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Oncology Exam 3 > Melanoma > Flashcards

Melanoma Flashcards

1
Q

Who is melanoma more common in?

A

Caucasians > AA

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2
Q

Melanoma accounts for ___% of skin cancer fatalities

A

75

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3
Q

T/F there has been a steady increase in new cases of melanoma but the death rate has stayed the same

A

true!

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4
Q

Risk factors for melanoma

A 
Male
>60 years old
Personal or family history
Genetic factors
Immunocompromised
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5
Q

Susceptible populations in melanoma

A

Fitzpatrick type I or II = fair skin, light hair, light eyes

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6
Q

What is the biggest cause of melanoma?

A

UV radiation!

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7
Q

What does UV radiation do to the skin?

A
  1. DNA changes
  2. Impairs immune function
  3. Increase growth factors
  4. Form ROS
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8
Q

T/F blistering sunburns do not increase your risk of melanoma

A

False!

1 occurrence doubles the risk!

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9
Q

T/F exposure to sunbeds/sunlamps <20 triples the risk of melanoma

A

False!

<30 triples the risk!

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10
Q

Who should receive yearly clinical exams for melanoma?

A

high risk patients

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11
Q

How often should you do self-exams for melanoma?

A

monthly

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12
Q

ABCDE of melanoma

A 
Asymmetry
Border irregularity
Color
Diameter
Evolving
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13
Q

T/F the histologic subtypes of melanoma have different treatments

A

false!
all treated the same
same prognosis

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14
Q

S/S of melanoma localized disease

A

usually asymptomatic, itch, ulcerated or bleed

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15
Q

S/S of melanoma larger lesions

A

Bulky
Inflammation
Bleed/crust
Sensory change

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16
Q

Diagnosis of melanoma

A

Biopsy
Complete history
Total body skin exam
Consider more workup if III/IV

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17
Q

Melanoma staging

A

Breslow’s thickness

III: lymph nodes
IV: metastatsis

18
Q

T/F stage III and IV Melanoma have a good prognosis

A

false!
rapidly decrease within first 2 years
Good = I or II

19
Q

Predictive survival factors of melanoma

A 
Age (>60 = worse)
Male = worse
Brewslow tumor thickness
Ulceration
Mitotic rate
LDH
20
Q

Sentinel node dissection if recommended for who in melanoma?

A

lesion > 1 mm thick

21
Q

Stage I or II treatment melanoma

A

wide excision then observe +/- sentinel node biopsy

22
Q

Stage III treatment melanoma

A

Wide excision of tumor
Complete lymph node dissection (CLND)
**adjuvant therapy)

23
Q

*Adjuvant therapy options in stage III melanoma

A

Chemo = NOT recommended outside trials
Immunotherapy = PD1 inhibitors*
Targeted therapies
Observe

24
Q

Is surgery curative in metastatic melanoma?

A

NO!

used for palliative reasons

25
Q

Main treatments for metastatic melanoma

A

Immunotherapy

Targeted therapy

26
Q

PD1 inhibitors in melanoma

A

Pembrolizumab

Nivolumab

27
Q

*Main counseling points on PD1 inhibitors

A

immune related ADE

Colitis, pneumonitis, hepatitis, nephritis

28
Q

Immunotherapy options in melanoma

A

PD1 inhibitors
CTLA4 inhibitors
IL2 inhibitors
Oncolytic virus

29
Q

PD1 inhibitor grade 2 or greater toxicity treatment

A

withhold treatment

resume when grade 1

30
Q

PD1 inhibitor grade 4 toxicity treatment

A

permanently discontinue

31
Q

T/F anti-CTLAs montotherapy are frontline in melanoma

A

false!
Only frontline if combo with nivo (PD1)

ORR, PFS, OS improved when combined with nivo
But increased toxicity!

32
Q

Front line options for melanoma

A

PD1 inhibitors

CTLA + nivo

33
Q

Who should not use aldesleukin?

A

patients with untreated/active brain metastases

Can only use in ECOG performance 0-1

34
Q

ADE of aldesleukin

A

Cytokine induced CLS (hypotension, visceral edema, dyspnea, tachycardia, arrhythmia)

*pulm edema –> don’t give fluids!

35
Q

How does the oncolytic virus work?

A

Modified HSV-1
Inject into lesion
Does nothing to healthy cells
Replicates in cancer cells and secretes GM-CSF and cell bursts

36
Q

*T-VEC pearls

A

Health care providers and caregivers need to be careful!

Sensitive to acyclovir and other antiviral meds (decrease effectiveness)

37
Q

*What type of drugs are vemurafenib, dabrafenib, encorafenib?

A 
BRAF inhibitors (V600E)
**not active against BRAF wild-type
38
Q

*What type of drugs are trametinib, cobimetinib, binimetinib?

A

MEK inhibitors

39
Q

*T/F BRAF/MEK inhibitor combos are recommended 1st line in melanoma

A

true!

may actually see less toxicity

40
Q

What is the only FDA approved chemo agent for metastatic melanoma in the US?

A

dacarbazine

41
Q

Why would you use nab-paclitaxel over paclitaxel?

A

higher bioavailability
Lower toxicity
increase response rate

Oncology Exam 3 (6 decks)

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