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Withrow > Melanoma > Flashcards

Melanoma Flashcards

Withrow 2019 - Chapter 20

1
Q

The most common sites of canine oral melanoma?

A

gingiva>lips>tongue>hard palate

Withrow 2019 - Melanoma (Ch 20)

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2
Q

What are the primary factors that determine biological behavior of canine melanoma?

A
  1. Site
  2. Size
  3. Stage
  4. Histologic parameters

Withrow 2019 - Melanoma (Ch 20)

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3
Q

Which immunohistochemical (IHC) markers are routinely used for the diagnosis of melanoma?
Which IHC markers have shown promise in improving the diagnosis of melanomas, beyond the typical markers?

A

Melanin A and S-100
PNL2 and tyrosinase

Withrow 2019 - Melanoma (Ch 20)

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4
Q

Which molecular pathway is implicated in both human and canine melanomas?

A

MAPK signaling pathway:

RAS>RAF>MEK>ERK

Withrow 2019 - Melanoma (Ch 20)

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5
Q

What is the BRAF mutation status in human and canine melanoma?

A

Commonly mutated in human cutaneous melanoma but not oral melanoma.
Unocommon in canine oral melanoma.

Withrow 2019 - Melanoma (Ch 20)

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6
Q

Which downstream mutation is identified in both human and canine melanomas?

A

constituitive activation of ERK

MAPK signaling pathway:RAS>RAF>MEK>ERK

Withrow 2019 - Melanoma (Ch 20)

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7
Q

Why can we consider KIT small molecule inhibitors in MMs unresponsive to Oncept?

A

A small percentatge of dogs w/ MM have exon 11 c-kit mutation

Withrow 2019 - Melanoma (Ch 20)

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8
Q

What IHC staining has beeen reported to be predictive for canine cutaneous and oral melanomas?

A

Ki67 IHC

Withrow 2019 - Melanoma (Ch 20)

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8
Q

Name all mutations in canine melanoma

A
  1. ERK constituitive activation
  2. Uncommonly BRAF mutation
  3. PI3K-Akt
  4. c-kit exon 11
  5. NRAS
  6. PTEN

Withrow 2019 - Melanoma (Ch 20)

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9
Q

Does Ki67 hold a prognostic importance for oral melanomas?

A

Yes!
It is prognostic for both cutaneous and

Withrow 2019 - Melanoma (Ch 20)

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10
Q

What are the median survival times, and 1- and 2-yr survivals for melanomas of the digit without LN and distant mets?

A

MST 12 mo
1-yr survival: 42-57%
2-yr survival: 11-13%

Withrow 2019 - Melanoma (Ch 20)

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11
Q

What percentage of dogs with digital melanoma have metastasis (LN or distant) at presentation?

A

30-40% have mets at presentation
The majority will develop mets eventually

Withrow 2019 - Melanoma (Ch 20)

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12
Q

What type of melanoma in humans is similar to the melanoma of the footpads in dogs?

A

Human acral lentiginous melanoma (plantar surface of the foot, palms of the hands and digits); has increase potential for mets

Withrow 2019 - Melanoma (Ch 20)

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13
Q

What are the most common sites of metastasis for canine melanoma?

A

LNs, lungs, liver, meninges, adrenal glands

Withrow 2019 - Melanoma (Ch 20)

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14
Q

Range of partial response to RT?

A

25-70%

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15
Q

Range of complete response to RT?

A

20-70%

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16
Q

ORR to RT including SD?

A

73%

17
Q

What is the PFS for RT when treating gross disease?

A

4 - 9 months

18
Q

What is the WHO staging scheme for canine oral melanoma based on?

A

Local tumor size and distant metastasis

19
Q

Local progression rate following RT for gross disease?

A

45%

20
Q

MST for dogs treated with RT?

A

4.5 - 15 months

21
Q

What is the range of total radiation dose used to treat melanomas in dogs?

A

24 - 57 Gy

22
Q

MST for cats with OMM treated with RT?

A

~5 months (146 days)

23
Q

Stages of canine oral melanoma

A

Stage I - Non-metastatic tumor less than 2cm
Stage II - Non-metastatic tumor 2cm to 4cm
Stage III - Tumor greater than 4cm and/or LN metastasis
Stage IV - Distant metastasis

24
Q

What is the overall PFS for dogs treated with Sx+carbo+/- RT? MST?

A

PFS - ~9 months (259 days)
MST - ~15 months (440 days)

No significant difference with or without RT

25
Q

Routine staging tests for melanomas

A

Regional LN evaluation - FNA vs histologic examination (investigate ipsilateral as well)
Thoracic radiographs or CT
Abdominal ultrasound or CT for melanomas arising from the oral cavity, digits, or pads
CT for surgical removal

26
Q

ORR for RT alone vs RT + temozolomide?

A

RT - 87%
RT + temo - 81%

27
Q

TTP for RT alone vs RT + temozolomide?

A

RT - 4 months (110 days)
RT + temo - 7 months (205 days)

28
Q

MST for RT alone vs RT + temozolomide?

A

RT - 6 months (192 days)
RT + temo - 13 months (402 days)

29
Q

What is a prognostic factor for PFS and MST for dogs treated with RT? What are the differences?

A

Size.
PFS: T1 - 11 months; T2 - 6 months; T3 - 7 months
MST: <5 cm3 - 21.5 months (86 weeks); 5-15 cm3 - 4 months (16 weeks); >15 cm3 - 5 months (21 weeks)

30
Q

% of metastasis to LN with lymphadenopathy vs without

A

70% vs 40%

31
Q
A
32
Q

What is the MST for dogs treated with RT based on stage?

A

I - 25 months (758 days)
II - 9 months (278 days)
III - 5 months (163 days)
IV - 3 months (80 days)

33
Q

What width skin margins are typically taken for benign cutaneous melanoma?

A

1cm

34
Q

What width skin marghins are ideal for malignant melanoma?

A

2-3cm

35
Q

What is the most effective local treatment for meulanoma?

A

surgery

36
Q

When removing gingival masses (melanoma), what should also be taken?

A

underlying bone

37
Q

Oral malignant melanoma developing at what site is amenable to excision of the soft tissues only?

A

buccal mucosa, lip, tongue

38
Q

Dogs with incomplete histologic excision are how many times more likely to die of tumor-related causes compared to those with complete margins?

A

3.6x

39
Q

In one study, dogs with tumors caudal to the third premolar tooth were how many times more likely to die from tumor related causes when compared to dogs with tumors rostral to PM3?

A

4.3x

40
Q
A

Withrow (7 decks)

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