Melanoma Flashcards
Who is melanoma more common in?
Caucasians > AA
Melanoma accounts for ___% of skin cancer fatalities
75
T/F there has been a steady increase in new cases of melanoma but the death rate has stayed the same
true!
Risk factors for melanoma
Male >60 years old Personal or family history Genetic factors Immunocompromised
Susceptible populations in melanoma
Fitzpatrick type I or II = fair skin, light hair, light eyes
What is the biggest cause of melanoma?
UV radiation!
What does UV radiation do to the skin?
- DNA changes
- Impairs immune function
- Increase growth factors
- Form ROS
T/F blistering sunburns do not increase your risk of melanoma
False!
1 occurrence doubles the risk!
T/F exposure to sunbeds/sunlamps <20 triples the risk of melanoma
False!
<30 triples the risk!
Who should receive yearly clinical exams for melanoma?
high risk patients
How often should you do self-exams for melanoma?
monthly
ABCDE of melanoma
Asymmetry Border irregularity Color Diameter Evolving
T/F the histologic subtypes of melanoma have different treatments
false!
all treated the same
same prognosis
S/S of melanoma localized disease
usually asymptomatic, itch, ulcerated or bleed
S/S of melanoma larger lesions
Bulky
Inflammation
Bleed/crust
Sensory change
Diagnosis of melanoma
Biopsy
Complete history
Total body skin exam
Consider more workup if III/IV
Melanoma staging
Breslow’s thickness
III: lymph nodes
IV: metastatsis
T/F stage III and IV Melanoma have a good prognosis
false!
rapidly decrease within first 2 years
Good = I or II
Predictive survival factors of melanoma
Age (>60 = worse) Male = worse Brewslow tumor thickness Ulceration Mitotic rate LDH
Sentinel node dissection if recommended for who in melanoma?
lesion > 1 mm thick
Stage I or II treatment melanoma
wide excision then observe +/- sentinel node biopsy
Stage III treatment melanoma
Wide excision of tumor
Complete lymph node dissection (CLND)
**adjuvant therapy)
*Adjuvant therapy options in stage III melanoma
Chemo = NOT recommended outside trials
Immunotherapy = PD1 inhibitors*
Targeted therapies
Observe
Is surgery curative in metastatic melanoma?
NO!
used for palliative reasons
Main treatments for metastatic melanoma
Immunotherapy
Targeted therapy
PD1 inhibitors in melanoma
Pembrolizumab
Nivolumab
*Main counseling points on PD1 inhibitors
immune related ADE
Colitis, pneumonitis, hepatitis, nephritis
Immunotherapy options in melanoma
PD1 inhibitors
CTLA4 inhibitors
IL2 inhibitors
Oncolytic virus
PD1 inhibitor grade 2 or greater toxicity treatment
withhold treatment
resume when grade 1
PD1 inhibitor grade 4 toxicity treatment
permanently discontinue
T/F anti-CTLAs montotherapy are frontline in melanoma
false!
Only frontline if combo with nivo (PD1)
ORR, PFS, OS improved when combined with nivo
But increased toxicity!
Front line options for melanoma
PD1 inhibitors
CTLA + nivo
Who should not use aldesleukin?
patients with untreated/active brain metastases
Can only use in ECOG performance 0-1
ADE of aldesleukin
Cytokine induced CLS (hypotension, visceral edema, dyspnea, tachycardia, arrhythmia)
*pulm edema –> don’t give fluids!
How does the oncolytic virus work?
Modified HSV-1
Inject into lesion
Does nothing to healthy cells
Replicates in cancer cells and secretes GM-CSF and cell bursts
*T-VEC pearls
Health care providers and caregivers need to be careful!
Sensitive to acyclovir and other antiviral meds (decrease effectiveness)
*What type of drugs are vemurafenib, dabrafenib, encorafenib?
BRAF inhibitors (V600E) **not active against BRAF wild-type
*What type of drugs are trametinib, cobimetinib, binimetinib?
MEK inhibitors
*T/F BRAF/MEK inhibitor combos are recommended 1st line in melanoma
true!
may actually see less toxicity
What is the only FDA approved chemo agent for metastatic melanoma in the US?
dacarbazine
Why would you use nab-paclitaxel over paclitaxel?
higher bioavailability
Lower toxicity
increase response rate
