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Derm Surg questions > Melanoma > Flashcards

Melanoma Flashcards

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Dermatology Board Prep flashcards
1
Q

what study to do to detect lymph node mets

A

ultrasound

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2
Q

what study to look for distant mets

A

PET-CT scan

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3
Q

What study to look for brain mets

A

MRI

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4
Q

In stage 4 melanoma what lab is elevated that predicts poor prognosis?

A

LDH

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5
Q

how much lower risk for recurrence if the the sentinel node is not positive?

A

5% lower risk for recurrance.

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6
Q

Positive sentinel node no longer need a complete node dissection. What should you do?

A

Monitor the nodal basin with ultrasound

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7
Q

What percent of people with a positive sentinel node biopsy do not have other nodes involved.

A

80%

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8
Q

What are the current guidelines for lymph nodes if there is a positive sentinel node biopsy?

A

Ultrasound monitoring q 4mos for 2 years and

q6 mos for 3 through 5 years

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9
Q

At what melanoma stage would imaging be considered to evaluate specific signs or symptoms.

A

IIB-IV

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10
Q

When can imaging screens stop for asymptomatic recurrence of melanoma?

A

5 years

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11
Q

What are the two treatment arms of metastatic melanoma?

A

Immunotherapy

Targeted therapy

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12
Q

What do immuno therapy monoclonal antibodies do?

A

Block inhibitory signals of the immune system increasing the immune response.

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13
Q

What type of antibody is ipilimumab?

A

CTLA-4 CTLA-4 blocks antigen presentation to the T cell.

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14
Q

What type of antibodies are nivolumab and pembrolizumab.

A

PD-1 antibodies between Tcells and tumor cells

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15
Q

What type of antibody is atezolizumab

A

PD-L1 (program cell death ligand)

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16
Q

What pathway does melanoma targeted therapy affect?

A

MAP kinase signaling pathway - regulates cell proliferation

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17
Q

What is the common mutation in melanoma

A

BRAF (V600E/K)

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18
Q

When is a melanoma not a candidate for BRAF inhibition targeted therapy.

A

When a patient test BRAF negative for a mutation.

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19
Q

What is a BRAF inhibitor always combined with in treatment?

A

MEK inhibitor - MEK is a down stream product of BRAF production.

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20
Q

What is Talimogene laherparepvec (T-VEC)

A

oncolytic viral TX

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21
Q

What type of virus is Talimogene laherparepvec (T-VEC)

A

Herpes Simplex

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22
Q

On dermatoscopic exam list four features of Lentigo Maligna.

A

Hyperpigmented follicular openings.
Annular granular patterns
Pigmented Rhomboid structures
Dark Blotches and obliterated hair follicles.

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23
Q

In doing T staging for melanoma for AJCC guidelines what criteria was dropped from the 7th to 8th edition

A

Mitotic rate.

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24
Q

What is the new depth for T1a for melanoma

A
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25
Q

What would a melanoma of breslow thickness .87 be reported as.

A

.9 They now round to to the .1mm either up or down.

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26
Q

What are the two features in T staging a melanoma.

A

Breslow thickness and ulceration.

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27
Q

How many of the T stages in melanoma have a and b components.

A

all of them.

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28
Q

what does the b component represent in the T stages of melanoma

A

ulceration

29
Q

what is the one exception to the b stage and ulceration.

A

A T1b can also be .8 to 1.0 without ulceration

30
Q

The T stages of the melanoma are what type of staging

A

Clinical

31
Q

What is the best way to biopsy a nail plate pigmented streak.

A

Proximal nail plate curl with a shave biopsy of the matrix.

32
Q

what are features of a melanoma of the nail bed.

A

A pigmented band of varying color and thickness.

33
Q

What percent of melanomas are familial?

A

10%

34
Q

When should a sentinel node bx be considered?

A

any thing T1a

35
Q

What is the risk percent of a T1a melanoma having a + sentinel node biospy?

A

<5%

36
Q

Acral and mucosal melanomas are more likely to have what kind of mutations?

