Melanoma Flashcards
What are the risk factors for melanoma?
unprotected sun exposure, fair skin, dysplastic naevi, immunosuppression, family history
What genes increase risk of melanoma?
CDKN2A, CDK4
What are the prognostic factors in melanoma?
tumour thickness, mitotic rate, ulceration, primary tumour location, older age, male, lymph nodes
What is the treatment for stage 0 melanoma?
surgical resection
What is the management for stage I melanoma?
surgical resection, consider sentinel LN biopsy
What is the management for stage II melanoma?
surgical resection, sentinel LN bx, consider adjuvant RTx and systemic Tx
What is the management for stage III melanoma?
surgical resection, nodal dissection, consider adjuvant RTx and systemic Tx
What is the most important mutation in melanoma?
BRAF
What are the BRAF inhibitors?
vemurafenib and dabrafenib
What percentage of patients on BRAF inhibitors develop resistance?
80%
How do you prevent BRAF inhibitor resistance?
use in combination with a MEK inhibitor
What are the common side effects of BRAF inhibitor and MEK inhibitors?
fever, rash, pruritus, photosensitivity
What are the immunotherapies available for melanoma?
Anti-CTLA4 (ipilimumab), PD-1 inhibitors (pembrolizumab, nivolumab)
Which is better anti-CTLA4 or PD-1 inhibitors?
PD-1 inhibitors
Which has better toxicity profile anti-CTLA4 or PD-1 inhibitors?
PD-1 inhibitors
What are the common sites of immune related adverse events?
skin, GI, liver, thyroid, adrenal, lung
What is the treatment for immune related adverse events?
if mild treat symptomatically, if moderate - oral steroids, if severe - high dose IV corticosteroids and stop immunotherapy
What are the most common cutaneous immune related adverse events?
maculopapular rash, steven johnson, sweet syndrome, bullous pemphigoid
What is the treatment for asymptomatic endocrinopathies?
monitoring
Should adjuvant treatment be used in stage III melanoma?
yes - evidence for improved survival with BRAF/MEK inhibitors and anti-CTLA4 inhibitors
