Lec 8: Skin Cancer Flashcards
Types of Skin Cancer
Melanoma Risk Factors
- Male sex
- Age > 50
- Family or personal history of prior melanoma
- Skin type (fair skin) - Melanin protects your skin, fair skin lacks melanin protection
- Multiple clinically atypical moles or dysplastic nevi (moles)
- Environmental –> Excessive sun exposure, UV based artificial tanning, residing near the equator
Nonpharm Prevention Strategies (Melanoma)
Goal is to minimize UV radiation exposure
- Avoid sun exposure between 10AM – 4PM
- Clothing protection
- Avoid tanning beds and sun lamps
- Broad spectrum sunscreen with minimum Sun Protection Factor (SPF) 15 -optimal use is 1 oz sunscreen (one palmful/shot glass) with reapplication every 2 hours, May need more frequent application if swimming or sweating
Screening Using ABCDE: Approximately 50% of melanomas
evolve from pre-existing nevi
Key Histological Subtypes (how melanoma grow)
Melanoma Treatment Modalities Based on different Stages - discuss general therapy options
So basically: for stage 1 and 2? just do surgery. For Stage 3 and 4? Surgery with sys tx and radiation…LOCAL TX is mainly for Stage 3!
Melanoma: Local Therapy: Talimogene
Laherparepvec (T-VEC)
Systemic Therapy: Adjuvant (Stage 3) Therapy - focus on first line stuff
Systemic Therapy: Metastatic (Stage 4)
AB is a 67-year male with stage III melanoma s/p wide excision and sentinel lymph node biopsy. Patient does not have a BRAF mutation. Which of the following adjuvant systemic
therapy is appropriate?
A. Dabrafenib + Trametinib
B. T-VEC
C. Pembrolizumab
D. Nivolumab + Ipilimumab
C. Pembro is the correct answer
.
First line for systemic adj tx is mono Nivo, mono Pembro, or if they have a BRAF 600 mutation = Debra+Tram combo
.
A is incorrect because they do not have BRAF mutation
B is incorrect because T-VEC is NOT first line
D is incorrect because that is for metastatic (Stage 4)
CLARIFY MQ is a 67-year male with newly diagnosed metastatic melanoma with CNS involvement and BRAF V600E mutation. He desires aggressive treatment. Which of the following is the
preferred first-line therapy per NCCN guidelines?
A. Dabrafenib + Trametinib
B. T-VEC
C. Pembrolizumab
D. Nivolumab + Ipilimumab
D. Nivolumab + Ipilimumab is the correct answer
.
A. is incorrect ! even tho they have the mutation, FIRST LINE IS ALWAYS IMMUNOTHERAPY regardless of BRAF mutation status
Inhibition of BRAF and MEK : why is it important to use the combination?
Combination is recommended as BRAF monotherapy can lead to resistance after 6-7 months ! so it’s better to just use the combination upfront! Even tho BRAF is upstream of MEK, MEK can be increased in resistance to drug!
BRAF and MEK Inhibitors combination options?
BRAF inhibitors Side Effects
-Pyrexia (fever)
- Rash
- Photosensitivity
- Alopecia
- Joint pain
- GI toxicity
MEK inhibitors Side Effects
- Rash
- Diarrhea
- Edema
- Cardiomyopathy
Pyrexia Management
Immune Related Adverse Effects (IRAE) of Immunotherapy
-Higher risk of IRAE with Anti-PD-1 + Ipilimumab than
Single PD-1 therapy
- Most common IRAE are listed, but all organs can be affected
Immunotherapy IRAE Management
Subsequent Therapy of Melanoma ..what to do if patient progresses on first line regimen?
Note: if patient was previously on immuno therapy for metastatic? we will now use BRAF+MEK combo!
Subsequent Therapy of Melanoma: Additional Targeted Therapy
Subsequent Therapy of Melanoma: Aldesleukin (IL-2)
Skin Cancer: Non Melanoma Classifications and Overview
-Basal Cell Carcinoma (BCC)
-Cutaneous Squamous Cell Cancer (cSCC)
-Merkel Cell Carcinoma (MCC)
Non Melanoma: Treatment Overview for the 3 different types of non melanoma
Non Melanoma: Hedgehog Inhibitors -> MOA, place in therapy, SE
