Single cells and nests of atypical melanocytes with pagetoid spread - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 12-07-2011
drnrpatel's Avatar
Guest
 
Steps History: 1+CK+CS
Posts: 441
Threads: 153
Thanked 394 Times in 211 Posts
Reputation: 417
Skin Single cells and nests of atypical melanocytes with pagetoid spread

A 73-year-old man of Irish descent is brought to the office by his daughter who recently noticed an enlarging dark spot on his back. The patient was a construction worker all his life and sustained multiple sunburns and chronic sun exposure throughout his adult years. He is in rather good health with only mild hypertension and arthritis. Over the previous 10 years, he has had multiple actinic keratoses and two basal cell carcinomas treated. His current medications include hydrochlorothiazide and naproxen. The family history is positive for nonmelanoma skin cancer. On physical examination, the patient is in no acute distress and his vital signs are within normal limits. On the right upper shoulder, there is a 2 x 3-cm dark brown patch with scalloped borders and several black macules at the periphery. You perform an excisional shave biopsy that reveals single cells and nests of atypical melanocytes with pagetoid spread throughout the epidermis and in the epidermis with a Breslow thickness of 1 mm. A thorough examination of lymph nodes is unremarkable. Complete blood counts, metabolic panel, liver function tests, alkaline phosphatase levels, and a chest x-ray are all within normal limits. In addition to performing a re-excision, which of the following procedures should be offered to the patient?

A. Bone scintigraphy
B. Needle aspiration of the regional lymph node
C. Sentinel lymph node biopsy
D. Radical lymph node dissection
E. Total body MRI
Reply With Quote Quick reply to this message
The above post was thanked by:
jahn77 (12-11-2011)



  #2  
Old 12-07-2011
bebix's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,357
Threads: 194
Thanked 3,259 Times in 881 Posts
Reputation: 3269
Default

C. Sentinel lymph node biopsy
Reply With Quote Quick reply to this message
  #3  
Old 12-07-2011
pass7's Avatar
USMLE Forums Guru
 
Steps History: 1+CK+CS+3
Posts: 406
Threads: 30
Thanked 140 Times in 108 Posts
Reputation: 150
Default

C. Sentinel lymph node biopsy
Reply With Quote Quick reply to this message
  #4  
Old 12-07-2011
jaimin's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 264
Threads: 15
Thanked 98 Times in 56 Posts
Reputation: 108
Default

C. Sentinel lymph node biopsy
Reply With Quote Quick reply to this message
  #5  
Old 12-08-2011
bassatom's Avatar
USMLE Forums Veteran
 
Steps History: Step 1 Only
Posts: 260
Threads: 28
Thanked 156 Times in 54 Posts
Reputation: 166
Send a message via Skype™ to bassatom
Default

C. Sentinel lymph node biopsy
Reply With Quote Quick reply to this message
  #6  
Old 12-08-2011
drnrpatel's Avatar
Guest
 
Steps History: 1+CK+CS
Posts: 441
Threads: 153
Thanked 394 Times in 211 Posts
Reputation: 417
Default

The correct answer is C. This patient has malignant melanoma. Even with melanomas that appear localized to the epidermis (melanoma in situ), available data suggests that 1-3% of these melanomas can eventuate in metastatic disease. This is most likely the result of rare neoplastic cells or nests present in the dermis at the time of diagnosis that are not detected with routine histopathologic evaluation. Current standard of care dictates that each patient diagnosed with a malignant melanoma 1 mm or greater in thickness should be offered sentinel lymph node biopsy. The value of this procedure for thin melanomas (<1 mm) is under debate. Sentinel lymph node biopsy with selective lymph node dissection has been developed as an alternative to elective lymphadenectomy or observation for patients with clinically negative regional lymph nodes who are at high risk for nodal metastasis.
Bone scintigraphy (choice A) is indicated in patients with bone pain or an elevated alkaline phosphatase level. It would be indicated if the sentinel lymph node biopsy confirms nodal involvement that implies metastatic disease.
Needle aspiration of the regional lymph node (choice B) is not used in the diagnostic and staging workup of melanoma because of low yield of positive results.
Radical lymph node dissection (choice D) is a procedure with high morbidity and no longer is performed in patients with melanoma in the absence of palpable lymph nodes.
Total body magnetic resonance imaging (choice E) may be done in patients with suspected or proven metastatic disease. In this case, a sentinel lymph node biopsy is the next appropriate step in management.
Reply With Quote Quick reply to this message



Reply

Tags
Dermatology-, Step-2-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Lymphatic spread from testicular cancer! INCOGNITO USMLE Step 1 Forum 11 07-23-2014 11:06 AM
Proliferation of atypical well differentiated keratinocytes drnrpatel USMLE Step 2 CK Forum 6 12-08-2011 10:07 PM
dermal infiltrates of atypical CD4+ T cells with cerebriform nuclei m82_ghasemi USMLE Step 1 Forum 5 10-03-2011 02:24 PM
cells that arise from arachnoid cells ricko335 USMLE Step 1 Forum 6 09-13-2011 08:11 AM
Cancers that spread Hematogenously jackat1000 USMLE Step 1 Mnemonics 0 02-18-2010 09:35 AM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)