Melanoma

Question 1

List the clinical presentation characterisitics of melanoma. (5)

Answer 1

asymmetric; irregular borders; variety of color; diameter > 6mm; evolution of a mole

Question 2

Does melanoma most commonly present as local, regional, or metastatic?

Answer 2

local

Question 3

What mutation should all melanoma patients be tested for?

Answer 3

BRAF

Question 4

When is surgery used as curative therapy?

Answer 4

in localized (early stage) disease

Question 5

When is radiation used in melanoma?

Answer 5

patients with positive lymph nodes and a high risk of recurrence

Question 6

What are the options for Stage IB and IIA melanoma?

Answer 6

observation

Question 7

What are the options for Stage IIB and IIC melanoma?

Answer 7

observation

Question 8

What are the options for Stage III resectable melanoma? (2)

Answer 8

observation; chemotherapy +/- radiation

Question 9

What chemotherapy options are there for Stage III resectable melanoma? (3)

Answer 9

nivolumab; pembrolizumab; dabrafenib/trametinib

Question 10

What treatment is available for nonresectable Stage III melanoma?

Answer 10

T-VEC

Question 11

What is first line PD-1 targeted treatment for metastatic melanoma? (2)

Answer 11

nivolumab; pembrolizumab

Question 12

What is first line BRAF targeted treatment for metastatic melanoma? (3)

Answer 12

dabrafenib/trametinib; vemurafenib/cobimetinib; encorafenib/binimetinib

Question 13

What is a unique toxicity of vemurafenib?

Answer 13

development of squamous cell carcinoma

Question 14

What is the dose limiting toxicity of trametinib?

Answer 14

fever

Question 15

In what patient population would you consider using nivolumab/ipilimumab?

Answer 15

younger, more active patients that can handle the high level of toxicity

Question 16

When do you assess efficacy of ipilimumab?

Answer 16

after 4 doses