Melanoma

Question 1

Risk factors for melanoma

Answer 1

male sex
age greater than 60
atypical moles
increased mole count
on and off sun exposure
red hair blue eyes pale skin
imunosuppression

Question 2

Superficial spreading melanoma

Answer 2

70% of cases
initially appears flat but subsequently becomes irregular and asymmetrical
more common in women

Question 3

Nodular Melanoma

Answer 3

appear dark blue-black in color and are usually raised and asymmetrical
appear on head neck and trunk
more common in men

Question 4

Lentigo maligna melanoma

Answer 4

presents on the face of elderly patients
tan lesion with areas of brown and black

Question 5

Acral lentiginous melanoma

Answer 5

frequently presents on the palms, soles, or under nail beds
more common in AA, asians, and hispanics
appears as brown stains

Question 6

Uveal melanoma

Answer 6

arises from pigmented eputhelium of the choroid
most common ocular melanoma
often metastasis in liver

Question 7

Clinical presentation

Answer 7

ABCDE
Asymmetric
irregular borders
wide variety of colors
diameter of >6mm
Evolution of a mole may be indicative of neoplastic transformation

Question 8

Surgery options

Answer 8

Mohs - small removal to avoid creator in skin (Usually when melanoma is on the face)

Question 9

Stage IB or IIA

Answer 9

clinical trial or observation

Question 10

Stage IIB or IIC

Answer 10

clinical trial, observation, pembrolizumab

Question 11

Stage III

Answer 11

Nivolumab, pembrolizumab, or dabrafenib/trametinib
(if BRAF mutant) +/- radiation, or observation

Question 12

Metastatic treatment

Answer 12

Anti-PD-1 monotherapy (choose one)
Nivolumab
pembrolizumab
OR
Dabrafenib/trametinib (combination targeted therapy BRAF V600 mutation)

Question 13

How to choose therapy

Answer 13

If the patient has a BRAF mutation start with targeted therapy
usually Dabrafenib with trametinib - BRAF inhibitor with MEK inhibitor