Melanoma Flashcards
First line management of acral melanoma
Checkpoint inhibitors
Drug approved for uveal melanoma and 2) HLA
HLA-A*02:01-positive
Tebentafusp
Size threshold for SNLB in melanoma
Greater than 0.8 mm
Dabrafenib tremetinib SE to know
Pyrexia
encobimetinib SE to know
ocular toxicity
Gene mutation associated with hereditary melanoma (familial atypical mole syndrome)
CDKN2A
p16
FAM syndrome presentation
A lot of atypical appearing moles
Other genetic syndromes associated with melanoma
BRCA2
pTEN (Cowden)
BAP1
Stage III melanoma definition
nodal mets OR *in transit metastases
Other indications for sentinel lymph node biopsy
- regression of tumor below breslow depth
- if base of tumor broadly transected on specimen (indicating tumor much thicker than actual read on path)
- presence of atypical features (melanocytic tumor of unknown potential)
TVEC mechanism + role
- oncolytic virus
- very limited role, possibly local control in elderly patient ineligible for immunotherapy
margins required in melanoma for wide local excision
IF <2mm, 1 cm margin
IF >2mm, 2 cm margin
*high yield
When adjuvant immunotherapy is indicated in stage II melanoma
high risk, so stage IIB and IIC
What are the BRAF/MEK combinations
dabrafenib/tremetinib
vemurafenib/cobimetinib
encorafenib/benimetinib
BRAF targeted therapy class effects
- QT prolongation
- increased risk of cutaneous squamous
- Keratoacanthomas
- LFT elevation
- photosensitivity
MEK targeted therapy class effects
- cardiotoxicity
- acne
- ocular toxicity
BRAF/MEK combination SE to know
pyrexia
uveal melanoma mutations
GNAC
GNA1
uveal melanoma associated hereditary syndrome
BAP1
mucosal and acral melanoma mutations
KIT
mucosal and acral melanoma drug
IF KIT mutant, imatinib
First line for metastatic merkel cell
immunotherapy
Role of T-VEC in melanoma
- unresectable cutaneous, subcuteanous, or nodal disease (reduces pain, improves QOL)
uveal melanoma surveillance
MRI abdomen (proclivity to met to liver)
preferred first line for cutaneous SCC in transplant patient
carbo/taxol
Stage III melanoma surveillance
CT chest/abdomen/pelvis and neck if head/neck primary q 3 months for first 3 years, then q months for up to 5 years
**Given positive sentinel lymph node biopsy, regional nodal US q 3 months (US surveillance of lymph node basin) (this was shown to be comparable to
Important caveat to Stage III melanoma management
- IF less than 1 mm tumor burden in sentinel lymph node, then no adjuvant (proceed to US of nodal basin). They have very good outcomes and weren’t included in trials
Most reported and least tolerated adverse effect of hedgehog inhibitors
muscle cramps or spasms
What is the clinical significance of melanoma excised from subcutaneous tissue
- this is in transit disease that needs adjuvant immunotherapy
Management of retinal detachment from MEK inhibitors
- rechallenge (doesn’t cause irreversible vision loss serious eye damage)
Gene mutation more commonly found in mucosal melanoma
KIT
Gene mutation more commonly found in acra melanoma
KIT
avelumab premedications
acetaminophen + antihistamine
(high rate of severe infusion reactions, only checkpoint inhibitor that requires premedication)
