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RT + O Exam 2018 > Melanoma > Flashcards

Melanoma Flashcards

RT + O Exam

1
Q

How many registrations and deaths were there in NZ in 2013?

A

2400 reg

350 deaths

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2
Q

Who has the highest rates of Melanoma in the world?

A

NZ and Aus

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3
Q

How common is Melanoma? And how common is it to die from it?

A

4th most common cancer in NZ
4th most common cause of death - men
6th most common cause of death - women

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4
Q

Is there a discrepancy between men and women/Maori and non Maori?

A

Men have higher incidence and mortality rates than women and it’s increasing.
More common in non-Maori

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5
Q

Melanoma Epidemiology

A 
NZ and Aus = highest rates in the world
4th most common cancer in NZ
4th most common cause of death - men
6th most common cause of death - women
2400 reg and 350 deaths
Men have higher incidence and mortality rates and it's increasing. 
More common in non-Maori
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6
Q

Why is incidence so high in NZ?

A

Exposure to UV
- 40% higher in summer than corresponding latitudes in N hemisphere
- Many melanoma types linked to UV radiation
- Hole in the Ozone layer
Continuous exposure to sun - outdoor vocations and lifestyles
- Healthy tan attitude
High proportion of population with skin types that burn easily - Genetic disposition/heritage
- English, Irish, Scottish

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7
Q

What risk factors are related to Genetic characteristics?

A

Genetic characteristics

  • Fair features
  • Large # of moles
  • Immunosuppression
  • Previous diagnosis or melanoma/skin cancers
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8
Q

What are the risk factors associated with Melanoma?

A

Genetic characteristics
Strong family history
Excess sun exposure/burns during childhood/adolescence = greater risk
Increased risk with use of sunbeds under the age of 35
Carcinogens - petroleum, benzene and pesticides

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9
Q

What are the 4 Predictive Factors for Melanoma?

A

Thickness: Breslow Scale + TNM
Ulceration: Ulcerated tumours typically have increased thickness compared with non-ulcerated and therefore have a tendency to metastasise
Mitotic rate: # of mitoses/mm^2, the greater the number of mitoses = worse prognosis
Lactate Dehydrogenase (LDH): Serum levels found in blood - most predictive of decreased survival

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10
Q

What does the A stand for in Clinical Presentation and what does it mean?

A

A - Asymmetry - the shape of one half does not match the other

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11
Q

What does the B stand for in Clinical Presentation and what does it mean?

A

B - Borders - the edges are ragged, uneven, blurred or irregular in outline, the pigment may spread into the surrounding skin

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12
Q

What does the C stand for in Clinical Presentation and what does it mean?

A

C - Colour variation - colour is uneven, and may include colours like black, brown and tan

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13
Q

What does the D stand for in Clinical Presentation and what does it mean?

A

D - Diameter - larger than 6mm or if the size changes and increases

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14
Q

What does the E stand for in Clinical Presentation and what does it mean?

A

E - Evolving - getting larger or changing

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15
Q

What is the surgical margin for melanoma in situ?

A

5-10mm

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16
Q

What is the surgical margin for a lesion less than 1mm thick?

A

10mm

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17
Q

What is the surgical margin for a lesion 1-2mm thick?

A

10-20mm

18
Q

What is the surgical margin for a lesion 2-4mm thick?

A

10-20mm

19
Q

What is the surgical margin for a lesion more than 4mm thick?

A

20mm

20
Q

When is a SLNB recommended/indicated?

A

For lesions thicker than 1mm

21
Q

What investigations are used for Melanoma?

A
  • Complete history and physical exam
  • Biopsies
  • FNA of LN
  • Routine blood tests
  • Ultrasound
  • CT
  • MRI
  • PET-CT
22
Q

What does biopsy selection depend on?

A
  • Tumour site
  • Tumour size
  • Consideration of future tmt
23
Q

What are the types of biopsies used for Melanoma?

