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BPT Oncology > Melanoma > Flashcards

Melanoma Flashcards

1
Q

What are the risk factors for melanoma?

A

unprotected sun exposure, fair skin, dysplastic naevi, immunosuppression, family history

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2
Q

What genes increase risk of melanoma?

A

CDKN2A, CDK4

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3
Q

What are the prognostic factors in melanoma?

A

tumour thickness, mitotic rate, ulceration, primary tumour location, older age, male, lymph nodes

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4
Q

What is the treatment for stage 0 melanoma?

A

surgical resection

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5
Q

What is the management for stage I melanoma?

A

surgical resection, consider sentinel LN biopsy

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6
Q

What is the management for stage II melanoma?

A

surgical resection, sentinel LN bx, consider adjuvant RTx and systemic Tx

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7
Q

What is the management for stage III melanoma?

A

surgical resection, nodal dissection, consider adjuvant RTx and systemic Tx

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8
Q

What is the most important mutation in melanoma?

A

BRAF

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9
Q

What are the BRAF inhibitors?

A

vemurafenib and dabrafenib

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10
Q

What percentage of patients on BRAF inhibitors develop resistance?

A

80%

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11
Q

How do you prevent BRAF inhibitor resistance?

A

use in combination with a MEK inhibitor

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12
Q

What are the common side effects of BRAF inhibitor and MEK inhibitors?

A

fever, rash, pruritus, photosensitivity

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13
Q

What are the immunotherapies available for melanoma?

A

Anti-CTLA4 (ipilimumab), PD-1 inhibitors (pembrolizumab, nivolumab)

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14
Q

Which is better anti-CTLA4 or PD-1 inhibitors?

A

PD-1 inhibitors

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15
Q

Which has better toxicity profile anti-CTLA4 or PD-1 inhibitors?

A

PD-1 inhibitors

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16
Q

What are the common sites of immune related adverse events?

A

skin, GI, liver, thyroid, adrenal, lung

17
Q

What is the treatment for immune related adverse events?

A

if mild treat symptomatically, if moderate - oral steroids, if severe - high dose IV corticosteroids and stop immunotherapy

18
Q

What are the most common cutaneous immune related adverse events?

A

maculopapular rash, steven johnson, sweet syndrome, bullous pemphigoid

19
Q

What is the treatment for asymptomatic endocrinopathies?

A

monitoring

20
Q

Should adjuvant treatment be used in stage III melanoma?

A

yes - evidence for improved survival with BRAF/MEK inhibitors and anti-CTLA4 inhibitors

BPT Oncology (10 decks)

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