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
Main treatments for metastatic melanoma
Immunotherapy | Targeted therapy
26
PD1 inhibitors in melanoma
Pembrolizumab | Nivolumab
27
*Main counseling points on PD1 inhibitors
immune related ADE | Colitis, pneumonitis, hepatitis, nephritis
28
Immunotherapy options in melanoma
PD1 inhibitors CTLA4 inhibitors IL2 inhibitors Oncolytic virus
29
PD1 inhibitor grade 2 or greater toxicity treatment
withhold treatment | resume when grade 1
30
PD1 inhibitor grade 4 toxicity treatment
permanently discontinue
31
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!
32
Front line options for melanoma
PD1 inhibitors | CTLA + nivo
33
Who should not use aldesleukin?
patients with untreated/active brain metastases Can only use in ECOG performance 0-1
34
ADE of aldesleukin
Cytokine induced CLS (hypotension, visceral edema, dyspnea, tachycardia, arrhythmia) *pulm edema --> don't give fluids!
35
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
36
*T-VEC pearls
Health care providers and caregivers need to be careful! | Sensitive to acyclovir and other antiviral meds (decrease effectiveness)
37
*What type of drugs are vemurafenib, dabrafenib, encorafenib?
``` BRAF inhibitors (V600E) **not active against BRAF wild-type ```
38
*What type of drugs are trametinib, cobimetinib, binimetinib?
MEK inhibitors
39
*T/F BRAF/MEK inhibitor combos are recommended 1st line in melanoma
true! | may actually see less toxicity
40
What is the only FDA approved chemo agent for metastatic melanoma in the US?
dacarbazine
41
Why would you use nab-paclitaxel over paclitaxel?
higher bioavailability Lower toxicity increase response rate