Melanoma & Skin Cancer Flashcards
What is a melanoma?
- Melanoma is a malignant tumor of
melanocyte origin - often occurs on the skin
- primarily due to the highest concentration
of melanocytes in all other parts of the
body, and is most often described in skin
tumors
What are the localisation of Melanoma and Clinical types of melanoma?
Localisation:
- skin
- ocular
- submucosa = oral, GIT, vagina, urethra
- Melanoma of unknown primary (MUP syndrome)
Clinical types:
- superficial
- nodular
- lentigo melanoma and lentigo maligna
- Acral lentiginous melanoma
- Amelanotic and desmoplastic melanoma
What are the risk factors?
hereditary:
- familial nevus dysplastic syndrome
- increased no.of moles (>120)
- > 6mm mole size
- FHx of + melanoma
Acquired:
- excess exposure to sun
- skin freckles
What is the ABCDE detection of melanoma?
Asymmetry
Border
Colour
Diametre
Evolving
PTH immunoprofile for melanoma?
Typical imunoprofile: S100+, HMB45+, MelanA+
What are the stages of Breslow scale?
STAGE 1: < 1mm
STAGE 2: 1-2mm
STAGE 3: 2.01-4mm
STAGE 4: > 4mm
Where does ocular melanoma metastasise?
Ocular melanoma metastasizes exclusively in liver (80%), rarely in CNS, while other sites are extremely rare (almost never)
-What is the treatment for unresectable/metastatic?
- anti-PD 1 monotherapy
pembrolizumab - BRAF mutation
Dabrafenib
What are some prognostic parameters in Melanoma?
Histological:
- Breslow scale (or Clark Scale)
- ulceration
- pigmentation
- melanoma regression
- TILS (Non-BRISK & BRISK)
- Cell type (epitheloid, spindle)
Clinical:
- LDH levels
- early vs advanced clinical stage
- number of metastatic sites
Local disease treatment for melanoma?
Excision margin based on depth in Breslow (mm)
Wide Local Excision Margins
Melanoma iS = 0.5cm margin
< 2mm (T1-T2) = 1 cm margin
> 2mm (T3-T4) = 2 cm margin
*done alongside sentinel lymph node biopsy
What is the ESMO treatment guideline for stage I-III melanoma?
- assess in SLN is positive or negative
Negative:
- FU, if relapse, then complete LN dissection (CLND)
- adjuvant tx
Positive:
- Adj Tx
or US based FU, assess for relapse, then CLND
When is RT recommended in melanoma?
- Post op RT incase of at least 1 of the following:
- 3 pathological LN
- Extracapsular spreading
- LN metastasis > 3 cm
Significance of adjuvant treatment in melanoma?
- beneficial to administer adj tx of high risk primary cutaneous melanoma (stage III and resectable IV)
Immune Checkpoint Inhibitor (ICI) e.g. pembrolizumb
Target Therapy e.g. dabrafenib for BRAF mutation
ESMO treatment of inoperable stage III-IV BRAF mutated melanoma?
1st line is immunotherapy
pembrolizumab
2nd line is targeted therapy
Dafrafenib
*if LDH elevated this can be 1st line due to high tumour burden
What are the types of basocellular carcinoma (BCC)?
- nodular
- superficial
- Morfeaform
- pigmentous
- fibroepithelial
Basic treatment for skin BCC?
- small dimension: surgery
- larger dimension: surgery, RT
- locally advanced: Neoadj hedgehog inhibitors, salvage surgery and RT
- metastatic: hedgehog inhibitor e.g. vismodegib
What is skin SCC and its basic treatment?
- ulcerative or exophytic lesion of skin
- metastatic potential > BCC, frequently in regional LN
First line treatment is surgery
What is Merkell Cell Carcinoma (MCC)
- high aggressive neuroendocrine skin carcinoma with high metastatic potential
- pink papula appearance with 20% from polyoma virus
- Pink papula (≈ 65% local, 26% in lymph nodes, 8% distant metastases)
- local disease treated by surgery
- advanced stage ICI e.g. pembrolizumab
- chemotherapy (Etopozid+Cisplatin)
What is Kaposi Sarcoma? (KS)
- indolent vascular tumour of endothelian origin
- caused by human herpes virus 8 (HH8)
- AIDS related
- mostly indolent but may be aggressive
- described as skin cancer, but histologically not
Types of KS?
- Classic: purple slow-growing macula (lower extremity, nose, ears)
Indolent disease course - Endemic: benign lymphadenopathy and children with fulminant lymphadenopathy (no HIV)
- Iatrogenic: immunosuppressive patients in SOLID organ tx or autoimmune disease
- Epidemic: HIV infection, in homosexuals, most aggressive form with M in LN and viscera
Diagnosis of KS?
- Pathohistological verification
- HIV status
- Lung, abdomen, pelvis CT
- Endoscopy
- PET-CT
Localised KS treatment?
- surgical excision
- cryotherapy
- laser ablation
- vincristine as a cytotoxic agent for intralesional application
Systemic KS treatment?
- cART for HIV/AIDS
- Doxorubicin, Paclitaxel
Is secondary skin cancer rare?
Yes
Although rare, it is still possible e.g. via haematological cancer
Biopsy and PH verification for diagnosis
Hematological cutaneous infiltration (leukomid)?
- Leukomid = skin myeloid sarcoma
- AML which infiltrates skin in a form of leukemid
- Presents as M4 and M5, FAB subtype of AML
- cutaneous infiltration as first sign of AML or AML relapse
- Tx same as for AML
- poor prognosis
