Surgical management decisions for common solid tumor resections and margin concepts tested on USMLE Step 2 CK.
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- What excision margin is recommended for melanoma in situ?
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0.5 to 1 cm- What excision margin is recommended for a melanoma with Breslow thickness of 1 mm or less?
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1 cm- What excision margin is recommended for a melanoma with Breslow thickness between 1.01 mm and 2 mm?
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1 to 2 cm- What excision margin is recommended for a melanoma thicker than 2 mm?
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2 cm- At what Breslow thickness is sentinel lymph node biopsy generally considered for melanoma?
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1 mm or greater (or thinner with ulceration or a high mitotic rate)- In breast conserving surgery for invasive cancer, an adequate margin is defined as ____.
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no ink on tumor- What is the standard next step when a lumpectomy specimen shows a positive margin?
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Re-excision to obtain a clear margin- What is the standard surgical treatment for ductal carcinoma in situ (DCIS)?
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Lumpectomy with radiation, or mastectomy for extensive disease- In breast cancer surgery, when is sentinel lymph node biopsy used instead of full axillary lymph node dissection?
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When the axilla is clinically node negative before surgery- What is the primary indication for a Whipple procedure (pancreaticoduodenectomy)?
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Resectable adenocarcinoma of the head of the pancreas- Which structures are removed en bloc in a classic Whipple procedure?
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Head of pancreas, duodenum, distal common bile duct, gallbladder, and gastric antrum- What is the surgical procedure of choice for a resectable tumor of the pancreatic body or tail?
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Distal pancreatectomy, often with splenectomy- What imaging finding generally makes a pancreatic head tumor unresectable?
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Encasement of the superior mesenteric artery (greater than 180 degrees of contact)- What margin of grossly normal bowel is generally required on each side of a colon cancer resection?
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At least 5 cm- What is the minimum number of lymph nodes that should be examined for adequate staging after colon cancer resection?
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12 lymph nodes
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