melanoma CBL case 1 Flashcards
what are non-modifiable risk factors for melanoma
moles: people with moles or unusual moles (dysplastic nevi) or have atypical moles have a higher risk of developing melanoma
family: 10% of people with melanoma have a family history of the disease
fair skin: fair complexion, blue eyes and freckles have a higher tendency to burn
familial melanoma: some mutations can be linked to melanoma although rare.
race: melanoma rates are 20 times higher In white people than black
age: mean age of people diagnosed with melanoma is 65
what are the modifiable risk factors for melanoma
indoor tanning: tanning beds and sunlamp exposure increases risk of developing all types of skin cancers
UV exposure: people who live at high altitudes or in areas with bright sunlight all year round have the highest risk of developing melanoma.
smoking: smokers are more likely to develop squamous cell skin cancers on the lips
chemical: some chemicals increase risk
what does the ABCDE rule stand for in melanoma
A: asymmetry - the two halves may differ
B: border - the edges may be irregular or blurred
C: colour - different shades
D: diameter - most melanomas are more than 6mm in diameter
E: evolving - changing in the moles over time
what are the skin cancer awareness programs in the UK and Australia
UK: Be Clear On Cancer. Awareness of the signs and symptoms of skin cancer encouraged anybody who noticed changes in their skin to visit a GP
Australia: Slip, Slop, Slap. Sun smart campaign. Aims to improve early detection of skin cancer by motivating young adults to check themselves, also had a UV smart van giving out free products
what is the 2 week wait protocol
if you have symptoms of cancer your doctor will refer you to the hospital for an urgent appointment because of the symptoms you present with could be cancer
what do pathologists look for
the thickness of melanoma, the presence or absence of ulceration and whether melanoma cells can be seen deep or peripheral edges of the biopsy.
what are Macmillan nurses and what are their roles
specialist cancer nurses with experience and qualifications in cancer care.
- help patients to understand their cancer diagnosis and treatment
- support patients through their cancer experience and offer personalised support
name impacts of melanoma diagnosis on the quality of life
- experiencing anxiety, depression, distress
- physical restrictions due to treatment
- strain on friends and relationships
- employment, the individual may need to stop working
what are the different stages of melanoma
stage 0: melanoma has grown no deeper than the epidermis
stage 1: melanoma is less than 1mm thick
stage 2: melanoma is between 1-4mm thick, not ulcerated with an outer layer of skin covering the tumour appearing broken
stage 3: cancer reaches lymph nodes where the cancer was originally diagnosed
stage 4: melanoma has metastasized to other parts of the body
THIS COULD COME UP IN MCQ, 5 different options
what is the treatment for each stage of cancer diagnosis
stage 0: wide excision, Imiquimod cream or radiation therapy
stage 1: sentinel lymph node biopsy. If no cancer cells are detected no further treatment. If cancer cells are detected lymph node dissection is required
stage 2: pembrolizumab (immune-checkpoint inhibitor) given after surgery to prevent the risk of cancer cells returning
stage 3: therapy drugs for BRAF mutation. Isolated limb infusion (chemo infused in limb) if melanomas are found on leg or arm
stage 4: immunotherapy, checkpoint inhibitors
how does melanoma develop
- melanin has anti-oxidant and pro-oxidant properties
- UV radiation stimulates the conversion of antioxidant to pro-oxidant
- pro-oxidant action of melanin results in an increase of intracellular oxygen radicals which causes DNA damage of melanocytes
- results in mutations that stimulate uncontrolled proliferation and differentiation
what happens to MAPK cascade during melanoma
firstly MAPK regulates cell proliferation, growth and migration. However, during melanoma, it is excessively activated. Which leads to uncontrolled growth and proliferation
what are the two main layers of the skin
epidermis and dermis
how does UV light affect skin
UVB induces a cascade of cytokines in the skin which causes an inflammatory response and causes sunburn.
UV also increases epidermis thickness. This contributes to epidermal hyperplasia which protects the skin better from UV penetration
what is the mutation of BRAF in melanoma
a mutation in BRAF activates downstream signalling in the MAP kinase pathway which regulates cell proliferation. Melanomas that contain this mutation are called BRAF positive.
BRAF positive is a lot more aggressive than BRAF negative. BRAF mutations are not inherited they are acquired by spontaneous mutation.
BRAF mutations are more common in younger patients than in older patients
