Melanoma

Question 1

Phenotypic indications for increased rx melanomA

Answer 1

1. light complexion and inability to tan
2. red hair
3. number of atypical nevi greatest than or equal to 10
4. anatomic location of atypical nevi (especially back)
5. freckles

Question 2

FAMMM

Answer 2

Familial Atypical Mole and Melanoma Syndrome

1) AKA dysplastic nevus syndrome, atypical mole syndrome
2. characterized by appearance of a large number of dysplastic nevi or atypical moles at an early age in combo with MM

Question 3

Genet assoc. with MM

Answer 3

CDKN2A

-two potential isoforms

Question 4

CDKN2A

Answer 4

1) two potential isoforms

2) trascnribes INK4A and p14ARF

Question 5

INK4A

Answer 5

controls progression through G1-S transition of cell cycle

Question 6

ARf

Answer 6

stabilizes tumor supressor protein p53

Question 7

other genes involved in MM

Answer 7

1. CDK4

2. MC1R

Question 8

CDK4

Answer 8

also involved in g1-s transition

Question 9

MC1R

Answer 9

melanocortin 1 receptor

• found on surface of melanocytes
• red hair and freckles assoc with certain alleles of mc1r
• phenotype is assoc. with increased rx MM

Question 10

pertinent family hx predicators

Answer 10

1) MM in first- or second-degree relatives
2) MM of more than three occurrences among any family members
3) MM with multiple primaries in one parent
4) MM with multiple primaries in any one individual
5) MM with multiple cases on same side of family
6) MM diagnosed in family member at young age (before 30)
7) Pancreatic adenocarcinoma
8) Breast cancer
9) Central nervous system cancers
10) Non-melanoma skin cancer

Question 11

dx melanoma

Answer 11

1. requires dermatological/provider investigation
2. ABCDES
3. asymmetry, itch, bleeding, satellite moles, moles growing in pattern around existing moles
4. bx to stage
   - wide local excision
   - lymph node mapping
   - imaging studies
   - lab assay (LDH)

Question 12

familial patters

Answer 12

1. younger at time dx < 30
2. more affected in 1st or 2nd degree releatives
3. higher risk for subsequent primary tumors
4. poor ability to tan, fair skin, red hair, multiple melanocytic nevi

Question 13

sporadic patterns

Answer 13

1. older at time dx > 30
2. no affected 1st/2nd degree relatives
3. few or no subsequent primary tumors
4. less likely to have poor ability to tan, fair skin, red hair
5. few or no dysplastic nevi

Question 14

Stage I mgmnt

Answer 14

surgical removal lesion with free margin

Question 15

stage II

Answer 15

surgical wide excision +/- sentinel node biopsy

Question 16

stage III

Answer 16

1. wide excision
2. node bx
3. adjuvant therapy with interferon

Question 17

stage IV

Answer 17

poor prognosis

-mets present
-surgery to debulk tumor
and prodive symptomatic relief
-rediation
-chemo
-no improvement overall survival