Malignant Melanoma Flashcards
Name some site extracutnaeous melanoma/amelanotic melanoma
Extra-cutaneous melanoma:. ((MLM, Amelanotic melanoma) melanocyte adjacent to
o Uveal tract-Choroid (most common); irish, conjunctiva, ciliary body
o Upper respiratory tract- common-nose and nasopharynx
o GIT- common- anus
o Genito-urinary tract- common- vagina.
o Leptomeninges.
Melanoma type
1.Superficial spreading melanomas
2. Nodular melanomas (NM)
3. Lentigo maligna melanomas
4. Acral lentiginous melanomas (ALM)
5. Mucosal lentiginous melanomas (MLM)/Desmoplastic
5 number +-
Most aggressive variety
Acral lentiguous melanoma
IHC for malignant melanoma
S-100
HMB-45
Melan A
Genetic changes seen in melanoma/ molecular change
Molecular- BRAF (40-50%), BRAF v600E-90%
➢ N-RAS
➢ KIT (C-KIT) in < 1%
➢ NTRK
➢ ALK, ROS-1
➢ CTLA-4
M staging for melanoma
Distant Metastasis (M)
M0 No detectable evidence of distant metastases
M1a Metastases to skin, subcutaneous, or distant LN
M1b Lung
M1c Other non-CNS site
M1d CNS
Also include LDH
Prognostic factors for melanoma
Primary melanoma:
Breslow thickness
Ulceration
Mitoses: indicates poor prognosis
RegionalLN involvement
Anatomic location: back, upper arm, neck,scalp worsenprognosis
Mucosal melanoma: difficult to cure
Mets: non visceral mets: better prognosis
Desmoplastic melanoma: favorable prognosis
Gender- improve survival
Risk factors for melanoma
familiar factor: CDKN2A gene, CDK4
family history of cut melanoma
environmental: tanning bed use, intermittent sun exposure(for trunk), residence in sunnier climate
immunosuppression
nevi: atypical moles/dysplastic nevi
increased mole count
precancerous lesion: actinic keratosis, childhood cancer
what is satelite lesion in melanoma
satelites are defined as any foci of clinically evident cutanous/sub cuteneus mets occurring within 2 cm of but discontiniuous from the primary
what is in transit metastases in melanom
any foci occurring >2cm from the primary in the region between the primary and regional lymph node basin
survival according to thickness in melanoma
<1mm : 90% 5 yr OS
1-2mm: 80-90%
2-4mm: 60-70%
>4mm: 50%
preferred chemotherapy in melanoma: stage III in adjuvant
nivolumab
pembrolizumab
dabrafenib/ trametinib
For high risk patient:
CVD: cpl+VBL+DAc
Dartmouth: CBDT
high risk feature for radiotherapy in nodal basin in clinically positive nodes
one parotid/two cervical/three inguinal/
size of node(>/3cm cervical, >/4cm axilla or inguinal).
presence of ECE
LVSI
free tumor in surrounding tissue
preferred chemotherapy in metastatic melanoma
combination checkpoint blockade:
nivolumab/ipilimumab
nivolumab/relatimab
anti PD-1 inhibitor:
pembrolizumab
nivolumab
other:
Dabrafenib/trametinib
vemurafenib/cobimetinib
indication of sentinel LNB in melanoma
> 0.8 mm thickness
ulceration
high mitotic count
clarks level IV
