Melanoma

Question 1

Etyology of melanoma?

Answer 1

De novo (most frequent) or by malignant conversion of a melanocytic nevus

Question 2

What are the two most common genes involved in Melanoma?

Answer 2

CDKN2A and CDK-4

Tali alterazioni rendono il soggetto affetto più sensibile ai danni indotti dall’esposizione solare, aumentando notevolmente il rischio di sviluppare melanomi.

Question 3

Primary prevention in Melanoma?

Answer 3

Avoid prolonged exposure to solar radiation or use protective creams with a high SPF (Sun Protection Factor).

Question 4

Secondary prevention in Melanoma?

Answer 4

Mole mapping and dermatological checks.

Question 5

What are the two main histological types of Melanoma?

Answer 5

Radial growth: it is the most common form of sporadic melanomas.

Vertical growth: such as nodular melanoma which does not grow radially, but arises directly by infiltrating the dermis and pushing downwards towards the subcutaneous tissue.

Question 6

The extent of dermal infiltration and tumor malignancy is measured using two systems:

Answer 6

-Clark score
-Breslow score

Question 7

Breslow score

Level 1

Answer 7

Thickness of ≤ 1mm

Question 8

Breslow score

Level 2

Answer 8

1.01-2 mm

Evaluate exportation of sentinal lymph node

Question 9

Breslow score

Level 3

Answer 9

2.01-4 mm

Question 10

Breslow score

Level 4

Answer 10

≥ 4mm; aggressive

Question 11

Clark score

level 1Clark score

Answer 11

Epidermis

Question 12

Clark score

level 2 Clark score

Answer 12

Superficial dermis

Question 13

Clark score

level 3 Clark score

Answer 13

Deep dermis

Question 14

Clark score

level 4 Clark score

Answer 14

Reticular dermis

Question 15

Clark score

level 5 Clark score

Answer 15

Hypodermis and subcutaneous tissue

Question 16

What are the possible distant metastasis of melalnoma?

Answer 16

Liver, Lungs, and CNS

Question 17

Which onset sites of melanoma are considered to have higher risk?

Answer 17

Trunk and head & neck

Question 18

How does superficial ulceration affect the melanoma?

Answer 18

worse prognosis

Question 19

Histological exam of Melanoma

If the exam is negative

Answer 19

The diagnostic procedure is finishing here

Question 20

Histological exam of Melanoma

Carcinoma in situ, what do you do?

Answer 20

An excision of 1cm on the margin of the lesion

send the patient also for a follow-up

Question 21

Histological exam of Melanoma

Breslow ≤ 1mm or Clark II, III

Answer 21

1.5 cm excision and follow-up

Question 22

Histological exam of Melanoma

Breslow > 1 mm, or Breslow ≤ 1 mm but Clark IV, V

Answer 22

3 cm excision + Sentinel Lymph Node biopsy

Question 23

Adjuvant therapy for localized Melanoma?

Answer 23

INF-alpha-2b

I.V

Question 24

Ipilimumab target?

Answer 24

Anti-CTLA-4

Question 25

what is the target of **Nivolumab** and **Pembrolizumab**?

Answer 25

**PD-1** receptor

Question 26

What mab can we use for **Melanoma** with **BRAF** mutation? ## Footnote The most common BRAF mutation is V600E, This substitution mimics phosphorylation of the activation loop, thereby inducing constitutive BRAF protein kinase activity.

Answer 26

**Vemurafenib** and **Dabrafenib**