Melanoma Treatment Guidelines 2021

Question 1

Optimal biopsy for suspicious pigmented lesion

Answer 1

complete excision with 2 mm margin and deep into upper cutis

Question 2

Punch biopsy is associated with

Answer 2

high rate of false neg

Question 3

Saucerization my be performed with

Answer 3

flat lesions

Question 4

MIS - Stage 0 - management

Answer 4

Primary care
Wide local excision 5-10 mm
Does not need sentinel node bx

Question 5

Invasive melanoma, Breslow < 1 mm, no ulceration, no mitoses

Answer 5

Wide local excision, 10 mm

No SLNB

Question 6

SLNB is necessary if …

Answer 6

Breslow > 0.1 mm
or Breslow > 0.8 with ulceration or mitoses
Or Bres

Question 7

All positive SLNB are considered for …

Answer 7

Adjuvant Rx

Question 8

Stage 1 and 2

Answer 8

Invasive melanoma with negative LNB

Question 9

Stage 3 and 4

Answer 9

Invasive melanoma with + SLNB +/- distant mets

Question 10

Stage 0 5 year survival

Answer 10

> 98%

Question 11

Stage 1 (A/B), classification

Answer 11

T1a: < 0.8 mm and nonulcerated
T1b:>= 0.8 mm or < 0.8 with ulceration
T2a:> 1-2 mm without ulceration

Question 12

Stage 1 (A/B), 5 year survival

Answer 12

97-92%

Question 13

Stage II (A/B/C), classification

Answer 13

T2b:1-2 mm with ulceration 
T3a:2-4 mm without ulceration
T3b:2-4 mm with ulceration
T4a:>4 mm without ulceration
T4b:>4 mm with ulceration

Question 14

Stage II (A/B/C), 5 year survival

Answer 14

81-53%

Question 15

Stage III (A/B/C/D), classification

Answer 15

N1a: 1 clinically occult (in snl bx)
N1b: 1 clinically detected
N1C: in transit, satellite, and or microsagellite mets
N2a: 2-3 clinically occult
N2b: 2-3, at least 1 clinically detected
N2c: 1 clinically occult or detected with in transit satellite and or microsatellite mets
N3a: 4 or more clinically occult
N3b: 4 or more, at least 1 clinically detected, or presence of matted nodes
N3c: 2 or more clinically occult or detected with in transit satellite and or microsatellite mets

Question 16

Stage III (A/B/C/D), survival

Answer 16

78-40%

Question 17

Stage IV classification

Answer 17

Distant metastasis: Location and LDH levels define sub stage.

Question 18

Stage IV prognosis

Answer 18

20-15%