Melanoma (Cut Off for Exam 2) Flashcards
1
Q
ABCDE of Melanoma Detection
A
- Asymmetry
- Borders (even or uneven)
- Color (multiple or one)
- Diameter (>6 mm)
- Evolving (changing)
2
Q
Sunscreen
A
- SPF extends time to skin burn
- Apply 15-30 minutes before sun exposure
- Protect lips with SPF15+ lip balm
- Reapply every 2 hours during exposure and after swimming or sweating
- Water resistant shown to be effective for up to 40 min of swimming
3
Q
Non-Melanoma BCC
A
- Most common
- Usually develop on sun-exposed areas like face, head, or neck
- If not removed completely, BCC can recur in same place on skin
- Those with previous BCC are more likely to develop new ones in different places
4
Q
Non-melanoma cSCC
A
- Cutaneous squamous cell carcinoma
- Found on surface of lungs, thyroid, and esophagus
- 2nd most common
- Commonly appear on sun exposed areas like face, ears, neck, lips, back of hands
- Can develop in scars or chronic sores elsewhere
5
Q
Melanoma Types
A
- Cutaneous
- Uveal
6
Q
Non-Melanoma Risk Factors
A
- UV light exposure
- Fair-colored skin
- Age
- Male
- Chemical exposure
- Previous skin cancer
- Smoking
- Viruses
- Immunocompromised
- Solid organ transplant recipients
7
Q
NM Treatment Options
A
- Goal: Cure and maximally preserve function
- Surgery, radiation (non-resectable), and chemotherapy are all options
8
Q
Non-melanoma + Surgery
A
- Moh’s micrographic surgery
- Curettage and electrodessication
- Surgical excision
9
Q
Non-melanoma + Chemo
A
- Not routinely used for BCC or SCC
- Topical imiquimod or 5-FU if surgery or radiation isn’t appropriate
- Metastatic disease is preferentially treatment
- Hedgehog inhibitors are very active against BCC
10
Q
NM-BCC Treatment
A
- Surgery: complete removal
- High risk patients may need radiation, cryotherapy, topical 5-FU or imiquimod
- Rarely reaches advanced stages so systemic therapy usually not used
- Advanced BCC more likely to use targeted therapy
11
Q
NM-SCC Treatment
A
- Surgery: complete surgical removal
- High risk patients may need radiation, cryotherapy, topical 5-FU or imiquimod
- Chemo may by an option through immunotherapy might be used first (cisplatin, 5-FU)
- Cemiplimab
12
Q
Hedgehog Pathway Inhibitors
A
- Vismodegib (Erivedge)
- Sonidegib (Odomzo)
- Used to treat advanced/recurrent BCC
- Capsules taken daily
- AE: muscle spasms, joint pain, hair loss, fatigue, changes in taste, poor appetite, weight loss, NVD/C, itchy skin
13
Q
EGFR Inhibitors
A
- Cetuximab (Erbitux)
- AE: rash, diarrhea, mouth sores, loss of appetite
14
Q
NM-BCC Follow-up
A
- Every 6 months for 5 years
- 36% of patients with develop another primary BCC w/in 5 years
15
Q
NM-SCC Follow-up
A
-Every 3 months for 5 years
THEN
-Every 6 months indefinitely
16
Q
Melanoma Treatment
A
- Goal/strategy based on stage
- Surgery, radiation, and chemo can all play a role
17
Q
Melanoma Surgery
A
- Complete surgical excision is best chance for cure
- May be used as single modality in localized and regional disease
- Sentinel lymph node mapping and evaluation
18
Q
Melanoma Radiation
A
- Limited role in melanoma
- Adjuvant therapy for prevention of nodal relapse in high-risk patients
- Stereotactic radio surgery can be useful for isolated brain metastasis
19
Q
PD1 Inhibitors
A
- MoA: blocks checkpoints that stops T-cells from attacking other cells in the body, boosts immune response
- Indication: advanced SCC that cannot be cured with surgery or RT
20
Q
Immune-Related Adverse Events
A
- Inflammation of organs: skin, liver/lungs, endocrine, GI
- Prevent with close monitoring and patient education
- Treat with 1-2 mg/kg/day of prednisone or methylprednisolone for up to 3 days, taper steroid over 4+ weeks
- If no response in 3 days, “steroid refractory,” consider additional forms of immune suppression
21
Q
BRAF Inhibitors
A
- BRAF mutation occurs in 40-60% of melanomas
- CYP3A4 substrates, so be aware of DDIs
- Toxicities: nausea, diarrhea, pyrexia, dermatologic, arthralgia, fatigue, alopecia
22
Q
MEK Inhibitors
A
- Used for BRAF 600E mutation
- Toxicities: Dermatologic, diarrhea, edema, cardiomyopathy, retinopathy, fatigue, peripheral edema
23
Q
BRAF/MEK Combo
A
- Better outcomes when combined
- Decreased incidence of dermatologic toxicities
- More pyrexia occurs
24
Q
KIT Mutation
A
- Imatinib
- Toxicities: Fatigue, edema, myelosuppression, cardiomyopathy, hepatotoxicities, GI discomfort, GI perforation, bullous dermatologic reactions
25
Q
NRTK (+)
A
- Larotrectinib or Entrectinib
- Toxicities: Neurotoxicity, increased LFTs, cough, N/V
26
Q
T-VEC
A
- Talimogene Laherparepvec
- Live oncolytic virus, generally modified HSV1
- Indication: unresctable cutaneous, SQ, and/or nodal tumors with recurrent melanoma after initial surgery
- Viral shedding may occur, avoid direct contact with treat site, dressings, body fluids
- Inject volume based on lesion size
- Toxicities: herpes, injection-site rxn, immune-mediated events, fatigue, chills, pyrexia
27
Q
Aldesleukin (IL-2)
A
- MoA: promotes proliferation, differentiation, and recruitment of T/B/NK cells/thymocytes
- Reserve for younger, healthier patients due to toxicities
- AVOID in patients with inadequate organ reserve, poor PS, CNS involvement
- Premeds
- Toxicities: capillary leak syndrome, visceral edema, constitutional symptoms, pruritis, eosinophilia, hepatic/renal dysfxn, N/V
28
Q
BCG
A
- Bacillus of Calmette and Guerin Vaccine
- Active immunity against mycobacterium tuberculosis
- Off label use for melanoma
- Toxicities: skin rxn, infections, anaphylaxis
29
Q
Melanoma + Chemo
A
- Limited role
- First line therapies are immune or targeted therapies
- Toxicities: nausea, myelosuppression, renal tox, hypersensitivities