A

Excisional biopsies (1-3mm thick) ideal and where appropriate
- Sent for pathological examination
Full thickness incisional biopsy if the lesion is too large to completely excise
Punch biopsy of the thickest part
SLNB

24
Q

What does Melanoma NZ do?

A

Provides info, promotion of early checks, involvement, support, research and clinical trials
Works closely with SunSmart and Health Promotion agency
Melanoma Awareness Week - Go Spotty Day

25
Q

What does MelNet (The Melanoma Network of NZ) do?

A

Network of professionals working to reduce the incidence and impact of Melanoma in NZ
Promotes education and the advancement of best practice
Holds 3 yearly summits

26
Q

Where are normal melanocytes found and what do they do?

A

They are found in the basal layer of the epidermis

They produce a protein called melanin which protects the skin by absorbing UV radiation

27
Q

What cell does Melanoma originate from and how does it begin?

A

Melanocyte cells. It starts from an uncontrolled proliferation of transformed melanocyte stem cells

28
Q

What is Melanoma in Situ?

A

Melanoma cells confined to the epidermis

29
Q

What is invasive melanoma?

A

When the melanoma cells have grown through the basement membrane and into the dermis

30
Q

What is metastatic melanoma?

A

Spread of melanoma via lymphatics or blood stream to other organs (lung, brain, bone, liver and skin)

31
Q

What is included in a Melanoma pathology report?

A
  • Diagnosis of primary melanoma
  • Breslow thickness to the nearest 0.1mm
  • Clarke’s Level of Invasion
  • Margins of excision
  • Mitotic rate
  • Whether or not there is ulceration
  • Comments about the cell type, growth pattern, invasion of blood vessels or nerves, inflammatory response, regression, and whether there is associated in-situ disease and or naevus (mole)
  • Immunochemical info (if tested)
32
Q

What are the 5 subtypes of Melanoma?

A 
Superficial Spreading
Nodular
Lentigo Maligna
Acral Lentiginous
Desmoplastic
33
Q

What is the Breslow scale?

A

Max thickness of lesion from the top of the skin’s surface to the deepest point of invasion
Measured by a pathologist with a microscope
Main measurement to decide the surgical margin, if SLNB or if further tmt is necessary
Use this as well as TNM staging to determine tmt

34
Q

What is Clarke’s Level?

A

Indicates how many layers of the skin the melanoma had invaded
Deeper level = greater risk of metastasis
Less reliable and more subjective than Breslow - also less indicative of outcomes

35
Q

When is RT used to treat Melanoma?

A
  • As a definitive tmt for unresectable disease or if the primary tmt is limited (due to location)
  • As adjuvant tmt post lymphadenectomy to improve regional control
  • Metastatic or recurrent disease
  • Palliation to primary, metastatic or regional foci to prevent pain, ulceration or bleeding
36
Q

What are the indications for adjuvant RT?

A
  • Large lymph nodes (>3cm)
  • 2 or more + LN
  • Extranodal extension
37
Q

What is the conventional fractionation schedule used?

A

48Gy in 20#, 2.4Gy/#

38
Q

What is the hypofractionated schedule used?

A

30Gy in 5#, 6Gy/#, 2#/week.
Often used for more radioresistant cells
Improves local control rates

39
Q

What is the palliative prescription used?

A

6Gy/# given 1# per week for 5-6 weeks

30Gy/10#

40
Q

When would stereotactic RT be used and what is the prescription?

A

Pts with good performance status with solitary brain mets

15-24Gy depending on location

41
Q

What types of RT are used?

A 
3DCRT most common, but IMRT and VMAT can be used.
Superficial better suited to some subtypes (lentigo maligna melanoma)
Brachy used (superflab bolus or custom cast)
42
Q

What are the options for Metastatic Melanoma?

A

Surgery - try to remove the lesion to prevent pain and ulceration
RT - Palliation to primary/to previously disected nodal basin
Chemotherapy - Dacarbazine
Immunotherapy
Stereotactic RT - Brain mets

RT + O Exam 2018 (5 decks)

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