figure 4.5. Punch biopsy of large cutaneous lesions. (A) Schematic view demonstrating that all layers of the skin can be sampled using this technique. (B) Different size punch biopsy tools that can be used. (A: From Arca MJ, Biermann JS, Johnson TM, et al.,32 by permission of

Surgical Oncology Clinics of North America.)

figure 4.6. Schematic diagram illustrating the lymphatic drainage of the breast and sentinel lymph nodes.

TABLE 4.3. Potential indications for prophylactic organ removal.

Prophylactic surgery

Potential indications

Bilateral mastectomy (patients with no history of cancer)

Bilateral mastectomy (patients with unilateral breast cancer)

Bilateral oophorectomy in patients with no history of cancer

Bilateral oophorectomy in addition to other abdominal cancer surgeries (postmenopausal women) Thyroidectomy

Total proctocolectomy

BRCA1 or BRCA2 mutation

Atypical hyperplasia or lobular carcinoma in situ (LCIS) Familial breast cancer

BRCA1 or BRCA2 mutation

Familial breast cancer or age of diagnosis less than 40 years

History of atypical hyperplasia or LCIS followed by unilateral breast CA Difficult to evaluate contralateral breast

BRCA1 mutation

Familial ovarian cancer

Hereditary nonpolyposis colorectal cancer

Hysterectomy for endometrial cancer Colon resection for colon cancer

RET proto-oncogene mutation Multiple endocrine neoplasia type 2A (MEN 2A) Multiple endocrine neoplasia type 2B (MEN 2B) Familial non-MEN medullary thyroid carcinoma (FMTC)

Familial adenomatous polyposis (FAP) or APC

mutation Ulcerative colitis

Hereditary nonpolyposis colorectal carcinoma (HNPCC) germ-line mutation

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