SM_258a: Melanoma Flashcards
Describe risk factors for melanoma
Melanoma risk factors
- Genetic: family history of dysplastic nevus, lightly pigmented skin, tendency to burn / inability to tan, red / blonde hair color, blue / green eyes, DNA repair defects
- Environmental: exposure to UV light, intense intermittent sun exposure, sunburn, residency in equatorial lattitudes, tanning
- Gene / environment interactions: melanocytic nevi (increased number., multiple dysplastic, congenital), freckles, personal history of melanoma
___ sun exposure increases risk for melanoma more than ___ sun exposure
Intermittent sun exposure increases risk for melanoma more than constant sun exposure
Melanocytes produce ____
Melanocytes produce melanin, which is the pigment found in skin, eyes, and hair
(melanoma is cancer arising from melanocytes)
Describe the role of UV skin damage in causing DNA damage
Role of UV skin damage in causing DNA damage
- Cyclobutane pyrimidine dimers
- DNA damage occurs immediately upon exposure and cell repair begins afterward
- Amount of melanin in skin plays an important role in UV absorption and photoprotection
- 30% of melanomas develop within existing dysplastic devus
- 70% of melanomas develop de novo: no precursor lesion
Guideline of ____ is used for referral to a genetics specialist in melanoma
Guideline of 3s is used for referral to a genetics specialist in melanoma
- Individual with 3 or more primary melanomas: 10-15% risk of P16 mutation
- Patients with ≥ melanomas among first or second degree relatives (45% risk of P16 mutation)
- Families w/ith presence of melanoma and/or pancreatic cancer in three family members (45% risk of P16 mutation)
____ is most common type of melanoma, associated with ____, and involves ____ mutation
Superficial spreading melanoma is most common type of melanoma, associated with intermittent sun exposure, and involves BRAF mutation
(lentigo maligna melanoma is associated with chronically sun exposed skin and involves c-Kit and NRAS mutations)
____ mnemonic is used to diagnose melanoma and stands for ____, ____, ____, ____, and ____
ABCDE mnemonic is used to diagnose melanoma and stands for asymmetry, border, color, diameter, and evolving
(general clinical exam, total body photography, dermoscopic exam)
Dysplastic nevi are ____ and have ____ pigment deposition, ____ contour, and ____ margins
Dysplastic nevi are multicolored na dhave asymmetric pigment deposition, asymmetric contour (macular and papular), and distinct margins
(dysplastic nevus syndrome has risk of developing into melanoma)
Management of the dysplastic nevi patient involves ____, ____, ____, and ____
Management of the dysplastic nevi patient involves close monitoring (full body exams every 6-12 months), dermoscopy of all atypical appearing nevi, whole body photos, and excision of any changing or markedly atypical nevi
Describe the types of melanoma
Types of melanoma
- Superificial spreading melanoma
- Nodular melanoma
- Lentigo malignant melanoma
- Acral lentiginous melanoma
Acral lentiginous melanoma has a higher incidence in ____ patients compared to other forms of melanoma and is associated with ____ prognosis because ____
Acral lentiginous melanoma has a higher incidence in dark skinned patients compared to other forms of melanoma and is associated with poorer prognosis because it is often not diagnosed
Pink or red dot is ____ melanoma
Pink or red dot is amelanotic melanoma
Describe workup / staging for melanoma
Melanoma workup / staging
- Dermatopathology
- Breslow thickness, Clark level
- Sentinel lymph node biopsy
- Following guidelines
- BRAF mutation testing
- Imaging: CXR, CT, MRI, PET/CT
Do a sentinel lymph node biopsy for melanoma if Breslow thickness is ____
Do a sentinel lymph node biopsy for melanoma if Breslow thickness is greater than 0.8 mm
(stage IB and above)
____ is the most important predictor of melanoma prognosis
Breslow level is the most important predictor of melanoma prognosis
(larger thickness associated with worse survival)
(radial growth phase is better than vertical growth phase, lymphatic / vascular invasion is poor prognosis, Clark level is not predictive of behavior of the melanoma, ulceration, mitotic rate, regression)
___ presence is associated with poor survival
Tumor ulceration presence is associated with poor survival
(presence of ulceration upstages the tumor grade from an A to B stage)
____ is most important pathologic assessment in addition to ulceration in predicting tumor aggression and involvement of lymph node
Mitotic rate is most important pathologic assessment in addition to ulceration in predicting tumor aggression and involvement of lymph node
(most predictive of lymph node involvement in tumors with 0.5 - 1 mm Breslow thickness)
Describe treatments for melanoma
Melanoma treatments
- Surgery: Breslow depth tells you what excision margins should be used
- Targeted therapy
- Immunotherapy
- Biochemotherapy
- Radiation therapy
- Intralesional therapy
Describe stage III melanoma workup and therapy
Stage III melanoma workup and therapy
- Workup: baseline imaging for staging - CT, PET/CT, brain MRI
- Treatment: primary (wide excision of primary tumor, no longer routinely recommended), adjuvant
- Adjuvant therapy if BRAF wild-type or unknown: nivolumab / pembrolizumab
- Adjuvant therapy if + BRAF V600 mutation: nivolumab / pembrolizumab
Describe stage IV melanoma treatment
Stage IV melanoma treatment
- Talimogene laherparepvec: oncolytic virus based on modified HSV1 that was designed to selectively replicate in and lyse tumor cells while promoting regional and systemic antitumor immunity, insertion gene for GM-CSF
- Anti PD-1 monotherapy: pembrolizumab, nivolumab
- Targeted therapy if BRAF mutated
Broad spectrum sunscreen covers ____ sun rays
Broad spectrum sunscreen covers UVA and UVB sun rays
___ is responsible for most skin cancer deaths
Melanoma is responsible for most skin cancer deaths
(despite only comprising 5% of skin cancers)
