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Flashcards in Melanoma Deck (8)
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Common somatic mutations in melanoma?

BRAF (50-60% of tumors), NRAS (15-20% of tumors). These confer poorer prognosis. Other genes: cKIT (acral, mucosal, lentigo maligna melanoma), GNAQ/GNA11 (uveal)


Risk factors for melanoma?

Dysplastic nevi, numerous benign nevi, fam history of melanoma, and fair skin that burns.


Common genes that are implicated in hereditary melanoma?

p16/CDKN2A and, much rarer, CDK4. Pancreatic cancer can also be seen in patients with CDKN2A mutations. BRCA2 carriers as well. BAP1 mutations (uveal melanoma)


Four subtypes of melanoma?

Superficial spreading, nodular, lentigo maligna, and acral lentiginous


Prognostic factors for melanoma?

Tumor thickness, mitotic rate, ulceration. Other poor prognostic factors are increased invasiveness (Clark level), lack of tumor-infiltrating lymphocytes, presence of microscopic satellites. Other factors: location, age, sex, regional nodes. One regional node: 40-50% risk of recurrence; multiple modes: 75% risk.


Treatment of melanoma?

Surgical excision. For tumor >= 1 mm thick or with ulceration or high mitotic count or Clark level IV or V, perform sentinel lymph node dissection. If SLN neg and primary = 4 mm, consider adjuvant therapy.


Adjuvant therapy for high-risk melanoma?

High dose IFN alpha-2b, clinical trial, or observation. IFN improves relapse free survival but not OS. Other approaches include ipilimumab and chemo/IL-2 in clinical trials.


Surveillance strategy for melanoma?

No clear guidelines. For stage one and stage two, regular physical exam and annual skin exam. Chest x-ray and LDH optional. CT or PET can be considered.