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ENT Cutaneous Malignancies > Melanoma > Flashcards

Melanoma Flashcards

1
Q

What percentage of mucosal melanomas present

in the head and neck?

A

55%

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2
Q

What is the most common head and neck site

where mucosal melanoma is found?

A

Nasal cavity

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3
Q

Where do most melanomas arise?

A

● Most melanomas arise on the trunk and extremities.
● Nodular melanoma and lentigo maligna melanoma more
commonly occur in the head and neck than other
subtypes.

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4
Q

What is the incidence of lymphatic metastasis in

malignant melanoma?

A

Incidence varies by subtype, depth, and location.
● < 0.75 mm: < 5%
● 0.75 to 4.0 mm: 15 to 20%
● 4.0 mm: 34%
Incidence increases with ulceration, nodular type, Clark
level IV or V, and elevated mitotic rate.

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5
Q

What is the metastatic rate of desmoplastic

melanoma?

A

Pure desmoplastic melanoma displays regional lymph node involvement in 0 to 2.2% of cases, whereas mixed desmo-
plastic melanoma has regional lymph node involvement in 8.5 to 22%. Distant metastasis is similar in the two
subtypes, at approximately 11 to 12%.

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6
Q

How has the incidence of melanoma changed in the United States in the last 30 years?

A

● It has seen a threefold increase in the white population.

● The rate has been stable in the black population.

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7
Q

What are the risk factors for cutaneous

melanoma?

A

Family history, lightly pigmented skin, tendency to burn, red hair, DNA repair defects (e.g., xeroderma pigmentosum), chronic and intense sun exposure, equatorial residence, tanning bed use, immunosuppression, > 100 melanocytic nevi, more than five atypical melanocytic nevi,
multiple solar lentigines, personal history of cutaneous
melanoma

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8
Q

What familial autosomal dominant disorder

greatly increases the risk of melanoma?

A

Atypical mole syndrome

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9
Q

What are the common subtypes of cutaneous

melanoma?

A 
● Superficial spreading (57%)
● Nodular melanoma (21%)
● Lentigo maligna (9%)
● Acral lentiginous (4%)
● Unclassifiable (4%)
● Other (5%)
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10
Q

What sizes of congenital nevus have an increased

risk of developing into melanoma?

A

Giant congenital nevus (2 cm or larger)

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11
Q

What is the most common histologic subtype of

melanoma?

A

Superficial spreading

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12
Q

What is the second most common histologic
subtype of melanoma and the most aggressive
subtype?

A

Nodular melanoma

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13
Q

What differentiates lentigo maligna from lentigo

maligna melanoma?

A

Lentigo maligna melanoma has invasion into the dermis.

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14
Q

What subtype of melanoma is found on the soles

of feet or palms of hands?

A

Acral lentiginous

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15
Q

Which melanoma subtype is considered the least

aggressive?

A

Lentigo maligna melanoma. It displays a long radial growth

phase relative to other subtypes.

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16
Q

What are the most common genetic aberrations

found in melanoma?

A

● Chronic sun-damaged skin: KIT > KIT + NRAS = BRAF =
NRAS
● Nonchronic sun-damaged skin: BRAF > > NRAS
● Mucosal: KIT > > NRAS

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17
Q

What are the ABCDEs of melanoma?

A 
● A = asymmetry
● B = border irregularity
● C = color variability
● D = diameter greater than 6 mm
● E = evolving over time
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18
Q

What is the clinical evaluation that all patients with

newly diagnosed melanoma should receive?

A

Full-body skin examination, including hair-bearing areas and
intertriginous areas, and examination of the relevant lymph
node basins

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19
Q

When should imaging be performed in malignant

melanoma?

A

● Extensive primary (fixation, perineural symptoms)
● Abnormal or equivocal adenopathy
● Stage III or greater disease
● Specific signs or symptoms to suggest metastatic disease

20
Q

What is the most ideal method to obtain a biopsy

of a lesion suspicious for melanoma?

A

Narrow-margin excisional biopsy with adequate depth to

determine accurate Breslow depth

21
Q

What histopathologic markers are commonly used

to identify melanoma?

A

● Homatropine methylbromide (HMB-45)
● S-100 protein
● Melan-A (MART-1)

22
Q

What is the preferred evaluation of suspicious
lymphadenopathy in patients with cutaneous
melanoma?

