Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Dermatology Board Prep > DERM (18) Skin Growths > Melanoma > Flashcards

Melanoma Flashcards

1
Q

What percent of skin cancer deaths occur from melanoma?

A

75%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What type of melanoma is most common in patients with darker skin types?

A

Acral lentiginous subtype

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are 3 main risk factors for melanoma?

A

Genetic phenotypic, gene/environmental interactions, and UVR exposure (most important for Caucasians and Hispanics)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the genetic mutation responsible for familial melanoma (FAMMM syndrome)?

A

CDKN2A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What other cancer can the CDKN2A mutations cause?

A

Pancreatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What type of radiation is more important for melanoma? and why?

A

UVB > UVA, this penetrates to the DEJ, which is where the melanocytes are located

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the most important clinical/cutaneous risk factor for melanoma?

A

Total # of melanocytic nevi>more than 5 atypical nevi > lentigines sun exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the most common types of melanoma that arise from people with many nevi?

A

Superficial spreading then nodular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What types of UVR exposure are important in melanoma?

A

Intermittant and chronic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What two mutations are mutated in 80% of melanocytic nevi and melanomas? And what pathway are they part of?

A

NRAS and BRAF –> part of the MAPK pathway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the most common mutation in BRAF?

A

V600E (valine to glutamine switch at 600)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What body sites are the BRAF mutated melanomas most common in?

A

Areas that are non-chronic sun-damaged (superficial spreading most common type of melanoma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are 3 genes that are more commonly involved in melanomas arising from chronically sun-damaged sites?

A

NRAS and C-kit CCND1/CDK4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What clinically sites in melanoma more often have mutations in CCND1/CDK4?

A

Acral and mucosal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What sites for melanoma more commonly have c-KIT mutations?

A

Mucosal, acral, and chronic sun-damaged

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is upregulated on melanomas to inhibit t-cell activation?

A

CTLA4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the “little red riding hood” sign for melanoma?

A

Erythema or inflammation surrounding a melanoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the Garbe’s rule in melanoma?

A

Essentially asserts that if a patient is worried about a lesion then this should lower the threshold to bx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Most is the most common type of melanoma?

A

Superficial spreading

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How often do superficial melanomas arise within a nevus?

A

50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

2nd most common melanoma in Caucasians?

A

Nodular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the difference between nodular and superficial spreading types of melanoma?

A

In superficial spreading, there is a longer, slower, horizontal growth phase that transitions to a rapid vertical growth phase

In nodular melanoma there is de-novo vertical growth, no horizontal growth phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the most common mutation in nodular melanomas?

A

NRAS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the growth phase like for lentigo maligna melanoma?

A

Long horizontal growth phase precedes invasion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What % of lentigo maligna goes to LMM?

A

~5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Clinical morphology of LM?

A

Macule, it is flat because the pathology is only in the epidermis and not dermal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the most common mutation in acral lentiginous melanoma?

A

c-KIT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the Hutchinson sign for nail matrix melanoma?

A

Extension of brown or black pigment beyond the nail bed into the nail folds.

Also melanonychia with a width greater than 3mm is a risk of nail-fold melanoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What pathophysiologic factors occur in the vertical growth phase of melanoma?

A

Angiogensis, expression of VEGF, decreased responsiveness to inhibitory cytokines, ability to metastasize.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How is Breslow depth measured?

A

Measured in mm from top of the granular cell layer or base of superficial ulceration to the deepest point of tumor invasion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the different Clark levels?

A

1=epidermis

2=papillary dermis

3=papillary/reticular dermis interface (fills papillary dermis)

4=invasion into the reticular dermis

5=invasion into the SQ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Is prognosis worsened with ulceration?

A

Yes, ulceration receives a change in T-stage from “a” to “b”

  • An ulceration width >3mm is associated with mitoses and risk of metastasis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the prognostic index in the setting of melanoma?

A

Mitoses (mitotic rate) x tumor thickness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are satellite deposits and why are they important in the setting of melanoma?

A

Microsatellites separated from the main body of the tumor but in close proximity (<1cm) [Should have some normal stromal between these nests or cells and the main tumor]

  • Better indicator of occult region LN mets in clinical stage I melanoma than the tumor thickness
  • Recent study showed that microsatellites predict locoregional relapse but not overall survival
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is neurotropism in the setting of melanoma and what is the importance?

