Malignant Melanoma Flashcards
Malignant melanoma is the least common of the top 3 skin cancers. What is the annual incidence of this in the UK?
1 - 160
2 - 1600
3 - 16,000
4 - 160,000
3 - 16,000
Is malignant melanoma more common in darker or fairer skin types?
- fair skin types
When does malignant melanoma more commonly present?
1 - face
2 - head
3 - back
4 - legs
3 - back
- occurs on skin infrequently exposed to sun
- sudden bursts are worse when compared to cumulative exposure
Which of the following is the main risk factor for skin cancer?
1 - socioeconomic background
2 - age
3 - family history
4 - gender
2 - age
Reflects long term accumulation of DNA damage
Which of the following is the key risk factors for malignant melanoma?
1 - gender
2 - burning episodes
3 - sun bed exposure
4 - age
3 - sun bed exposure
- 86% of melanoma’s are caused by exposure to UV rays
Malignant melanoma are typically caused by overexposure to ultraviolet radiation
Which of the following is a malignant melanoma?
- bottom left
Melanoma Detection
A - Asymmetry
B - Border (irregular)
C - Colour (more than 2 colours)
D - Diameter (>7mm)
E - Evolution
LOOK FOR UGLY DUCKLING
- important to identify these things to the patient
- do not need all of these
- evolution is key!! History is therefore very important
What is the best cure for melanoma?
1 - immunotherapy
2 - excision
3 - efudix cream
4 - early detection
4 - early detection
- prevent
- immunotherapy has improved those where early detection is not always done
If a melanoma metastasises on the skin, should we be looking for further brown nodules?
- no
- typically red nodules close to the scar for melanoma excision
What is the ONLY modifiable risk factor for skin cancer?
1 - sun exposure
2 - weight
3 - immunotherapy
4 - smoking
5 - age
1 - sun exposure
Avoiding peak UV times can help mitigate the risks associated with skin cancer. What are peak UV times?
1 - 9am - 1pm
2 - 11am - 12pm
3 - 11am - 3pm
4 - 1-3pm
3 - 11am - 3pm
Which of the following are ways to minimise UV exposure and reduce the risk of skin cancer?
1 - Wear hats, sun glasses, clothes
2 - Sunscreen on face and as needed elsewhere
3 - Broad spectrum of >SPF30
4 - Suncream containing UVA: 4-5 stars
5 - all of the above
5 - all of the above
If a malignant melanoma is identified they are typically treated with a wide local incision. Which of the following would trigger the need to perform a sentinel lymph node biopsy?
1 - >65
2 - tumour depth >0.8mm
3 - >3 colours in melanoma
4 - bleeding from melanoma
2 - tumour depth >0.8mm
In high risk tumours, this threshold is lowered to >75mm
Breslow thickness is used to assess this
Which of the following methods is most typically used to stage a melanoma if metastasis is suspected?
1 - whole-body and brain contrast-enhanced computed tomography (CT) scan
2 - whole-body and brain contrast MRI
3 - PET-CT
4 - X-ray
1 - whole-body and brain contrast-enhanced computed tomography (CT) scan
MRI may be used in special circumstances
What is the main stay of treatment in patients with suspected malignant melanoma?
1 - cryotherapy
2 - beclometasone
3 - incision of melanoma, histology, depth measurement and return for wide excision
4 - wide local incision followed by chemotherapy and radiotherapy
3 - incision of melanoma, histology, depth measurement and return for wide excision
If a sentinel lymph node biopsy is performed and lymph nodes are found to be positive, how are try typically treated?
1 - radiotherapy
2 - chemotherapy
3 - lymphadenopathy
4 - hormonal therapy
3 - lymphadenopathy
If it is a singular lymph node, lymph node dissection can be performed
If a patient has metastatic disease associated with malignant melanoma they may be give adjuvant therapy alongside surgery/radiotherapy. This is commonly pembrolizumab, but what is the mechanism of action of this drug?
1 - binds to receptors on tumours and inhibits their growth
2 - inhibits PD-L1 on tumours cells
3 - inhibits cytotoxic T cells
4 - stimulates new antibodies against tumours
2 - inhibits PD-L1 on tumours cells
PD-L1 = Programmed death-ligand 1
PD-L1 on tumours is able to inhibit cytotoxic T cells so they do not kill the tumour
Without PD-L1, PD-1 on T cells can induce lysis of tumours
Diarrhoea is a common adverse effect of chemotherapy medications. Which of the following side effects are the cause of Diarrhoea following chemotherapy?
1 - intestinal obstruction
2 - intussusception
3 - colitis
4 - all of the above
3 - colitis
If a patient is experiencing diarrhoea as a side effect of chemotherapy medication, which of the following medications would be most effective at alleviating the diarrhoea?
1 - Loperamide
2 - Macrogol
3 - Senna
4 - Lactulose
1 - Loperamide
This is an Antipropulsives / Antidiarrhoeals
All the others are stimulants or laxatives and would make diarrhoea worse
If a patient presents with suspected immunotherapy toxicity following melanoma malignancy therapy, all of the following should be performed, EXCEPT which one?
1 - admit and rehydrate
2 - give loperamide
3 - Bloods- FBC, U&Es, LFTs, CRP, TFTs
4 - blood transfusion
5 - Rule out infection (MC&S, C diff toxin)
6 - antibiotics for signs of colitis
7 - Steroids
8 - Sigmoidoscopy/ colonoscopy +/- biopsy
4 - blood transfusion
A 73-year-old woman is seen by the dermatologist with a mole on her back. It measures 8mm in diameter, has irregular borders and is noted to have variation in colour. A biopsy taken confirms malignant melanoma with an invasive depth of 4mm, there is also ulceration present. The tumour is shown to carry a BRAF mutation and has a high mitotic rate. She has asked if she is likely to die from the illness.
Which is the worst prognostic factor in this case?
1 - BRAF mutation
2 - Depth of the lesion
3 - Diameter of the lesion
4 - Mitotic rate
5 - Ulceration
2 - Depth of the lesion
Accounts for around 70% of prognostic factor