A

FNA with or without ultrasound. Equivocal adenopathy can
be evaluated with ultrasound. Suspicious adenopathy
should be biopsied. A normal ultrasound does not replace
sentinel lymph node biopsy.

23
Q

What are potential sites for occult primaries in
patients with metastatic melanoma of the head
and neck?

A

Ocular, mucosal, external auditory canal, hair-bearing areas,
or tumor regression

24
Q

Describe the Clark levels for melanoma staging.

A

● Level I: Epidermis only
● Level II: Through basal cell layer into papillary dermis
● Level III: Fills papillary dermis, to junction with reticular
dermis
● Level IV: Involves reticular dermis
● Level V: Subcutaneous tissue

25
Q

What is the stage of a 2-mm-thick melanoma

without ulceration?

A

T2a, stage IB

26
Q

What are the M stages of melanoma metastasis?

A

● M1a: Metastatic melanoma to dermis
● M1b: Metastatic melanoma to the lung
● M1c: Metastatic melanoma to other visceral organs or
abnormally elevated LDH

27
Q

What is the most common site of melanoma

metastasis?

A

Regional lymph nodes

28
Q

How does mitosis impact T stage in cutaneous

melanoma?

A

T1 lesions with one or more mitoses/mm2 are T1b.

29
Q

How does ulceration impact T stage in cutaneous

melanoma?

A

Lesions ulceration are upstaged to b (i.e., T1a vs. T1b)

30
Q

What differentiates Stage III A, B, and C disease in

cutaneous melanoma?

A

● IIIA: Any T-a and N-a (i.e., T4aN2a)
● IIIB: One of T or N is a, one is b (i.e., T4aN2b or T4bN2b)
or any T1–4aN2c
● IIIC: Any T1–4b and N1–2b or N2c or any TN3 (i.e.,
T1bN2b or T1aN3)
● All must be M0 (M1 = stage 4)

31
Q

What is the lifetime risk of developing a second

primary melanoma?

A

4 to 8%

32
Q

In localized melanoma, what is the most important prognostic factor?

A

Tumor thickness (Breslow depth of invasion)

33
Q

What is the most significant prognostic factor in

patients with stage III melanoma?

A

Presence of in-transit metastasis or in-satellite metastasis

34
Q

What are the respective 5-year survival rates for
melanoma patients with positive and negative
sentinel lymph nodes?

A

56% vs. 90%

35
Q

What is the 5-year survival for a patient with

metastatic melanoma?

A

10 to 20%

36
Q

What serum factor is an independent predictor of

survival in stage IV metastatic melanoma?

A

LDH

37
Q 
What is the treatment of choice for superficial-
thickness melanomas (< 1.01 mm)?
A

Wide local excision with 1 cm margins

38
Q

When should sentinel lymph node biopsy be
considered in melanoma measuring 0.75 to
1.00 mm?

A

Tumors with ulceration or one or more mitosis/mm2

39
Q 
What is the treatment of choice for intermediate
thickness melanomas (1.01 to 4.00 mm)?
A

Wide local excision with 2-cm margins and sentinel lymph

node biopsy

40
Q

What is the treatment of choice for deep thickness

melanomas (> 4.00 mm)?

A

Wide local excision with 2-cm margins and sentinel lymph

node biopsy

41
Q

Which chemotherapeutic agent is approved for

treatment of stage IV melanoma?

A

Dacarbazine

42
Q

What is the treatment of choice for melanoma

involving the auricle?

A

Wide local excision

43
Q

What adjuvant therapy is approved for use after

surgery for stage III melanoma?

A

Interferon-α2b

44
Q

What is the recommended treatment for Spitz

nevus?

A

In many instances, Spitz nevus is difficult to distinguish

from melanoma even for experienced pathologists. There-
fore, complete excision is essential.

45
Q

What are the contraindications to methylene-blue

dye injection?

A

● Previous hypersensitivity
● Pregnancy
● Concurrent use of selective serotonin reuptake inhibitor
or other serotonergic drugs (serotonin syndrome)
● Glucose-6-phosphate dehydrogenase deficiency

46
Q

What are the most common complications associated with Mohs surgery?

A

Complication rates in Mohs surgery are quite low, with
hematoma and graft necrosis being among the most
common.

ENT Cutaneous Malignancies (5 decks)

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