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Oncology > Melanoma > Flashcards

Melanoma Flashcards

1
Q

Melanoma originates from these embyonic cells?

A

neural crest cells which migrate to skin, aerodigestive tract and uvea

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2
Q

Recognized risk factors?

A
  • personal or family history
  • multiple benign or atypical nevi (>50)
  • intermittent severe sunburns
  • sensitivity to sun exposure
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3
Q

Subtypes of melanoma (order of frequency) ?

A
  • Superficial spreading (70%): sun-exposured, classic irregular nodule
  • Nodular (20%): rapid growing, homogenous darkly pigmented
  • Lentigo maligna: chornically solar-damaged skin, older pts on head and neck
  • Acral lentiginous: Asian and african descent: subungually on the palms and soles
  • Desmoplastic: rare and aggressive; usually amelanotic
  • Uveal melanoma: can dx w/o biopsy, usually met to liver
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4
Q

Most common molecular features and historical correlate?

A
  • Activating BRAF (50%) mutations; usually seen in intermittently solar damaged skin rather than chronic
  • KIT: usually acral lentignous
  • NRAS (15%): can be seen in both
  • GNAQ or GNA11: 50% of uveal
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5
Q

What is molecular feature of inherited melanoma

A

-alteration of tumor suppressor CDKN2A encoding p16INK4A and p19ARF

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6
Q

What is summary of TNM staging in melanoma?

A

0: confined to epidermins
I: Ib: 4cm with ulceration
III: positive nodes: IIIa: Ib disease with 1-3micronodes, IIIb: any size with 1-3 macro nodes no ulceration, IIIc: IIIb with ulceration or in-transit mets/satellites
IV: metastasis

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7
Q

Prognostic variables in primary cutaneous melanoma?

A

Lymph node positivity
Breslow depth (tumor thickness)
microscopic ulceration
mitotic rate (thin primary

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8
Q

Melanoma with no nodes is treated how?

A

Surgery with adequate margins

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9
Q

Margin recommendations for melanoma?

A 
Tumor size: Margin
melanoma in situ: 0.5 cm
0.5-1mm: 1.0 cm
1-2mm: 1.0-2.0 cm
>2mm: 2.0cm
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10
Q

When do you perform sentinal lymph node mapping/ biopsy? Data? Survival Benefit?

A

lesions >=1cm in breslow depth; if high risk features than

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11
Q

What is standard of care for positive nodes on SLN mapping in melanoma?

A

complete lymphadenectomy (this is being formally answered in MSLT-II)

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12
Q

What is satellitosis?

A

at least 1 seperate focus adjacent to primary

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13
Q

What is in-transit?

A

not immediately adjacent but within draining nodal basin

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14
Q

Standard of care for in-transit?

A

surgical resection if possible

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15
Q

What is survival for Stage IIIA, IIIB & IIIC in melanoma respectively?

A

80, 60, & 40%

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16
Q

What defines Stage III disease in melanoma and how is it managed?

A

Lymph node involvment,

surgical resection followed by adjuvant therapy or observation

17
Q

What are adjuvant options?

A

clinical trial, radiotherapy (for regional control) or high dose interferon alpha-2b

18
Q

How is interferon usually given?

A

20 million units/m2 IV M-Fx4 weeks followed by 10 million units/m2 subq 3xweek for 48 weeks

19
Q

What’s the data show for interferon in stage IIB-III melanoma?

A

OS and DFS at 5 years that disappears in meta-anaysis with median follow-up of 12.6 years

20
Q

In addition to standard toxicities, what else are you concerned for with interfereon therapy?

A

liver dysfunction myeosupression and depression

21
Q

What is standard surviellance for early stage melanoma followed by resection?

A

Exam 3-4 months, for first 2 years, then q6 months for next 3 years
NO imaging, only at clinican’s discretion
LDH is only lab value to follow

22
Q

What is management of recurrent disease?

A

Depends:

- if local can resect; if unresectable considered hyperthermic or isolated limb infusion

23
Q

What is Stage IV melanoma further classified by? (2 factors beginning with L)

A

location and LDH

24
Q

What is M1a, M1b or M1c disease imply? And respective survival?

A

M1a: distant skin, subcutaneous or nodal metastatic disease with normal LDH (30%)
M1b: lung metastasis with normal LDH (20%)
M1c: visceral mets or any mets with LDH elevation (10%)

25
Q

What if available, is the most important therapeutic option, melanoma?

A

surgical resction

26
Q

What are your options for unresectable melanoma?

A
  • Dacarbazine
  • IL-2
  • ipilumumab
  • vemurafenib
  • nivolumab +/- ipi
  • dabrafenib + trametinib (mek inhibitor)
  • clinical trial
27
Q

Name an unusual side effect of vemurafenib therapy?

A

incidence of squamous cell carcinoma and keratoacanthoma

28
Q

what is a common complicating factor limiting treatment options in melanoma?

A

brain involvement

Oncology (7 decks)

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