A

The tendency to adopt a circumferential arrangement around small nerves in the deep dermis and subcutaneous tissue

  • Significant risk of local recurrence
  • Neurotropic melanomas Neurotropism + neural transformation (spindle-shaped cells with neuroma-like patterns may invade cranial nerves and their major branches
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is the importance of lymphocyte infiltration in melanoma?

A

Increased ratio of width of the lymphocytic infiltrate to the width of the tumor = increased survival

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Definition of micrometastases?

A

Diagnosed after sentinel or elective lymphadenectomy by microscopy without clinical evidence of detection.

Macrometastese are those that are palpable, visible on imaging, or those that show extracapsular invasion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is nest discohesion in melanoma on histopathology?

A

Nests that fragment into individual cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Which stain is the most specific to melanoma?

A

SOX10, intranuclear stain that is most specific to melanoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Why is tyrosinase/hMB45 less specific for melanoma?

A

The transfer of melanosome to keratinocytes makes it so you can get staining in the keratinocytes creating false positives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is the definition of local recurrence in melanoma?

A

A lesion that arises within 2cm of scar from primary excision

42
Q

When should a sentinal lymph node biopsy be performed?

A

0.8 to <1cm can consider, if greater than 1cm it should be done

43
Q

What medications can be used to treat melanomas with c-kit mutations?

A

Imatinib, nilotinib, dasatinib, sunitinib

44
Q

What are the 2 BRAF inhibitors commonly used/available?

A

Vemurafenib and dabrafenib (notice the raf in name)

45
Q

What lesions are associated with BRAF inhibitor treatment?

A

Most common lesions are: verrucous keratosis, SCC, and keratoacanthoma

46
Q

What is a MEK inhibitor used in melanoma?

A

Trametinib

47
Q

What is one reason why MEK inhibitors should be used in combo w/ BRAF inhibitors?

A

Decreases risk of SCC from BRAF inhibitors

48
Q

Aside from melanoma, what other cutaneous neoplasms/conditions can imatinib or dasatinib be used for?

A

DFSP, myeloproliferative hypereosinophilic syndrome

49
Q

What are some commonly used PD-1 inhibitors for melanoma?

A

Pembrolizumab, nivolumab

50
Q

What are some PD-L1 inhibitors that are used in melanoma?

A

Atezolizumab, durvalumab, avelumab

51
Q

What does CDKN2A encode for?

A

p14 and p16 - regulates Rb and p53 activity

52
Q

What are the wavelengths and the penetration depths (in anatomical terms) for UVA, UVB, and UVC?

A

UVC= Superficial spinous layer (250nm)

UVB= Papillary dermis (300nm)

UVA= Deep dermis (350nm)

53
Q

Most common body site for NRAS mutated melanomas? What types of Melanomas are these usually?

A

Chronically sun-damaged sites, nodular melanomas

54
Q

Most common body site for c-KIT mutated melanomas? What types of Melanomas are these usually?

A

Chronically sun-damaged sites, mucosal and acral melanomas

55
Q

Most common body site for CCND1/CDK4 mutated melanomas? What types of Melanomas are these usually?

A

Chronically sun-damaged sites, mucosal and acral melanomas

56
Q

Most common body site for GNAQ/GNA11 mutated melanomas? What types of Melanomas are these usually?

A

Uveal melanoma, blue nevi, and nevus of Ota

57
Q

Most common body site for BAP-1 mutated melanomas? What types of Melanomas are these usually?

A

Uveal melanoma, malignant cellular blue nevi (worse prognosis)

Internal malignancies like mesothelioma, renal cell carcinoma, and others

58
Q

What mutations are a/w non-sun damaged areas and superficial spreading melanomas?

A

BRAF

59
Q

What mutations are a/w chronic sun-damaged skin and nodular melanomas?

A

NRAS

60
Q

What mutations are a/w chronic sun-damaged skin and acral/mucosal melanomas?

A

c-KIT, CCND1/CDK4

61
Q

What mutations are a/w uveal melanoma?

A

BAP-1, GNAQ/GNA11 (BAP-1 worse prognosis)

62
Q

How does melanoma evade immune detection?

