melanoma Flashcards
phenotypic risk factors of melanoma
- fair complexion
- red or blonde hair
- presence of >50 moles
- presence of atypical moles
- family history
- male
- > 60
environmental risk factors of melanoma
- Hx of excess sun exposure
- tanning bed use
- history of severe sunburns as child or teen
- exposure to UV treatment
growth sequence of melanoma
- radial growth phase (lateral)
- vertical growth phase
- lymph system distribution
- vascular distribution
things to evaluate in determining the stage of melanoma
- depth of invasion
- ulceration of tumor
- mitotic rate
- lymphovascular invasion
follow up staging to be done after initial staging
-sentinel lymph node biopsy (Breslow depth)
o if it is + then CT of chest or PET CT
-genetic testing for BRAF and cKIT mutations
most common mutation in melanoma
BRAF v600E
treatment decisions of melanoma are based on
- age
- comorbid disease states
- stage
- genetic mutations
- patient wishes/desires
typical treatment for stage 0 and 1 melanoma
wide excision surgery
surveillance
typical treatment for stage 2 melanoma
wide excision surgery
sentinel lymph node biopsy
surveillance
typical treatment for stage 3 melanoma
surgery
adjuvant immunotherapy
typical treatment for in transit mets
surgery
intra-lesional immunotherapy?
adjuvant immunotherapy
typical treatment for stage 4 melanoma
palliative immunotherapy and surgery/radiation
immunotherapy of choice in melanoma
nivolumab
14 day cycle, 1 year therapy
drug therapy if BRAF v600 mutation is present
dabrafenib/trametinib
drug therapy if cKIT mutation is present
imatinib
