Exam 2 - Melanoma Weddle Flashcards
melanocytes synthesize ________ to protect tissues from UV radiation induced damage
melanin
70% of melanoma cases; initally appears flat but subsequently becomes irregular and asymmetrical
a. superficial spreading melanoma
b. nodular melanoma
c. lentigo maligna melanoma
d. acral lentiginous melanoma
e. uvual melanoma
a. superficial spreading melanoma
15% melanoma cases; appears dark blue-black in color; appears on head, neck and trunk
a. superficial spreading melanoma
b. nodular melanoma
c. lentigo maligna melanoma
d. acral lentiginous melanoma
e. uvual melanoma
b. nodular melanoma
-presents on the face of elderly pts
-tan lesion with areas of brown and black
-low propensity to metastasize
a. superficial spreading melanoma
b. nodular melanoma
c. lentigo maligna melanoma
d. acral lentiginous melanoma
e. uvual melanoma
c. lentigo maligna melanoma
-frequently presents on the palms, soles, or under nail beds
-lesions often have irregular, convoluted borders
-more common in African-Americans, Asians, and Hispanics
a. superficial spreading melanoma
b. nodular melanoma
c. lentigo maligna melanoma
d. acral lentiginous melanoma
e. uvual melanoma
d. acral lentiginous melanoma
-arises from pigmented epithelium of the choroid
-most common ocular melanoma
-often metastasis in liver
a. superficial spreading melanoma
b. nodular melanoma
c. lentigo maligna melanoma
d. acral lentiginous melanoma
e. uveal melanoma
e. uveal melanoma
clinical presentation of melanoma acronym
ABCDE
-Asymmetric
-irregular Borders
-wide variety of Colors
-Diameter of > 6 mm
-Evolution of a mole
gold standard diagnostic work up of melanoma
biopsy of suspected lesion
purpose of a sentinel-node biopsy in melanoma diagnostics
determines if the melanoma has invaded lymph node beds
if a melanoma is a clinical or pathologic stage IV, the tumor tissue should be tested for what mutations?
BRAF V600E and K mutations
T or F: radiation is used in all melanoma pts
F (could be offered in adjuvant setting for select pts with positive lymph nodes and high risk of relapse)
look at melanoma tx overview (slide 20)
okay
the Checkmate 238 trial found that toxicities were higher with which adjuvant drug?
a. nivolumab
b. ipilimumab
b. ipilimumab
adjuvant dabrafenib/trametinib is used in which stage of melanoma?
a. IB or IIA
b. IIB or IIC
c. III
d. unresectable stage III with in-transit lesions
c. III
how long should adjuvant dabrafenib/trametinib be used in stage III melanoma pts?
a. one month
b. three months
c. six months
d. one year
e. for life
d. one year
SE of adjuvant dabrafenib/trametinib (3 of them)
-fever
-fatigue
-nausea
T or F: immunotherapy can take weeks to see effect
T
for metastatic melanoma, what are the 3 combination targeted therapy if BRAF V600 mutant is present?
-dabrafenib/trametinib
-vemurafenib/cobimetinib
-encorafenib/binimetinib
unique toxicity of vemurafenib
development of squamous cell carcinoma (up to 26%)
encorafenib and binimetinib have less occurrence of which common side effect?
less fevers
match these 6 drugs to its partner in combination therapy for BRAF V600 mutation:
vemurafenib
binimetinib
trametinib
encorafenib
dabrafenib
cobimetinib
dabrafenib/trametinib
vemurafenib/cobimetinib
encorafenib/binimetinib
BRAF resistance to single agent therapy typically occurs around ___-___ months
6-7 months (so combo therapy preferred)
two PD-1 inhibitors for melanoma (slide 39)
nivolumab, pembrolizumab
two CTLA-4 inhibitors for melanoma (slide 39)
ipilimumab, tremelimumab
two PD-L1 inhibitor drugs for melanoma (slide 39)
atezolizumab, durvalumab
T or F: all pts should receive all 4 doses of ipilimumab unless experiencing life threatening toxicities
T (typically the tumor might get worse initially, but will get better over time)
immunotherapy response is measured by what? (slide
immune related response criteria (irRC)
_____ and _____ toxicities are the most common with ipilimumab
skin; GI
which toxicities of ipilimumab take the LONGEST to reverse (and may not reverse)?
a. skin
b. GI
c. liver
d. endocrine
d. endocrine
T or F: chemo usually cures any pt in the metastatic setting, either single agent or combo therapy
F (rarely cures; response rate ~10%)
interleukin 2 role in melanoma (fallen out of favor)
stimulator of cytotoxic T cells, has activity against melanoma cells
drug associated with life threatening capillary leak syndrome
a. interferon alfa
b. interleukin 2
c. pembrolizumab
d. dabrafenib/trametinib
b. interleukin 2
what is another immunotherapy drug for melanoma that is not IL-2?
interferon alfa
melanoma screening: the American Academy of Dermatology recommends a self-exams to check for melanoma how often (not a high risk pt)?
a. weekly
b. biweekly
c. monthly
d. yearly
c. monthly
how often should high-risk pts be receiving a clinical exam for melanoma?
a. weekly
b. biweekly
c. monthly
d. yearly
d. yearly
T or F: pts with a strong family history of melanoma should have a clinical exam by a physician
T
melanoma prevention: what SPF sunscreen should be used?
15 or greater
which drug can be used in stage IIB or IIC melanoma pts?
a. nivolumab
b. dabrafenib/trametinib
c. pembrolizumab
d. pemetrexed
c. pembrolizumab
T-VEC, topical imiquimod and radiation can be used in this stage of melanoma tx
a. IB or IIA
b. IIB or IIC
c. III
d. unresectable stage III with in-transit lesions
d. unresectable stage III with in-transit lesions
