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)
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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
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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
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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
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5
Q

Melanoma Types

A
  • Cutaneous

- Uveal

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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
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7
Q

NM Treatment Options

A
  • Goal: Cure and maximally preserve function

- Surgery, radiation (non-resectable), and chemotherapy are all options

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8
Q

Non-melanoma + Surgery

A
  • Moh’s micrographic surgery
  • Curettage and electrodessication
  • Surgical excision
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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
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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
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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
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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
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13
Q

EGFR Inhibitors

A
  • Cetuximab (Erbitux)

- AE: rash, diarrhea, mouth sores, loss of appetite

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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

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15
Q

NM-SCC Follow-up

A

-Every 3 months for 5 years
THEN
-Every 6 months indefinitely

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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