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E CAN ext. > Malignant Melanoma > Flashcards

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

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25
Q

How is a persons 7-point checklist score determined?

A

Major features score 2 points each, and minor features score 1 point each

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26
Q

What are the major features on the 7-point checklist score for malignant melanoma?

A
  • Change in size
  • Irregular shape
  • Irregular colour
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27
Q

What are the minor features on the 7-point checklist score for malignant melanoma?

A
  • Largest diameter 7mm or more
  • Inflammation
  • Oozing
  • Change in sensation
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28
Q

What are the primary investigations for malignant melanoma?

A
  • Visual inspection

- Removal for histology where necessary

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29
Q

How is a diagnosis of malignant melanoma made?

A

Excisional biopsy

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30
Q

What further investigations may be done in malignant melanoma once a diagnosis is established?

A
  • Sentinel lymph node biopsy
  • CXR and liver ultrasound, or CT scan of chest, abdomen, and pelvis
  • Blood tests
  • Bone scan
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31
Q

What blood tests should be done in the further investigation of malignant melanoma?

A
  • FBC
  • LFTs
  • LDH
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32
Q

When should a bone scan be done in the further investigation of malignant melanoma?

A

If there is indication of bone disease

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33
Q

What is Tx in malignant melanoma?

A

Primary tumour cannot be assessed

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34
Q

What is T0 in malignant melanoma?

A

No evidence of primary tumour

35
Q

What is Tis in malignant melanoma?

A

Tumour in situ

36
Q

What is T1 in malignant melanoma?

A

Thickness 1mm or less

37
Q

What is T1a in malignant melanoma?

A

Without ulceration in mitosis <1/mm^2

38
Q

What is T1b in malignant melanoma?

A

With ulceration

39
Q

What is T2 in malignant melanoma?

A

Thickness 1.01-2mm

40
Q

What is T2a in malignant melanoma?

A

Without ulceration

41
Q

What is T2b in malignant melanoma?

A

With ulceration

42
Q

What is T3 in malignant melanoma?

A

Thickness 2.01-4mm

43
Q

What is T3a in malignant melanoma?

A

Without ulceration

44
Q

What is T3b in malignant melanoma?

A

With ulceration

45
Q

What is T4 in malignant melanoma?

A

Thickness >4mm

46
Q

What is T4a in malignant melanoma?

A

Without ulceration

47
Q

What is T4b in malignant melanoma?

A

With ulceration

48
Q

What is N1 in malignant melanoma?

A

One metastatic node

49
Q

What is N1a in malignant melanoma?

A

Micromets

50
Q

What is N1b in malignant melanoma?

A

Macromets

51
Q

What is N2 in malignant melanoma?

A

2-3 mets

52
Q

What is N2a in malignant melanoma?

A

Micrometastasis

53
Q

What is N2b in malignant melanoma?

A

Macrometastasis

54
Q

What is N3 in malignant melanoma?

A

More than 4 metastatic nodules, or matted nodes

55
Q

What is M1 in malignant melanoma?

A

Evidence of metastasis

56
Q

What is M1a in malignant melanoma?

A

Distant skin, subcutaneous, or nodal mets

57
Q

What is M1b in malignant melanoma?

A

Lung mets

58
Q

What is M1c in malignant melanoma?

A

All other visceral mets, or any distant mets with elevated serum LDH

59
Q

What can happen once melanoma cells have reached the dermis?

A

They may spread to other tissues via the lymphatic system

60
Q

Where can melanoma cells spread via the lymphatic system?

A
  • Local lymph nodes
  • Bloodstream
  • Other organs
61
Q

Where can metastases from malignant melanoma occur?

A

Virtually anywhere, at any time

62
Q

What are the most common sites for metastases of malignant melanoma?

A
  • Lymph nodes
  • Liver
  • Lung
  • Bone
  • Brain
63
Q

What are the management options in stage 0 malignant melanoma?

A
  • Surgery

- Topical imiquimod

64
Q

What should the margin be when excising stage 0 malignant melanoma?

A

At least 0.5cm

65
Q

When should topical imiquimod be considered to treat stage 0 melanoma?

A

If surgery to remove the entire lesion with 0.5cm clinical margin would lead to unacceptable disfigurement or morbidity

66
Q

What should you consider after treatment for stage 0 melanoma?

A

Repeat skin biopsy for assessment after treatment to check it has been effective

67
Q

How is stage 1 melanoma managed?

A

Excision

68
Q

What margin is required for excision of stage 1 melanoma?

A

At least 1cm

69
Q

How is stage 2 melanoma managed?

A

Excision

70
Q

What margin is required for excision of stage 2 melanoma?

A

At least 2cm

71
Q

When should therapeutic lymph node dissection be offered in stage 3 melanoma?

A

In people with palpable 3b or 3c melanoma, or nodal disease detected by imaging

72
Q

What is the first line option if palliative treatment for in-transit melanoma metastases is needed?

A

Palliative surgery

73
Q

What are the options for the palliation of in-transmit melanoma mets if surgery is not feasible?

A
  • Systemic therapy
  • Isolated limb infusiion
  • Isolated limb perfusion radiotherapy
  • Topical agent, e.g. imiquimod
74
Q

What can be used in the palliation of superficial melanoma skin metastases?

A

Topical imiquimod

75
Q

What can be used in the palliation of metastases in the skin form tumours of a non-skin origin?

A

Electrochemotherapy

76
Q

What are the management options in stage 4 melanoma?

A
  • Surgery or other ablative treatments

- Systemic anti-cancer treatments

77
Q

What is the purpose of surgery in stage 4 melanoma?

A

To prevent and control symptoms

78
Q

What systemic anti-cancer treatments can be used in melanoma?

A
  • Targeted treatments
  • Immunotherapy
  • Cytotoxic chemotherapy
79
Q

Give 2 targeted treatments for melanoma?

A
  • Dabrafenib

- Vemurafenib

80
Q

When are targeted treatments recommended for melanoma?

A

For treated unresectable or metastatic BRAF V600 mutation-positive melanoma

81
Q

Give an immunotherapy for melanoma

A

Ipilimumab

82
Q

When is immunotherapy recommended in melanoma?

A

For treating unresectable or metastatic melanoma in people who have received prior therapy

83
Q

Give a cytotoxic chemotherapy for melanoma

A

Dacabazine

84
Q

When is cytotoxic chemotherapy recommended in melanoma?

A

For stage IV metastatic melanoma if immunotherapy or targeted therapy is not suitable

E CAN ext. (47 decks)

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