Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

FITZPATRICK'S DERMATOLOGY 9TH EDITION (SHAMMY) > 20 - 116: MELANOMA > Flashcards

20 - 116: MELANOMA Flashcards

You may prefer our related Brainscape-certified flashcards:
Dermatology Board Prep flashcards
1
Q

This melanoma subtype is most commonly arise from a slowly changing preexisting nevi. Arises commonly on intermittently sunexposed skin: the lower extremities in women and upper back in men

A

Superficial Spreading Melanoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

This melanoma begins de novo on the trunk with rapid evolution, 5% are amelanotic, with highest association with BRAF gene mutation.

A

Nodular Melanoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

This melanoma is most commonly seen in the 7 thto 8 th decades, on sun exposed face, cheeks & nose, with history of cumulative sun exposure. With a prolong radial growth phase then invades. More frequently associated with c-kit aberrations.

A

Lentigo Maligna Melanoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Most common site for acral lentiginous melanoma

A

Sole>Palm&Subungal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Suspicion of malignancy in pigmented nail lesions include the following except.

a. Pigmentation extending to the periungual skin
b. Pigmentation is isolated on a single digit
c. Occurrence in 2 nd to 3 rd decade of life
d. Pigmentation occurring after a history of trauma after ruling out subungual hematoma

A

Answer: C. 4th -6th decade table 116-1 p 1986

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

This immunostain has high specificity for melanoma cells

a. S100 and Sox-10
b. HMB-45
c. Melan-A
d. MiTF

A

Answer: B. p 1994

  • S100 and Sox 10 are expressed in all melanomas but also in melanocytic nevi
  • HMB 45 is a monoclonal antibody with high specificity for melanoma cells
  • Melan A is expressed in both benign and malignant lesions. More sensitive than HMB 45, more specific than S 100

So yung ranking: Top 1. HMB-45 2. Melan-A 3. S100

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Useful marker for amelanotic melanoma since this stains the nucleus, whereas all other markers are mainly intracytoplasmic

A

MiTF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Correct arrangement visceral sites of melanoma metastasis

A

Lung > liver > brain > bone > GI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

This is the single most important prognostic factor for survival and clinical management on localized stage I and II cutaneous melanoma

A

Breslow thickness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Stage of melanoma where the patient has microscopic nodal disease to bulky clinical nodes or in transit metastasis

A

III

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the standard of therapy for primary cutaneous melanoma?

A

Wide local excision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Surgical margins for melanoma 1 to 2 mm thickness

A

1-cm – 2-cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Stage 4 systemic treatment for melanoma

a. Immune checkpoint blocker
b. Targeted therapy
c. Low-dose interferon for high risk primary
d. A and B
e. All

A

d. A and B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

A powerful staging tool that identifies micrometastatic nodal disease.

A

SLNB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

In management of satellite or in-transit metastases, it is an effective and tolerable treatment option for patients with in-transit metastases but needs special technical equipment.

A

Electrochemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Most common subtype of melanoma

A

Superficial spreading melanoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

subtype of melanoma most commonly associated with preexisting nevi

A

Superficial spreading melanoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

second most common melanoma subtype and accounts for approximately 15% to 30% of all melanomas

A

NODULAR MELANOMA NM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Most common site of nodular melanoma

A

Trunk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

It is more common to begin de novo than to arise in a preexisting nevus

A

nodular melanoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

SSM is diagnosed most commonly on intermittently sunexposed areas, most frequently the _____ of women, and the _______ of men.

A

lower extremity - women

upper back - men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

This type of melanoma most commonly begin de novo than to arise in a preexisting nevus

A

Nodular melanoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What types of melanoma have the highest rate of mutations in the BRAF gene?

A

SSM, NM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

is a melanoma in situ with a prolonged radial growth phase

A

Lentigo Maligna

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

LM is a melanoma in situ with a prolonged radial growth phase that eventually becomes invasive and is then called ________

A

LENTIGO MALIGNA MELANOMA (LMM)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Age group where LM and LMM are commonly found

A

7th to 8th decades
Uncommon before age 40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Most common location of LM and LMM

A

chronically sun-exposed face, on the **cheeks and nose **in particular; the neck, scalp, and ears in men.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

sun exposure history of LM and LMM

A

cumulative sun exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

are associated with significantly higher rates of extensive subclinical lateral growth, resulting in higher recurrence rates with standard recommended margins and failure to completely excise the lesion

A

LM and LMM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

these types of melanoma have the least common association with nevi, at 3% of cases

A

LM and LMM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

These types of melanoma have the highest rate of association with desmoplastic melanoma

A

LM and LMM

32
Q

represents the most common form of melanoma in darker-pigmented individuals

A

ACRAL LENTIGINOUS MELANOMA ALM

33
Q

most common site for ALM

A

sole, with the palm and subungual locations following

34
Q

This type of melanoma is not thought to be associated with sun exposure.

A

ACRAL LENTIGINOUS MELANOMA (ALM)

35
Q

Subungual melanoma, considered a variant of ALM, generally arises from what part of the nail?

A

Nail matrix, most commonly on the great toe or thumb

36
Q

finding of pigmentation on the proximal nail fold

A

Hutchinson sign

may be noted with subungual melanoma

37
Q

In acral melanoma, the most frequent targetable mutation is

A

BRAF Mutation

38
Q

When will you consider Malignancy in Pigmented Nail Lesions?

A
39
Q

associated with higher local recurrence but lower nodal metastatic rates than other subtypes of melanoma

A

DESMOPLASTIC MELANOMA (DM)

40
Q

In desmoplastic melanoma, BRAF and NRAS mutations are not found; instead, other genetic alteration known to activate the MAPK signaling cascade were identified, for example, mutations in ____________ in more than 90% of cases.

