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MSK/Derm > SM 258: Melanoma > Flashcards

SM 258: Melanoma Flashcards

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Dermatology Board Prep flashcards
1
Q

What is Melanoma?

A

A deadly cancer arising from Melanocytes in the Basal layer of the Epidermis

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2
Q

Where can Melanoma arise?

A

Anywhere there is skin

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3
Q

What are Melanocytes?

A

Cells found in the basal layer of the Epidermis which produce Melanin

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4
Q

Why do differences in skin color arise?

A

Differences in the amount of Melanin produced by Melanocytes, not the number of Melanocytes

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5
Q

In which race and sex is Melanoma most prevalent?

A

Whites, Men, and risk increases with age

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6
Q

What are genetic risk factors for Melanoma?

A

Family history of Melanoma or dysplastic Nevi

Lightly pigmented skin = tendency to burn not tan

DNA repair defects

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7
Q

What environmental factors predispose Melanoma?

A

Exposure to UV light, intense intermittent sun exposure, sunburn, and Tanning

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8
Q

Is intense intermittent sun exposure more of a risk than continued moderate UV light exposure?

A

Intense intermittent sun exposure is more of a risk than moderate continued UV light exposuer

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9
Q

How does childhood sunburn predispose Melanoma?

A

Even a single blistering sunburn in childhood doubles a childs chances of developing Melanoma later in life

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10
Q

What are Melanocytic Nevi?

A

A genetic predisposition to form a large number of moles, and over 50 moles is a risk factor for Melanoma

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11
Q

What are atypical Melanocytic Nevi?

A

People with atypical Nevi or large Nevi have a higher risk of developing Melanoma

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12
Q

Do freckles predispose Melanoma?

A

Yes

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13
Q

Where do Melanomas develop?

A

Some develop in an existing mole, but most develop de novo and have no precursor lesion

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14
Q

How does UV skin damage lead to Melanoma?

A

UV light exposure causes Cyclobutane Pyrimidine Dimers which damages DNA immediately, and people with DNA repair defects are less likely to fix these errors

People with light skin have less Melanin to protect against UV light

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15
Q

When is a Naevus?

A

A group of Melanocytes

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16
Q

Why does Melanoma rate increase with age?

A

Cumulative UV damage over time

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17
Q

What is an intermediate neoplasm?

A

A Naevus which has continually been damaged by UV light, eventually forming Melanoma in situ

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18
Q

What is Melanoma in situ?

A

Melanoma confined to the Epidermis

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19
Q

What is invasisve Melanoma?

A

Melanoma that penetrates the Dermis

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20
Q

What can emerge as a Melanoma matures?

A

Point mutations, copy number mutations, and driver mutations

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21
Q

How does a Melanoma spread?

A

Blood vessels as well as lymph nodes to regional and distant sites

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22
Q

Where does Melanoma spread via lymph?

A

Regional lymph nodes show Melanoma deposits through repeat seeding

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23
Q

Where does Melanoma spread via blood?

A

Distal areas via blood stream, such as the Brain and lung

24
Q

Where do germ line mutations arise that lead to Melanoma?

A

P16 and CKD4

25
Q

When is a person referred to a genetic specialist for Melanoma?

A

3 or more primary melanomas

3or more melanomas among first or second degree relatives

26
Q

What other cancer does P16 predispose?

A

Pancreatic cancer - a Melanoma patient with this mutation should be monitored for Pancreatic cancer

27
Q

What is superficial spreading Melanoma?

A

Most common Melanoma, associated with intermittent sun exposure and due to BRAF mutation

28
Q

What is Lentigo Maligna Melanoma?

A

Associated with crhonically sun exposed skin, due to c-Kit and NRAS mutations

29
Q

What is Acral Lentiginous and Mucosal Lentiginous Melanoma?

A

Not sun related and due to mixed mutations, in areas like the mouth, toe, or vaginal mucosa (not sun exposed)

30
Q

What are Nodular Melanomas?

A

Vertical growth phase only due to BRAF mutations

31
Q

What is a self skin exam and how does it relate to Melanoma?

A

A monthly self exam in a well lit mirror to examine all areas of their body to detect Melanoma

32
Q

What is the ABCDE Mmnemonic for Melanoma?

A

Asymmetry in the appearance of the Mole
Border is irregular
Color is not uniform and may be different shades
Diameter > 6mm
Evolving mole is changing in size, shape, and color

33
Q

Who should do a full skin exam?

A

Only board certified Dermatologists

34
Q

What does a Dermatologic exam involve?

A

General clinical exam, total body photography, and dermoscopic exam

35
Q

What are Nevi?

A

Nevi = Moles, everyone gets them

36
Q

How can Nevi get bigger?

A

Sunburn, pregnancy can make them bigger and darker

37
Q

What does a Dysplastic Nevi look like?

A

Multicolored, asymmetric pigment and contour, indistinct margins

These are concerning for becoming Melanoma

38
Q

What is Dysplastic Nevus Syndrome?

A

Patients with 100+ melanocytic nevi that are large and clinically atypical with a high risk of developing Melanoma

39
Q

How should someone with Dysplasic Nevi be managed?

A

Close monitoring with full body exams, Dermoscopy of atypical body, whole body photography, and biopsy of anything atypical

40
Q

What suggests Nodular Melanoma?

A

A rapidly growing mole that is bleeding

41
Q

Where do Lentigo Maligna Melanoma appear?

A

On sun exposed surfaces of old people

42
Q

What is the Breslow level?

A

A measurement of the top to the bottom of the Melanoma; if it’s > 0.8mm, get a Sentinel Lymph Node biopsy to look for Melanoma mets and whole body imaging

43
Q

What does the Breslow level predict?

A

The Brewlow level is the most important predictor of prognosis for a Melanoma

44
Q

What factors other than Breslow level predict Melanoma prognosis?

A

Ulceration, Mitotic Rate, Regression

45
Q

What is better, an ulcerated or unulcerated Tumor?

A

Ulcerated is worse

46
Q

Is a high mitotic rate or low mitotic rate Melanoma better?

A

Low mitotic rate is better

47
Q

When should a Sentinel Lymph Node biopsy be done?

A

A Melnoma with a Breslow level > 0.8 or ulcerations

48
Q

What is the treatments for Melanoma?

A

Surgery alone if it has no mets, targeted therapy and immunotherapy as well as radiotherapy

49
Q

How does tumor thickness alter surgical excision margins?

A

Lower thickness is a smaller margin of surgical removal

50
Q

What is Adjuvant therapy?

A

Therapy given after a surgery “cures” a cancer to prevent spread or return

51
Q

What is Ipilimumab?

A

An antibody that binds to CTLA4 on T cells to inactivate Tcells

52
Q

How do anti-PD-1 inhibitors work?

A

Prevent tumors from using PD-1 to induce apoptosis in activated Tcells and allow activated T cells to kill the tumor

53
Q

What is in transit melanoma?

A

Melanoma in the skin but not in any other organs

54
Q

What is systemic Melanoma?

A

A Melanoma that is seeded in other organs

55
Q

What is the treatment for Systemically metastisized Melanoma?

A

PD-1 Inhibitors

56
Q

What is T-VEc

A

An oncolytic virus based on modified HSV that promotes anti-tumor immunity

57
Q

What SPF sunscreen should you use?

A

SPF 30 for 97% of UVB rays from the sun

MSK/Derm (46 decks)

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