Melanoma Flashcards

1
Q

Risk factors associated with melanoma

A
Age greater than 15 
  Median age 61
History of cutaneous melanoma
Dysplastic nevi
High density of common nevi and atypical nevi Cutaneous melanoma in 1st degree relative Immunodeficiency or immunosuppression
High degree of freckling
Sunburns easily or tans rarely
Blonde or red hair
Blue, green, or gray eyes
Socioeconomic status (higher > lower)
Race (Caucasians > Hispanics > African Americans
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2
Q

Pathogenesis of melanoma

A

Most often arise from epidermal melanocytes of the skin
-Can also arise from noncutaneous melanocytes

In adults, most melanocytes are located at the epidermal-dermal junction of the skin and the choroid of the eye
-May also be found in tissue such as meninges, the alimentary (GI) tract, and respiratory tracts

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3
Q

Common clinical features of melanoma

A

Any lesion that changes appearance over time

A-asymmetry
B-border (irregular borders)
C-color (often variegated ranging from tan, blue-black, red, purple, or white)
D- diameter (frequently larger than 6mm)
E- enlargement/evolution (sudden change)

Other: a lesion that swells, bleeds, or oozes

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4
Q

External risk factors for melanoma

A

Intense intermittent sun exposures
History of sunburn
More than four painful sunburns before age 15 years
Recreational sun exposure

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5
Q

Other risk factors for melanoma

A

Maternal-fetal transfer
-Most likely cancer to metastasize to the placenta and fetus during pregnancy

Genetics

  • Dysplastic nevus syndrome (DNS)
    • 8-10% of cases of melanoma are associated with DNS
    • 400-1000X increased risk than general population
  • BRAF (V600E) somatic mutations
    • Occurs in 25%-75% of melanoma patients
    • Link between UV radiation and melanoma
    • Common in melanomas arising from skin with intermittent sun exposure
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6
Q

____ makes up 90% of all melanomas

A

Cutaneous melanoma

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7
Q

Development of melanoma (progression)

A

-Melanocytic Atypia

  • Atypical melanocytic Hyperplasia
  • Radial Growth Phase (early stage of melanoma when the tumor is thin and primarily intraepidermal in location)
  • Primary Melanoma
  • Lymph-Node Metastatic Melanoma
  • Distant Metastatic Melanoma
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8
Q

___ are involved in the progression more often than in most other solid tumors

A

Immune factors

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9
Q

Melanoma cells can proliferate without ___

A

Growth factors

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10
Q

___, although rare, are a well documented phenomenon seen in melanoma.

Associated with…

A

Spontaneous cancer regressions

Host immunity

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11
Q

Stage:

Melanoma in situ

A

Stage 0

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12
Q

Stage:

Melanoma with clinically positive nodes, microscopic satellitosis, and/or in-transit disease

A

Stage III

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13
Q

Stage:

Melanoma with distant metastatic disease

A

Stage IV

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14
Q

Tx for Stage 0-II melanoma

A

SLNB (-) or NA for Stage 0:

  1. Clinical Trial
  2. Observation
  3. Interferon alpha
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15
Q

Drugs that are only indicated if pt has a BRAF (V600) mutation

A

“nib”
dabrafenib
vemurafenib
trametinib

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16
Q

Preferred meds for advanced/meta melanoma

A
Ipilimumab
Dabrafenib+trametinib*
Dabrafenib*
Vemurafenib*
* indicates BRAF (v600) mutation
17
Q

Examples of Immunotherapy in melanoma

A

Interferon

Interleukin-2

18
Q

High dose interferon (HDI)

A

Used in pts with high risk dz

-not stage 4

19
Q

IFN-alpha ADEs

A

fever
chills
psych/behavioral

20
Q

CTLA-4 targeted tx drug

A

Ipilumumab
increased upregulation of T-cells
1st drug to show survival benefit***

21
Q

Ipilumumab ADEs

A

Skin Rash

Colitis