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A - MSRA Cancer Care [1] > [6] Malignant Melanoma > Flashcards

[6] Malignant Melanoma Flashcards

1
Q

What is a malignant melanoma?

A

Cancerous growth of melanocytes

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2
Q

Where do malignant melanomas arise from?

A

The vast majority arise from skin, but malignant melanomas have been described in nearly every organ of the body

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3
Q

Where are normal melanocytes found?

A

In the basal layer of the epidermis

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4
Q

Are more melanocytes found in black or white skin?

A

The same

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5
Q

How do melanocytes differ in black and white skin?

A

Melanocytes in black skin produce much more melanin

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6
Q

What do non-cancerous growths of melanocytes result in?

A

Moles and freckles

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7
Q

What mutation is associated with malignant melanoma?

A

BRAF mutations

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8
Q

What is BRAF?

A

A serine/threonine protein kinase activating the MAP kinase/ERK-signalling pathway

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9
Q

What % of melanomas have activating BRAF mutations?

A

50%

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10
Q

What has BRAF V600 been implicated in?

A

Different mechanisms underlying the development of melanomas

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11
Q

What are the types of malignant melanomas?

A
  • Superficial melanoma
  • Nodular melanoma
  • Lentigo maligna melanoma
  • Acral lentiginous malignant melanoma
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12
Q

What are the characteristics of superficial melanomas?

A

Large, flat, irregularly pigmented lesion which grows laterally before vertical invasion develops

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13
Q

What is the most invasive type of malignant melanoma?

A

Nodular

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14
Q

How do nodular melanomas present?

A

Rapidly growing pigmented nodule which bleeds or ulcerates

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15
Q

What is a lentigo maligna?

A

Melanoma in situ

It is not the same as a lentigo maligna melanoma

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16
Q

What is a lentigo maligna melanoma?

A

When a patch of lentigo maligna develops a papule or nodule, signally an invasive tumour

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17
Q

How does acral lentiginous malignant melanoma present?

A

Pigmented lesions on palm, sole, or under the nail

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18
Q

When does acral lentiginous malignant melanoma present?

A

Late

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19
Q

What are the risk factors for malignant melanoma?

A
  • Previous primary invasive melanoma
  • Naevi
  • Sun exposure
  • Pale Caucasian skin
  • Family history of melanoma
  • Past pesticide exposure
  • Higher socio-economic group
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20
Q

What % of people with malignant melanoma will develop a further lesion, or a different type of skin cancer?

A

3-5%

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21
Q

What kind of sun exposure in particular increases the risk of malignant melanoma?

A
  • Sharp, short bursts of acute exposure in childhood
  • Severe sunburn in childhood
  • Past sunbed use, especially before age 30
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22
Q

What features of pale skin indicate an increased risk of malignant melanoma?

A
  • Poor ability to tan

- Freckled complexion

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23
Q

What are the features of the appearance of malignant melanoma?

A
  • Asymmetrical
  • Irregular border
  • Irregular colour
  • Diameter greater than 7mm
  • Evolving
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24
Q

When should people be referred under the 2WW for malignant melanoma?

A

If they have a suspicious pigmented skin lesion with a weighted 7-point checklist score of 3 or more

25
How is a persons 7-point checklist score determined?
Major features score 2 points each, and minor features score 1 point each
26
What are the major features on the 7-point checklist score for malignant melanoma?
- Change in size - Irregular shape - Irregular colour
27
What are the minor features on the 7-point checklist score for malignant melanoma?
- Largest diameter 7mm or more - Inflammation - Oozing - Change in sensation
28
What are the primary investigations for malignant melanoma?
- Visual inspection | - Removal for histology where necessary
29
How is a diagnosis of malignant melanoma made?
Excisional biopsy
30
What further investigations may be done in malignant melanoma once a diagnosis is established?
- Sentinel lymph node biopsy - CXR and liver ultrasound, or CT scan of chest, abdomen, and pelvis - Blood tests - Bone scan
31
What blood tests should be done in the further investigation of malignant melanoma?
- FBC - LFTs - LDH
32
When should a bone scan be done in the further investigation of malignant melanoma?
If there is indication of bone disease
33
What can happen once melanoma cells have reached the dermis?
They may spread to other tissues via the lymphatic system
34
Where can melanoma cells spread via the lymphatic system?
- Local lymph nodes - Bloodstream - Other organs
35
Where can metastases from malignant melanoma occur?
Virtually anywhere, at any time
36
What are the most common sites for metastases of malignant melanoma?
- Lymph nodes - Liver - Lung - Bone - Brain
37
What are the management options in stage 0 malignant melanoma?
- Surgery | - Topical imiquimod
38
What should the margin be when excising stage 0 malignant melanoma?
At least 0.5cm
39
When should topical imiquimod be considered to treat stage 0 melanoma?
If surgery to remove the entire lesion with 0.5cm clinical margin would lead to unacceptable disfigurement or morbidity
40
What should you consider after treatment for stage 0 melanoma?
Repeat skin biopsy for assessment after treatment to check it has been effective
41
How is stage 1 melanoma managed?
Excision
42
What margin is required for excision of stage 1 melanoma?
At least 1cm
43
How is stage 2 melanoma managed?
Excision
44
What margin is required for excision of stage 2 melanoma?
At least 2cm
45
When should therapeutic lymph node dissection be offered in stage 3 melanoma?
In people with palpable 3b or 3c melanoma, or nodal disease detected by imaging
46
What is the first line option if palliative treatment for in-transit melanoma metastases is needed?
Palliative surgery
47
What are the options for the palliation of in-transmit melanoma mets if surgery is not feasible?
- Systemic therapy - Isolated limb infusiion - Isolated limb perfusion radiotherapy - Topical agent, e.g. imiquimod
48
What can be used in the palliation of superficial melanoma skin metastases?
Topical imiquimod
49
What can be used in the palliation of metastases in the skin form tumours of a non-skin origin?
Electrochemotherapy
50
What are the management options in stage 4 melanoma?
- Surgery or other ablative treatments | - Systemic anti-cancer treatments
51
What is the purpose of surgery in stage 4 melanoma?
To prevent and control symptoms
52
What systemic anti-cancer treatments can be used in melanoma?
- Targeted treatments - Immunotherapy - Cytotoxic chemotherapy
53
Give 2 targeted treatments for melanoma?
- Dabrafenib | - Vemurafenib
54
When are targeted treatments recommended for melanoma?
For treated unresectable or metastatic BRAF V600 mutation-positive melanoma
55
Give an immunotherapy for melanoma
Ipilimumab
56
When is immunotherapy recommended in melanoma?
For treating unresectable or metastatic melanoma in people who have received prior therapy
57
Give a cytotoxic chemotherapy for melanoma
Dacabazine
58
When is cytotoxic chemotherapy recommended in melanoma?
For stage IV metastatic melanoma if immunotherapy or targeted therapy is not suitable

A - MSRA Cancer Care [1] (47 decks)

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