Melanoma Flashcards
Epidemiology
5th most common cancer in men/women
Risk factors
Age: increased > 50 yo
Male
Atypical moles or dysplastic nevi
Tendency for sunburn: red hair, blue eyes, light skin complexion
Immunosuppression
Environmental factors:
Tanning beds
Sunnier climate near equator
Sun exposure
Superficial spreading melanoma
Initially flat, but becomes irregular and asymmetrical rapidly
More common in women
Nodular melanoma
Vertical growth with a dark blue-black color
Raised and asymmetrical
Present on head, neck, trunk
More common in men
Lentigo Maligna Melanoma
Tan lesion with area of brown/black
Present on face in elderly patients
Arcal Lentiginous Melanoma
Irregular, convoluted borders appearing as brown stains (>3 cm)
Present on palms, soles, or under nail beds
More common in AA, Asians, Hispanics
Uveal Melanoma
Metastasis in liver
Presentation ABCDE
Asymmetrical
Borders that are irregular
Colors that vary
Diameter of > 6 mm
Evolution of mole
85% present with local disease
< 5% present with metastatic disease
Screening
Monthly self-exams
Annual clinical exams via physician for high-risk patients/FH
Sunscreen
Avoid sun exposure between 10am and 4pm
Avoid tanning beds
Diagnosis
Skin exam
Biopsy–>gold standard
For superficial lesions, wide-local excision with removal of underlying subcutaneous fat is indicated
Sentinel-node biospsy to detect if invaded to lymph node
CT scans
BRAF mutations–> 50% of patients have this mutation
Surgery
Mohs surgery–> thin slices
Clinical lymph nodes without metastasis–> wide excision of primary site and lymph nodes
Sentinel lymph node positive–> full dissection
NO RADIATION
NO RADIATION
Stage 1
observation of clinical trial
Stage II
observation of clinical trial
Stage III
Dabrafenib and Trametinib THEN Pembrolizumab/Nivolumab x 1 year
Dabraf/Tramet only in stage III BRAF V600 mutation and SLN metastasis > 1 mm