A

Kit

37
Q

Lentigo Maligna melanomas are more likely to have what type of mutations.

A

UV induced NRAS mutations

38
Q

superficial spreading melanomas are more likely to have what type of mutations

A

BRAF

39
Q

uveal melanoma mutations are more likely what?

A

GNAQ

40
Q

On histologic exam what is the one feature that might make one consider a sentinel node bx if the breslow thickness was <8mm

A

ulceration

41
Q

Does pregnancy affect prognosis in a pregnant female with melanoma?

A

no

42
Q

What drug is associated with development of multiple halo nevi

A

Infliximab (Remicade) tx for autoimmune disease.

43
Q

What are some of the histopathological criteria for melanoma 5 with MART1 stain

A

When using MART 1 stain

  1. nests of three or more atypical melanocytes
  2. pagetosis (melanocytes above DE junction)
  3. Confluence of 9 or more adjacent melanocytes with variability along the margin.
  4. vertical stacking of melanocytes
  5. atypical nests in the dermis
44
Q

What three stains should be used in desmoplastic Melanoma (spindle cell melanoma)

A

Sox10, S100, p16 other common melanoma stains may be negative.

45
Q

In the year following a diagnosis of a halo nevus what is the risk for developing a melanoma for that year.

A

1%

46
Q

What are the #1 and #2 sites for mets with a melanoma.

A

Skin and Lungs

47
Q

where is the most common location for melanoma in men

A

back

48
Q

Where is the most common location site for melanoma in women?

A

leg

49
Q

Which type of melanoma on the head/neck is there no difference in survival btw wide local excision and Mohs.

A

nodular melanoma shows same survival rate for both types of surgery. Better survival for others with Mohs.

50
Q

How might high citrus consumption lead to an increased risk for melanoma?

A

The psoralens in the citrus and Psoralen is a photo carcinogen (this is a theory)

51
Q

High testosterone not only contributes to > risk for melanoma but what other cancer.

A

Prostate.

52
Q

Is a nevoid melanoma a melanoma arising out of a nevus?

A

No, it is a melanoma that is easily mistaken both clinically and histologically as a nevus.

53
Q

What is the key feature that distinguishes a lentigo maligna from melanoma in situ

A

Lentigo maligna is on chronic solar damaged skin.

54
Q

What percent of Lentigo Maligna develop Lentigo Maligna melanoma

A

5%

55
Q

What is happens to prognosis with regression?

A

Unsure, the point is being argued. Some say worse some studies say better. I would go with worse if they are talking about risk for mets.

56
Q

On dermatoscopic exam melanin in the furrows vs the ridges is more likely to be benign or malignant on acral skin?

A

benign

57
Q

on acral skin malignant melanoma melanocytes tend to aggregate around what structures.

A

acrosyringeal openings. sometimes you can see the acrosyringeal openings on the broad ridge

58
Q

Parallel furrow patterns are what in acral pigmentation

A

benign (broad ridge narrow furrows)

59
Q

Parallel ridge patterns are what in acral pigmentation

A

malignant (broad ridge narrow furrows)

60
Q

After a lymphadenectomy in a node + patient what are the risk factors for recurrance

A 
Extracapsular extension
more than 4 nodes involved
A node >3cm
Cervical node involvement
Recurrent disease
61
Q

If someone is being treated for advanced melanoma with an immune check point inhibitor (umabs ) are they still at increased risk for a second melanoma

A

yes

62
Q

What umab can cause pigment loss

A

Pembrolizumab (Think P for pigment loss)

63
Q

What is a T1b stage for melanoma

A
64
Q

What does the a and b mean in the staging of melanoma.

A

a without ulceration

b with ulceration

65
Q

What is a T4b melanoma

A

> 4mm breslow thickness with ulceration

66
Q

What breslow thickness would a .96 mm measurement be reported as?

A

1.0 mm the breslow thickness is rounded

67
Q

What is a T3a melanoma stage

A

2.0-4.0 mm no ulceration

68
Q

What is a T2 melanoma

A

1.0-2.0mm with unknown ulceration

Derm Surg questions (26 decks)

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