Melanoma

Question 1

Who is melanoma more common in?

Answer 1

Caucasians > AA

Question 2

Melanoma accounts for ___% of skin cancer fatalities

Answer 2

75

Question 3

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

Answer 3

true!

Question 4

Risk factors for melanoma

Answer 4

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

Question 5

Susceptible populations in melanoma

Answer 5

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

Question 6

What is the biggest cause of melanoma?

Answer 6

UV radiation!

Question 7

What does UV radiation do to the skin?

Answer 7

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

Question 8

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

Answer 8

False!

1 occurrence doubles the risk!

Question 9

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

Answer 9

False!

<30 triples the risk!

Question 10

Who should receive yearly clinical exams for melanoma?

Answer 10

high risk patients

Question 11

How often should you do self-exams for melanoma?

Answer 11

monthly

Question 12

ABCDE of melanoma

Answer 12

Asymmetry
Border irregularity
Color
Diameter
Evolving

Question 13

T/F the histologic subtypes of melanoma have different treatments

Answer 13

false!
all treated the same
same prognosis

Question 14

S/S of melanoma localized disease

Answer 14

usually asymptomatic, itch, ulcerated or bleed

Question 15

S/S of melanoma larger lesions

Answer 15

Bulky
Inflammation
Bleed/crust
Sensory change

Question 16

Diagnosis of melanoma

Answer 16

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

Question 17

Melanoma staging

Answer 17

Breslow’s thickness

III: lymph nodes
IV: metastatsis

Question 18

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

Answer 18

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

Question 19

Predictive survival factors of melanoma

Answer 19

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

Question 20

Sentinel node dissection if recommended for who in melanoma?

Answer 20

lesion > 1 mm thick

Question 21

Stage I or II treatment melanoma

Answer 21

wide excision then observe +/- sentinel node biopsy

Question 22

Stage III treatment melanoma

Answer 22

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

Question 23

*Adjuvant therapy options in stage III melanoma

Answer 23

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

Question 24

Is surgery curative in metastatic melanoma?

Answer 24

NO!

used for palliative reasons

Question 25

Main treatments for metastatic melanoma

Answer 25

Immunotherapy | Targeted therapy

Question 26

PD1 inhibitors in melanoma

Answer 26

Pembrolizumab | Nivolumab

Question 27

*Main counseling points on PD1 inhibitors

Answer 27

immune related ADE | Colitis, pneumonitis, hepatitis, nephritis

Question 28

Immunotherapy options in melanoma

Answer 28

PD1 inhibitors CTLA4 inhibitors IL2 inhibitors Oncolytic virus

Question 29

PD1 inhibitor grade 2 or greater toxicity treatment

Answer 29

withhold treatment | resume when grade 1

Question 30

PD1 inhibitor grade 4 toxicity treatment

Answer 30

permanently discontinue

Question 31

T/F anti-CTLAs montotherapy are frontline in melanoma

Answer 31

false! Only frontline if combo with nivo (PD1) ORR, PFS, OS improved when combined with nivo But increased toxicity!

Question 32

Front line options for melanoma

Answer 32

PD1 inhibitors | CTLA + nivo

Question 33

Who should not use aldesleukin?

Answer 33

patients with untreated/active brain metastases Can only use in ECOG performance 0-1

Question 34

ADE of aldesleukin

Answer 34

Cytokine induced CLS (hypotension, visceral edema, dyspnea, tachycardia, arrhythmia) *pulm edema --> don't give fluids!

Question 35

How does the oncolytic virus work?

Answer 35

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

Question 36

*T-VEC pearls

Answer 36

Health care providers and caregivers need to be careful! | Sensitive to acyclovir and other antiviral meds (decrease effectiveness)

Question 37

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

Answer 37

``` BRAF inhibitors (V600E) **not active against BRAF wild-type ```

Question 38

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

Answer 38

MEK inhibitors

Question 39

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

Answer 39

true! | may actually see less toxicity

Question 40

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

Answer 40

dacarbazine

Question 41

Why would you use nab-paclitaxel over paclitaxel?

Answer 41

higher bioavailability Lower toxicity increase response rate