A 29-year-old woman had a 2.5-mm Breslow thickness melanoma removed from her right shin. She was referred for wide local excision of the scar and consideration of sentinel node biopsy. In what proportion of patients with a negative sentinel node biopsy does nodal recurrence subsequently develop in the same lymph node basin?

Related MCQs

• A 42-year-old woman is evaluated because she has noticed a thickening in her left breast over the past few weeks. She noticed it a few months ago, but because it seems to come and go, she put off seeking medical attention. She is premenopausal. She had menarche at age 13 years. When she was 35 years, she had one child (whom she breast-fed) after a normal first full-term pregnancy. She took oral contraceptives for 10 years before her pregnancy. She has no known radiation exposure and no family history of breast cancer. On physical examination, there appears to be some asymmetry in breast tissue density in the upper outer quadrant of the left breast compared with the right one, but no discrete mass. There are no palpable lymph nodes. Results of a mammogram are negative. What would be the most appropriate next step in this patients management?
• A 50-year-old menstruating woman has a 1 .5-cm moderately differentiated breast cancer. The lesion is completely excised, and the margins of the excision are negative. Axillary node sampling shows that she has three positive nodes. The tumor is negative for estrogen and progesterone receptors and is highly positive for HER2. She is otherwise healthy. Her mother had breast cancer at 62 years and was treated by mastectomy; she is alive and healthy at the age of 80 years. The patients sister had breast cancer at 54 years and was treated by breast conservation therapy; 4 years later she died of a recurrence of breast cancer. The patient has seen two different surgeons with opposing viewpoints regarding the best treatment, and she has been reading extensively on the Internet and has become confused about her options. Which of the following represents the best treatment for this patient?
• A 44-year-old woman has a lumpectomy and radiation therapy for stage II breast cancer. She receives 6 months of chemotherapy. Her periods cease while she is receiving chemotherapy, and she remains amenorrheic. Her tumor was found to be rich in estrogen receptor, and she is taking tamoxifen. Her hair is growing back and her energy is returning, but she is having severe hot flushes that keep her awake at night. She is so tired during the day that she is unable to perform her job in a satisfactory manner. She also relates that she and her husband have been unable to have satisfying sexual relations because intercourse is painful for her. What would be the most appropriate treatment for this patient?
• A 64-year-old woman has the following family history: One sister, who was a smoker, had lung cancer at the age of 63 years; another sister had breast cancer at the age of 70 years. Her father had prostate cancer at 82 years of age, and her mother had breast cancer at age 71 years. She has three other sisters, now aged 58, 60, and 65 years who have no history of cancer. She has two daughters and two sons between the ages of 25 and 39 years, who have no history of cancer. Her ancestry is European in general, and she is not of known Ashkenazi Jewish descent. She is concerned that “cancer runs in the family” and would like to have one of those “gene tests” she has read about. What is the best advice to give her and her family?
• A 32-year-old woman is evaluated because of a painless swelling in her lower neck. She noted the swelling about 3 weeks ago and now thinks it is getting larger. She has no history of foreign travel. She smokes but does not drink alcohol. She owns a cat. She has not had fever or unexplained weight loss, but has had night sweats twice in the past week. She has been feeling fatigued lately and has noted dyspnea on exertion. On physical examination, a 3 X 5-cm left supraclavicular lymph node is palpable. It is firm but not rock-hard and is nontender. The remainder of her physical examination and results of a complete blood count are normal. What is the best next step in this patient‟s management?
• A 74-year-old woman presents for an urgent office visit. She has been experiencing epigastric discomfort over the last 3 months. Discomfort is worse during meals and prevents her from eating full portions. She has lost 5.4 kg (12 Ib). She also reports dyspnea on exertion. She has been taking ramipril, aspirin, and simvastatin. On physical examination, her pulse rate is 88/min, and her blood pressure is 155/85 mm Hg. There is mild epigastric tenderness with palpation. Her spleen is massively enlarged and palpable at the umbilicus. The edge of her liver is also palpable 6 cm below the costal margin. Her hemoglobin is 7.5 g/dL, mean corpuscular volume 89 fL, leukocyte count 11,200/μL, and platelet count 114,000/μL. Peripheral blood smear shows numerous erythroblasts, myeloid precursors, and teardrop cells. Bone marrow cannot be aspirated, and biopsy specimen shows marked fibrosis. Analysis of blood is negative for t(9;22) by fluorescent in situ hybridization (FISH). What is the most l
• A 45-year-old woman has recently undergone lumpectomy and radiation therapy for a stage II breast cancer. She received chemotherapy for 6 months. Her periods ceased while she was receiving chemotherapy, and she remains amenorrheic. Her tumor was rich in estrogen receptor, and she is taking tamoxifen. Her hair is growing back, her energy is returning, and she has no specific complaints, but she is worried about recurrence. In addition to routine follow-up, what is the most appropriate management of this patient?
• A 45-year-old woman is evaluated because of a palpable 2-cm right axillary lymph node. The lymph node is completely resected, and histologic study shows adenocarcinoma; hormone receptors are negative. Bilateral mammography is negative, as is MRI of the right breast. CT scans of the chest and abdomen are negative for tumor, and no further lymphadenopathy is detected. Results of bone scan and MRI of the head are also unremarkable. The patient had been previously healthy and has never smoked. Which of the following statements about this patients condition is correct?
• A 58-year-old postmenopausal woman has been taking hormone replacement therapy with combined estrogen and progestin for the past 4 years because she was told it would decrease her risk for heart disease. Her father died at age 65 years of heart disease, and she is concerned that she is also at risk. Recently, her sister has been diagnosed with breast cancer. Her mother died of breast cancer. Three years ago, the patient had a breast biopsy that showed atypical hyperplasia. She has not had a hysterectomy. The patient is considering chemoprevention for breast cancer, but is nonetheless concerned about heart disease. Her calculated risk of breast cancer is 10.4% over the next 5 years. Which of the following options is reasonable to consider for this patient?
• A 65-year-old woman has a modified radical mastectomy for a 1.0-cm, well-differentiated breast cancer. The tumor is positive for estrogen and progesterone receptors and negative for HER2. Sentinel node mapping and excision show that none of the three lymph nodes removed is positive for metastasis. She is otherwise healthy. What is the best treatment for this patient at this time?