Skin Cancer and Melanoma

Question 1

What is the first line treatment for metastatic Merkel Cell Cancer?

Answer 1

Avelumab, response rate of 60%

Question 2

What is the rate of infusion reaction with avelumab and which pre-meds should be given?

Answer 2

25% will have severe infusion reaction, pre med with paracetamol and anti-histamine

Question 3

In what setting is Vismodegib use? What type of drug is it?

Answer 3

SMO inhibitory. Used for locally advanced and metastatic BCC

Question 4

What is used first line for advanced or metastatic cutaneous SqCC?

Answer 4

Cemiplimab, anti-PD1 antibody

Question 5

What percentage of melanoma patients have a BRAFm?

Answer 5

50%

Question 6

Which BRAF mutations are targetable?

Answer 6

V600E and V600K

Question 7

What is the second most common mutation found in melanoma?

Answer 7

NRAS 13-25%

Question 8

What WLE margins are suggested with a Breslow thickness up to 2mm

Answer 8

1cm

Question 9

What WLE margins are suggested with a Breslow thickness > 2mm

Answer 9

2cm

Question 10

What melanoma thickness is considered high risk?

Answer 10

> 4mm

Question 11

What melanoma thickness is considered medium risk?

Answer 11

1-4mm

Question 12

What is the likelihood of SLN involvement in intermediate risk melanoma?

Answer 12

15-25%, group where SLNB likely to be of most benefit

Question 13

When would you consider SLNB in low risk melanomas (0.75-1mm thick)?

Answer 13

If ulceration or elevated tumour mitotic rate

Question 14

When would you give adjuvant SACT in melanoma?

Answer 14

Node positive patients

Question 15

What percentage of patients have brain metastases at diagnosis of metastatic disease (melanoma)?

Answer 15

15-25%

Question 16

How would you manage isolated metastatic recurrence?

Answer 16

Aim for complete surgical resection followed by adjuvant treatment

Question 17

What are the rate of G3 or G4 toxicity with Ipilimumab and nivolumab?

Answer 17

50-60% cancer

Question 18

What is the mOS for patients on ipi/nivo?

Answer 18

6.5 years

Question 19

Is a MEK inhibitory downstream or upstream to BRAF inhibitor?

Answer 19

Downstream

Question 20

What is the most common ocular S/E for BRAFi?

Answer 20

Anterior uveitis

Question 21

What is the most common ocular S/E for MEKi?

Answer 21

Retinopathy (retinal vein occlusion and retinal vein detatchment).

Question 22

How should you manage Tram related retinal detatchment?

Answer 22

Withhold drug, seek ophlalmology opinion. If symptoms improve/resolve within 3 weeks can restart MEKi at same or lower dose.

Question 23

Is dabrafenib or trametinib more likely to cause chills?

Answer 23

Dabrafenib

Question 24

Mucosal melanomas have a high prevalence of which gene alteration?

Answer 24

KIT (including missense and copy number amplifications) and NRAS

Question 25

Which chromosomal aberration is high risk for metastatic spread in uveal melanomas

Answer 25

Monosomy 3 (gain of chromosome 8q)

Question 26

What are the most commonly identified somatic mutations in uveal melanoma?

Answer 26

GNAQ and GNA11

Question 27

How do you manage Kaposis sarcoma initially?

Answer 27

Initiation of HAART, most will respond to this alone.