi
s more common in brunettes than blondes. In relation to risk by hair colour, the relative risk compared to black hair is: redhead - 3.6 times higher, brunette - 2.8 times higher, blonde - 2.4 times higher. The risk of transformation of a giant hairy naevus is variably quoted as between 1 and 40%. However, it is now thought to be well below a 10% lifetime risk. Delay in diagnosis can lead to a worse prognosis in those with black skin. Spitz naevi occur in children and young adults. The unfortunate and now obsolete synonym, juvenile melanoma, was applied to the seminal works on these tumours. They are not malignant lesions and should be differentiated from the rare cases of true melanoma in this age group. There is some grey in this area, and there are reports of an entity termed ‘malignant Spitz naevus’. References: Gnepp DR. Diagnostic surgical pathology of the head and neck, 2nd ed. SaundersElsevier, 2009: 1050-1. Spitz S. Melanomas of childhood. Am J Pathol 1948; 24: 591-609. Smith KJ, et al. Spindle cell and epithelioid cell nevi with atypia and metastasis (malignant Spitz nevus). Am J Surg Pathol 1980; 13: 931-9.