SM_258a: Melanoma Flashcards Preview

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Flashcards in SM_258a: Melanoma Deck (22)
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1
Q

Describe risk factors for melanoma

A

Melanoma risk factors

  • Genetic: family history of dysplastic nevus, lightly pigmented skin, tendency to burn / inability to tan, red / blonde hair color, blue / green eyes, DNA repair defects
  • Environmental: exposure to UV light, intense intermittent sun exposure, sunburn, residency in equatorial lattitudes, tanning
  • Gene / environment interactions: melanocytic nevi (increased number., multiple dysplastic, congenital), freckles, personal history of melanoma
2
Q

___ sun exposure increases risk for melanoma more than ___ sun exposure

A

Intermittent sun exposure increases risk for melanoma more than constant sun exposure

3
Q

Melanocytes produce ____

A

Melanocytes produce melanin, which is the pigment found in skin, eyes, and hair

(melanoma is cancer arising from melanocytes)

4
Q

Describe the role of UV skin damage in causing DNA damage

A

Role of UV skin damage in causing DNA damage

  • Cyclobutane pyrimidine dimers
  • DNA damage occurs immediately upon exposure and cell repair begins afterward
  • Amount of melanin in skin plays an important role in UV absorption and photoprotection
  • 30% of melanomas develop within existing dysplastic devus
  • 70% of melanomas develop de novo: no precursor lesion
5
Q

Guideline of ____ is used for referral to a genetics specialist in melanoma

A

Guideline of 3s is used for referral to a genetics specialist in melanoma

  • Individual with 3 or more primary melanomas: 10-15% risk of P16 mutation
  • Patients with ≥ melanomas among first or second degree relatives (45% risk of P16 mutation)
  • Families w/ith presence of melanoma and/or pancreatic cancer in three family members (45% risk of P16 mutation)
6
Q

____ is most common type of melanoma, associated with ____, and involves ____ mutation

A

Superficial spreading melanoma is most common type of melanoma, associated with intermittent sun exposure, and involves BRAF mutation

(lentigo maligna melanoma is associated with chronically sun exposed skin and involves c-Kit and NRAS mutations)

7
Q

____ mnemonic is used to diagnose melanoma and stands for ____, ____, ____, ____, and ____

A

ABCDE mnemonic is used to diagnose melanoma and stands for asymmetry, border, color, diameter, and evolving

(general clinical exam, total body photography, dermoscopic exam)

8
Q

Dysplastic nevi are ____ and have ____ pigment deposition, ____ contour, and ____ margins

A

Dysplastic nevi are multicolored na dhave asymmetric pigment deposition, asymmetric contour (macular and papular), and distinct margins

(dysplastic nevus syndrome has risk of developing into melanoma)

9
Q

Management of the dysplastic nevi patient involves ____, ____, ____, and ____

A

Management of the dysplastic nevi patient involves close monitoring (full body exams every 6-12 months), dermoscopy of all atypical appearing nevi, whole body photos, and excision of any changing or markedly atypical nevi

10
Q

Describe the types of melanoma

A

Types of melanoma

  • Superificial spreading melanoma
  • Nodular melanoma
  • Lentigo malignant melanoma
  • Acral lentiginous melanoma
11
Q

Acral lentiginous melanoma has a higher incidence in ____ patients compared to other forms of melanoma and is associated with ____ prognosis because ____

A

Acral lentiginous melanoma has a higher incidence in dark skinned patients compared to other forms of melanoma and is associated with poorer prognosis because it is often not diagnosed

12
Q

Pink or red dot is ____ melanoma

A

Pink or red dot is amelanotic melanoma

13
Q

Describe workup / staging for melanoma

A

Melanoma workup / staging

  • Dermatopathology
  • Breslow thickness, Clark level
  • Sentinel lymph node biopsy
  • Following guidelines
  • BRAF mutation testing
  • Imaging: CXR, CT, MRI, PET/CT
14
Q

Do a sentinel lymph node biopsy for melanoma if Breslow thickness is ____

A

Do a sentinel lymph node biopsy for melanoma if Breslow thickness is greater than 0.8 mm

(stage IB and above)

15
Q

____ is the most important predictor of melanoma prognosis

A

Breslow level is the most important predictor of melanoma prognosis

(larger thickness associated with worse survival)

(radial growth phase is better than vertical growth phase, lymphatic / vascular invasion is poor prognosis, Clark level is not predictive of behavior of the melanoma, ulceration, mitotic rate, regression)

16
Q

___ presence is associated with poor survival

A

Tumor ulceration presence is associated with poor survival

(presence of ulceration upstages the tumor grade from an A to B stage)

17
Q

____ is most important pathologic assessment in addition to ulceration in predicting tumor aggression and involvement of lymph node

A

Mitotic rate is most important pathologic assessment in addition to ulceration in predicting tumor aggression and involvement of lymph node

(most predictive of lymph node involvement in tumors with 0.5 - 1 mm Breslow thickness)

18
Q

Describe treatments for melanoma

A

Melanoma treatments

  • Surgery: Breslow depth tells you what excision margins should be used
  • Targeted therapy
  • Immunotherapy
  • Biochemotherapy
  • Radiation therapy
  • Intralesional therapy
19
Q

Describe stage III melanoma workup and therapy

A

Stage III melanoma workup and therapy

  • Workup: baseline imaging for staging - CT, PET/CT, brain MRI
  • Treatment: primary (wide excision of primary tumor, no longer routinely recommended), adjuvant
  • Adjuvant therapy if BRAF wild-type or unknown: nivolumab / pembrolizumab
  • Adjuvant therapy if + BRAF V600 mutation: nivolumab / pembrolizumab
20
Q

Describe stage IV melanoma treatment

A

Stage IV melanoma treatment

  • Talimogene laherparepvec: oncolytic virus based on modified HSV1 that was designed to selectively replicate in and lyse tumor cells while promoting regional and systemic antitumor immunity, insertion gene for GM-CSF
  • Anti PD-1 monotherapy: pembrolizumab, nivolumab
  • Targeted therapy if BRAF mutated
21
Q

Broad spectrum sunscreen covers ____ sun rays

A

Broad spectrum sunscreen covers UVA and UVB sun rays

22
Q

___ is responsible for most skin cancer deaths

A

Melanoma is responsible for most skin cancer deaths

(despite only comprising 5% of skin cancers)

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