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Melanoma Flashcards

1
Q

What cancer is the most common oral malignancy in the dog?

A

melanoma

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2
Q

What are the most common locations of oral melanoma?

A

(in order of decreasing frequency)
Gingiva, lip, tongue, and hard palate

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3
Q

What are the most common breeds for oral melanoma?

A

Scottish Terrier, Golden, Chow chow, poodles, and dachshund

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4
Q

What are some primary factors that determine biological behaviour of oral melanoma?

A

site, size, location, stage, and histological parameters

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5
Q

What are some IHC stains for oral melanoma?

A

Melan-A, PNL-2, S-100, tyrosinase
small subset is also positive for c-kit
NRAS and PTEN mutations also noted

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6
Q

What’s the MST for digital melanoma without LN or distant metastasis?

A

MST approx 1 year
1y survival rate 42-57%, 2y survival rate 11-13%

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7
Q

What’s the % of metastasis on presentation for digital melanom?

A

30-40%

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8
Q

What’s the prognosis of foot pad melanoma compared to digital melanoma?

A

similiar

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9
Q

Define the oral melanoma staging system.

A

Stage 1: tumour <2cm, no mets
Stage 2: tumour between 2-4cm, no mets
Stage 3: tumour >4cm and/ or LN mets
Stage 4: any tumour size with distant mets

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10
Q

What’s the MST for oral melanoma based on staging?

A

Stage 1: 511-874 days (17-39m) - more recent studies = 12-14m
Stage 2: 160-818 days (5-27m)
Stage 3: 168-207 (5-7m)
Stage 4: 87days (3m)

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11
Q

What % of LN can be metastatic but still feel normal (ie not enlarged) for oral melanoma?

A

40%

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12
Q

What’s the % of LN metastasis for oral melanoma on presentation when the LN is enlarged?

A

70%

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13
Q

What are some sites of distant metastasis for melanoma?

A
  • abdominal LN
  • liver
  • adrenal glands
  • other intra-abdominal sites
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14
Q

T or F. Most canine cutaneous melanoma = benign

A

true

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15
Q

What’s ideal surgical margin for cutaneous melanoma?

A

minimum 1-2 cm
ideally 2-3cm and 1 fascial plane deep

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16
Q

What margin should be aimed for oral melanoma?

A

1-2cm

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17
Q

What’s the risk of dying for tumour related causes if the histo margin is incomplete for oral melanoma?

A

3.6x more likely

18
Q

At what location oral location is the patient more likely to die due to tumour?

A

caudal to P3 - 4.3x more likely

19
Q

How sensitive is melanoma to radiation?

A

it’s considered radio-resistant

20
Q

What are the pros and cons of hypofractionated radiation therapy?

A

Pro:
- less acute side effects
Cons:
- lower overall biological equivalent dose
- higher risk of late side effects

21
Q

Should you RT a suspect draining LN for oral melanoma even if it’s not enlarged?

A

Yes, still a 40% chance that it is metastatic

22
Q

What’s the reported partial response rate for oral melanoma treated with RT?

A

25-67%

23
Q

What’s the reported complete response rate for oral melanoma treated with RT?

A

19-69%

24
Q

What’s the overall response rate of oral melanoma to RT?

A

82-94%

25
Q

How quickly can the oral melanoma respond to RT?

A

can see dramatic change within a few weeks
but durability of control will be an issue
PFS 3.6-8.6m

26
Q

What’s the local recurrence rate for microscope oral melanoma treated with RT?

A

just over 25% (26, 27%)

27
Q

What’s the reported MST for oral melanoma treated with RT?

A

4.5-14.7m

28
Q

What’s the protocol and MST for the Freeman et al 2003 paper on oral melanoma?

A

9Gy x 6 weekly fractions
most were stage 1
used cisplatin or carboplatin as radiosensitizer - administered 1h prior to RT
MST = around 1 year, quite a few were lost to follow-up, estimated survival
no mention of side effects
median time to metastasis = 10.2m

29
Q

What are the findings in the Farrelly et al 2004 paper on cat oral melanoma?

A

hypofractionated RT (3x8Gy)
5 cats, 1 CR, 2 PR
MST: 146 days from start of RT. All died due to tumour progression

30
Q

The longest MST for canine oral melanoma was reported by whom? What was the treatment protocol?

A

Dank et al, 2012
- 17 dogs total, 11 had Sx + RT + chemo; 6 had Sx + chemo
- mostly stage II
- PFS = 259 days
- MST = 440 days (387days no RT), not significantly changed when RT was added
- but those treated with RT had lower local recurrence rate (27% vs 67%)

31
Q

What were the main findings in the Kawabe et al 2015 paper on oral melanoma RT?

A

MST
Stage I = 758 days (25m)
Stage II = 278 days (9m)
Stage III = 163 days (5m)
Stage IV = 80 days (<3m)
Orthovoltage is sig worse than megavoltage

32
Q

What difference did the Cancedda et al 2016 paper find for canine melanoma?

A

not just all oral melanoma
RT = 5Gy x 5 fraction over 2.5 weeks
Adding in temozolomide (60mg/m2 PO x 5 days, 28d cycle) did have a sig improved PFS but not MST
RT only: PFS = 110 days, MST = 192 days
RT + temozolomide: PFS = 205 days, MST = 401 days
- similar ORR 86.7% vs 81.1%

33
Q

Theon et al 1997. found several prognostic factors for oral tumours treated with RT. What were some for the oral melanomas?

A

Size
RT = 4Gy x 12fx on M-W-F
T1- PFS = 11.3m
T 2 - PFS = 6.0m
T3 - PFS = 6.7m
- most common failure = distant metastasis

34
Q

What was the prognostic factor found in the Blackwood et al 1996 study on RT for oral melanoma?

A

Tumour <5cm3 more likely to achieve CR and longer MST
RT = 9Gy x 4 weekly fx
MST =
- 21.5m for <5cm3
- 4m for 5-15cm3
- 5m for >15m3

35
Q

What was the prognostic factor found in the Bateman et al 1994 study on RT for oral melanoma?

A

Stage (size was found to be non prognostic!)
MST
- Stage 1 = 758 days (25m)
- Stage 2 = 278 days (9m)
- Stage 3 = 163 days (4m)
- Stage 4 = 80 days (2.6m)

36
Q

What prognostic factor was found in the Freeman et al 2003 paper?

A
  • no radiographic evidence of bony invsaion = significant longer time to first event
  • but bone involvement was reported in up to 92% of the dogs with melanoma
37
Q

In what location would chemotherapy be indicated for canine melanoma?

A

oral, digital, or pad melanoma
any cutaneous with high grade/ high ki-67/ high MI

38
Q

What’s the % of patients responding to chemo in the Boria et al 2004 study?

A

18%, combination of cisplatin and piroxicam

39
Q

What’s the % of patients responding to chemo in the Rassnick et al 2001 study?

A

this is canine malignant melanoma (not just oral)
28% with carboplatin

40
Q

Generally speaking, what’s the consensus on chemo following RT in the more recent studies for melanoma?

A

no significant differences in outcome

41
Q

How does the Oncept vaccine work?

A

human tyrosinase DNA, encoded on bacterial plasmid –> dendritic cells present the antigen –> immune response
the human tyrosinase is similar enough to canine counterpart that it’s recognized as foreign, but will still target the canine ones (overexpressed on tumour cells)

42
Q

Which tumour type can be difficult to distinguish with oral melanoma?

A

oral fibrosarcoma

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