A

neurofibromin (NF1)

41
Q

most frequent location for mucosal melanoma

A

nasal cavity

42
Q

this type of melanoma describes a heterogeneous group of rare lesions that histologically resemble benign nevi by their symmetry and apparent maturation with descent in the dermis, thus with greater potential for misdiagnosis

A

NEVOID MELANOMA

43
Q

subtype of melanoma that clinically and histologically resembles a Spitz nevus, but tends to be larger and have asymmetry and irregular coloration.

A

SPITZOID MELANOMA

44
Q

Uveal melanomas account for about 5% of all melanomas and develop mainly where?

A

choroid, followed by ciliary body and iris of the eye

45
Q

most common primary intraocular malignancy.

A

UVEAL MELANOMAS

46
Q

T/f. Vitiligo in association with melanoma has a worse prognosis.

A

False

The development of a melanoma-associated vitiligo as an accompanying autoimmune disease against melanocytes is reported to occur in up to 4% of patients and is associated with a better prognosis.

p1989

46
Q

best measures to estimate melanoma risk

A

Risk prediction models reveal in detail that the number of nevi, presence of freckles, history of sunburn, hair color, and skin color are the best measures to estimate melanoma risk

46
Q

Most common sites of melanoma in younger men and women

A

Men - trunk and upper back
Women - Lower legs and trunk

47
Q

most common location for melanoma in older persons

A

face

with the addition of the neck, scalp, and ears as well, in older men

48
Q

phenotypic features associated with an increased risk of melanoma of 2- to 3-fold

A

Light skin pigmentation, blond or red hair, blue or green eyes, prominent freckling tendency, and tendency to sunburn with Fitzpatrick skin phototype I–II

49
Q

There is an increased risk of melanoma associated with nevi, both in a quantitative (ie, number of nevi) and qualitative (ie, typical vs atypical nevi) manner.

Adults with more than _________ clinically typical-appearing nevi, children with more than _________ typical-appearing nevi, and any patient with atypical nevi are at risk.

A

Adults: > 100 nevi
Chihldren: > 50 nevi

50
Q

large congenital nevi is defined in most studies as greater than how many cm in diameter?

A

> 20 cm

51
Q

enumerate the ABCDE checklist of melanoma

A

A stands for asymmetry (one half is not identical to the other half),
B for border (irregular, notched, scalloped, ragged, or poorly defined borders as opposed to smooth and straight edges),
C for color (having varying shades from one area to another),
D for diameter (ie, greater than 5 mm), and
E for evolution (changes in the lesion over time).

52
Q

dermoscopic findigs of melanoma

A
53
Q

Immunohistochemical stains expressed by almost all melanomas but also by melanocytic nevi, and other tumor types, including cutaneous neural tumors

A

S100 and Sox10 proteins

54
Q

monoclonal antibody with high specificity for melanoma cells

A

HMB-45

55
Q

may be useful, especially in amelanotic melanomas, as it is a marker in the nucleus, whereas all other markers are mainly intracytoplasmic.

A

microphthalmiaassociated transcription factor (MiTF)

56
Q

Immunohistochemically, Desmoplastic Melanomas commonly express only __________________ and lack other melanocytic markers like HMB-45, Melan-A, and MiTF.

A

Desmoplastic Melanoma

(+) S100 and Sox10
(-) HMB-45, Melan-A, and MiTF

57
Q

this marker for melanoma is a bit more specific than LDH but lacks sensitivity

A

Serum S100B

58
Q

far more sensitive and accurate at detecting microscopic metastases than PET scan, CT scans, or ultrasonographic imaging combined with lymph node fine-needle aspiration

A

SENTINEL LYMPH NODE BIOPSY (SLNB)

59
Q

Based on this risk stratification, SLNB is recommended in patients with a melanoma ≥____ mm Breslow thickness.

A

1 mm

60
Q
A
61
Q

The visceral sites of metastasis of melanoma from most to least common.

A

lungs (18%-36%),
liver (14%-20%),
brain (12%-20%),
bone (11%-17%), and
GI tract (1%-7%)

LuLiBraBoG

62
Q

defined as the presence of histologically confirmed melanoma in a lymph node, visceral site, or distant skin/subcutaneous tissues without a history or evidence of a primary cutaneous, mucosal, or ocular melanom

A

Metastatic melanoma of unknown primary (MUP)

63
Q

The single most important prognostic factor for survival and clinical management in localized stage I and II cutaneous melanoma

A

tumor thickness

64
Q
A
65
Q

second most powerful predictor of survival, after tumor thickness

A

mitotic rate of 1/mm2 or greater

66
Q

most powerful prognostic factor for survival in melanoma

A

status of the regional lymph nodes,

with regional lymph node metastasis portending a worse prognosis.

67
Q

most significant prognostic factor with respect to disease-free and disease-specific survival.

A

SLN status

68
Q

standard of therapy for primary cutaneous melanoma

A

wide local excision (WLE)

69
Q

For melanoma in situ, what are the margins of excision?

A

0.5 - 1 cm

70
Q

For melanoma with <1 mm Breslow depth, what is the margin of excision.

A

1 cm

71
Q

For melanoma with 1 - 2 mm Breslow depth, what is the margin of excision.

A

1 - 2 cm

72
Q

For melanoma with >2 mm Breslow depth, what is the margin of excision.

A

2 cm

73
Q

For patients with stage III disease in the USA, treatment with this anti-CTLA-4 antibody is FDA approved.

A

Ipilimumab

74
Q

only FDA-approved chemotherapy for metastatic melanoma

A

dacarbazine (DTIC)

FITZPATRICK'S DERMATOLOGY 9TH EDITION (SHAMMY) (122 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions