An excisional biopsy is performed and the diagnosis of superficial spreading melanoma is confirmed. The lesion is 1.1 mm thick. Which of the following is the most appropriate next step in management?
ASurgical excision with 0.5-1 cm safety margins only
BSurgical excision with 1 cm safety margins only
CSurgical excision with 1-2 cm safety margins only
DSurgical excision with 0.5-1 cm safety margins and sentinel lymph node study
ESurgical excision with 1-2 cm safety margins and sentinel lymph node study
A 58-year-old man presents with lower back pain that started a couple of weeks ago and is gradually increasing in severity. At present, he rates the intensity of the pain as 6/10. There is no radiation or associated paresthesias. There is no history of trauma. Past medical history is significant for aggressive squamous cell carcinoma of the right lung status post surgical resection followed by adjunct chemotherapy and radiation therapy that was completed 6 months ago. A technetium bone scan reveals metastatic lesions in the lumbar vertebrae at levels L2–L4. The physician explains to the patient that these are likely metastatic lesions from his primary lung cancer. Which of the following best describes the mechanism that most likely led to the development of these metastatic lesions?
ATranscoelomic
BLymphatic spread
CCollagenase produced by cancer cells dissolves the basement membrane and aids in cellular invasion
DHematogenous spread
EPTH (parathormone)-related protein production by tumor cells
A 52-year-old man with stage IV melanoma comes to the physician with his wife for a routine follow-up examination. He was recently diagnosed with new bone and brain metastases despite receiving aggressive chemotherapy but has not disclosed this to his wife. He has given verbal consent to discuss his prognosis with his wife and asks the doctor to inform her of his condition because he does not wish to do so himself. She is tearful and has many questions about his condition. Which of the following would be the most appropriate statement by the physician to begin the interview with the patient's wife?
AHave you discussed a living will or goals of care together?
BWe should talk about how we can manage his symptoms with additional chemotherapy.
CWhy do you think your husband has not discussed his medical condition with you?
DWhat is your understanding of your husband's current condition?
EYour husband has end-stage cancer, and his prognosis is poor.
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