Melanoma

Question 1

melanoma

Answer 1

Melanoma is the most serious form of skin cancer and the sixth most common cancer in North America

incidence increases with age

●Asymmetry 
●Border irregularities
●Color variegation 
●Diameter ≥6 mm
●Evolution: a lesion that is changing in size, shape, or color, or a new lesion

Question 2

melanoma management

Answer 2

Proper surgical management is critical for the diagnosis, staging, and optimal treatment of primary cutaneous melanoma

Wide local excision

0.5cm margin for in situ lesions
1cm margin for less than 1 mm of invation
2cm margin for melanomas with greater invasion

sentinel lymph node biopsy
-tumor greater than 1mm thick or high risk

positive lymph node
- full lymph node resection

determine BRAF status

Question 3

metastatic melanoma

Answer 3

Pembrolizumab and nivolumab, antibodies directed against the programmed death 1 (PD-1) protein, have become the preferred approach to immunotherapy in patients with advanced melanoma

Ipilimumab, an antibody directed against the cytotoxic T-lymphocyte antigen 4 (CTLA-4) receptor on T lymphocytes, may retain a role in combination with anti-PD-1 antibodies and in patients who have progressed on anti-PD-1 antibody therapy.

Vemurafenib and dabrafenib, inhibitors of BRAF, have demonstrated dramatic antitumor activity in phase III trials in patients with advanced disease whose tumors have characteristic mutations in BRAF. However, virtually every patient treated with an inhibitor of BRAF eventually has disease progressio