melanoma Flashcards
who is highest risk of melanoma
white men >50 yo
most common type of ca in what age/
25-29
more melanoms from existing nevus or de novo
de novo
nevus histo
very organized
do melanocytes mature w descent?
in nevi yes, melanoma no
of melanocytes are above the basal layer…
BAD SIGN
radial growth phase
melanoma in situ
vertical growth phase
melanoma that is now invading dermis
nevi and melanoma in common
melanocytes
share mut like BRAF
lots of nevi >50 ^ risk
20% melanomas from existing nevi
etiology melanoma
multifact
genetic predisp? BRAF?
environment (UV
underlying immune status
melanoma risk factors
>50 nevi giant congenital nevi atypical nevi hx of blister sunburns fam hx melanoma light complexon tanning bed imm dysfn
subtypes of melanoma
acral lentiginous lentigo maligna nodular superficial spreading amelonotic
acral lengitinous melanoma
palmar, plantar, subungal skin
most common in pts w darker skin
lentigo maligna
older pts w sun-exp skin
melanoma in situ
slow growing, radial growth phase
nodular melanoma
sun exp skin
no preceding radial growth is what they say, but no really they start in epid and go into dermis quickly to ecome nodule
2x m>f
superficial spreading melanoma
radial growing
janky border
red/white/blue sign
other places melanoma can be
inner ear
medulla oblongata
vulva
*melanoma mets
lymphatics not exclusively though SKIN most common CNS most common cause of death node involvement is MOST IMPORTANT Px most important histo px factor: Breslow thickness, ulcration
most important px factor for melanoma met
node inv
most miportant histo px factor
brewslow thickness, ulcer
what Brewslow’s thickness
dist of inv from granulosum (top) to bottom of lesion
tx for melaonoma
catch early, cut it OUT
if met? IFNa, combo chemo, XRT, vax tx
mut in melanoma??
1/2 have BRAF mets
BRAF involved in waht pway
Ras-Raf-MEK-ERK MapK pway
vemurafenib
inhib BRAF for stage IV met melanoma
modest survival benefit (melanoma adapts to it)
combo w Ipilimumab
what is Ipilimumab
prevents dact of T cells
stops B7 on APC binding to CTLA-4 of T cell
sunlight and skin cancer?
UVB makes thymine dimers which are repaired by endonucleases
squamous cell - cumulative exp
basal cell – UV important but unrel to cumulative
melanoma – role along w genetic, envirnonment, imm
xeroderma dermatosum
no endonucleases working so can’t repair thymine dimers
sunscreen
SPF 30+, frequent application;