A

Normally B7 on APC cells binds CD28 on T-cells and activates host response. Melanoma cells increase the expression of CTLA-4 which inhibits CD28 and downregulates host response.

  • Loss of tumor-specific antigens
  • Loss of MHC-1 molecules
  • Secretion of immune inhibitory cytokines (Il-10 and TGF-beta)
  • Inducible IL-10 producing T-regs
63
Q

What is the most common mutation in superficial spreading melanoma?

A

BRAF

64
Q

What is the most common location for superficial spreading melanoma?

A

Trunk (men), Legs (women)

65
Q

Most common locations for nodular melanoma?

A

Head/neck, and back

66
Q

Most common locations for Lentigo Maligna Melanoma?

A

Nead and neck (sun-exposed sites)

67
Q

What is the epidemiology of acral lentiginous melanoma?

A

The raw rates are equally common among white and skin of color patients, however, among those with darker skin types this is the most common type of melanoma (they have overall lower rates of melanoma). It is most common in the 7th decade

68
Q

Definition of the radial phase of melanoma?

A

Is the progressive centrifugal spread of melanoma, can’t metastasize, invasion of the papillary dermis only by single nested cells can be seen, unless there are mitoses then this is considered vertical phase

69
Q

What are the essential histologic features reported for melanomas?

A

Breslow depth, Clark level, Ulceration, Satellite deposits, Lymphocyte infiltration, Lymphovascular invasion, Perineural involvement (neurotropism), Histological Subtype

70
Q

What is the definition of T1 melanoma?

A

Size <1.00mm –> T1a= <0.8 mm w/ no ulceration T1b=>0.8mm-1mm or either size w/ ulceration

71
Q

What is the definition of T2 melanoma?

A

1-2mm; T2a= 1-2mm w/o ulceration T2b= 1-2mm w/ ulceration

72
Q

What is the definition of T3 melanoma?

A

2-4mm; T3a=unknown or no ulceration T3B=w/ ulceration

73
Q

What is the definition of T4 melanom?

A

>4mm T3a=unknown or no ulceration T3B=w/ ulceration

74
Q

N0 definition?

A

No nodal metastases

75
Q

N1 definition?

A

1 Node + -N1a if only micrometastasis -N2b if macrometastasis

76
Q

N2 definition?

A

2-3 nodes

  • N2a if only micrometastasis
  • N2b if macrometastasis
  • N2c if in transit mets/satellite w/o metastatic nodes
77
Q

N3 definition

A

4 or more metastatic nodes, matted nodes, or in-transit mets/satellites with metastatic nodes

78
Q

Definition of in-transit metastases?

A

>2cm from the primary tumor, but not beyond the regional lymph node

79
Q

Definition of satellite lesions?

A

Satellite lesions: within 2cm of the primary

80
Q

Definition of M1 melanomas?

A

a=distant skin, subcutaneous, or nodal metastases w/ normal LDH b=lung metastases, LDH normal

c=all other visceral metastases or if serum LDH is elevated

d=neurologic/brain metastases (new for 8th edition)

81
Q

What are the appropriate margins for melanoma excision by size?

A

Mis: 0.5-1cm

Breslow <1mm = 1 cm WLE

Breslow 1-2mm = 1-2 cm WLE to fascia

Breslow <2mm = 2 cm WLE to fascia

82
Q

What is the definition of local recurrence?

A

Defined as any recurrence within 2 cm of the scar from the primary melanoma excision

  • Results from the extension of the primary tumor or intralymphatic spread
  • Risk is ~4%, and is increased in thicker or ulcerated tumors and those located on the head, neck or distal lower extremity
83
Q

What medications can be used for c-KIT mutations?

A

Imatinib, nilotinib, dasatinib, sunitinib

84
Q

What medications can be used for BRAF mutated melanomas?

A

Sorafenib, vemurafenib, and dabrafenib (notice the “raf” in the name)

Should be used with MEK inhibitors ideally to reduce resistance. (trematinib, cobimetinib, binimetinib)

85
Q

Most common side effects of braf inhibitors

A

Vemeruafinib/dabrafinib

cutaneous: exanthematous rash - papulopustular on face, torso and arms.
- keratotic lesoins (SCC and keratoacanthoma!)
- verrucous keratosis (MOST COMMON) benign
- photosensitivity, alopecia, plantar hyperkeratosis

non cutaneous: arthralgias, nausea, dirarrhea, fatigue, QT PROLONGATION and RETINAL VEIN THROMBOSIS

86
Q

Most common and most serious SE’s for MEK inhibitors?

