Melanoma

Question 1

Risk factors for melanoma

Answer 1

FH

Sun exposures

Multiple benign naevi (moles) or atypical naevi

Question 2

General specific management (pharmacological) principles in metastatic melanoma Mx (with initial spiel)?

Answer 2

The management of metastatic melanoma is a rapidly evolving field so I will check the latest guideline, speak to oncology colleagues, consider enrolling patient in a trial if deemed appropriate.

Generally - oligometastatic disease + good functional status → surgery

If targetable mutation present (BRAF, KIT)

• Newer guideline actually suggest PD1 as a first-line
• BRAF mutant (V600E/K mutation, 50%) → BRAF (e.g. Dabrafenib, Vemurafenib) or MEK inhibitor (Trametinib).
• Combination therapy offers longer PFS and OS (at the expense of toxicity - PBS subsidised) - hence it’s the first line if the patient is candidate
• KIT mutant → imatinib

No targetable mutations

• PD1 (Nivo/Pempro) > CTLA4 (ipilimumab) inhibitors or chemotherapy
• Combination therapy is suggested, especially for more aggressive disease (at the expense of toxicity)

Question 3

BRAF/MEK inhibitor side effects? (5)

Answer 3

Bleeding***

Retinal toxicity (ocular - uveitis, iritis)

Arrhythmia (and cardiac - cardiomyopathy, LVEF reduction)

Fever***

Skin Rash (+ non-melanoma skin Cas)