A

GI S/E most common, rash also very common (~57%), hypoalbuminemia, dysgeusia, xerostomia. CARDIOMYOPATHY, interstitial lung dz, RETINAL VEIN OCCLUSION.

87
Q

What are the main dermatologic applications of the tyrosine kinase inhibitors Imatinib/dasatinib?

A

Melanoma (c-kit), myeloproliferative hypereosinophilic syndrome, and DFSP.

88
Q

What are the most common cutaneous SE’s with tyrosine kinase inhibitors imatinib and dasatinib?

A

Cutaneous: rash (maculopapular, nonspecific), hypopigmented/depigmentation (due to inhibition of c-KIT which is involved in melanocyte activation), lichenoid eruptions (oral and mucosal), photosensitivity

89
Q

Most common SE’s of ipilimumab and tremelimumab?

A

Cutaneous: rash –> maculopapular or eczematous on trunk/extremities. pruritus, alopecia and hypopigmentation

Noncutaneous: GI (most severe) and common–> diarrhea, constipation, and bloating. Can be severe (life-threatening colitis w/ bowel perforation)

Uncommon: hypothyroidism, transaminitis, hepatitis, and hypopituitarism.

90
Q

Explain how PD-1 inhibitors work?

A

PD-1 is normally expressed on activated T cells. This binds to PD1-L1/L2 (expressed on tumor cells) –>deactivation of T-cells –>loss of immune responses.

Monoclonal antibodies target PD-1–> prevents T cells deactivation which increases the immune-mediated tumoricidal activity

91
Q

SE associated with PD-1 inhibitors?

A

Cutaneous: non-sepcific rash

Noncutaneous: fatigue, pruritis, pnemonitis, colitis, hepatitis, nephritis, reanl dysfunction, and thyroid dysfunction.

92
Q

What are the PD-L1 inhibitors and some primary uses for these?

A

Atezolizumab (urothelial carcinoma/nsclc), durvalumab (urotherlial carcinoma and unresectable nsclc) , avelumab (metastitic merkel-cell carcinoma)

93
Q

What is a “BAPoma”?

A

Epithelial Spitzoid nevus, associated with BAP-1 loss

94
Q

What is the immunohistologic staining of desmoplastic melanomas?

A

Melan-A/HMB-45 negative, S100 +, SOX-10 +

95
Q

What size of margins should be taken in an excisional biopsy of a pigmented lesion?

A

Somewhat controversial, if you feel strongly that it is Mis, can consider a full margin, but usually recommended 2mm margins and then re-excise if positive

96
Q

What are the general histologic features that would suggest melanoma?

A

Asymmetry, poor circumscription, irregularly sized and shaped junctional nests with discohesion, lentiginous/confluent growth along DEJ more than nests, pagetoid scatter “epidermal consumption”, which is where melanoma effaces epidermis which leads to epidermal thinning and ulceration, an extension to the adnexal epithelium, lack of maturation of dermal component, dermal mitoses, cytologic atypia (irregular large nuclei, w/ prominent red nucleoli)

97
Q

What is the staging definitions for IA-IIC?

A

All are N0/M0

IA = T1a

IB = T1b/T2a

IIA= T2b/T3a

IIB= T3b/T4a

IIC= T4b

98
Q

What is the definition of melanoma overall stages of IIIA-C?

A

For the III’s, it can be any T, M0, the differences come down to the N’s and higher combinations of T’s

IIIA = N1a/N2a and T1a-4a

IIIB = N1a/N2a if T4b or T1-4a N1b-N2b-c

IIIC = T4b N1B-N2c or any T + N3

99
Q

What is the definition of stage IV melanoma?

A

IV = any M1, as soon as there is metastasis = IV

100
Q

What mutations are commonly seen in Spitz nevi that are not often seen in melanomas?

A

H-ras mutations

101
Q

What two genes are most commonly mutated in melanoma?

A

BRAF and NRAS

DERM (18) Skin Growths (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions