Therapeutics of Melanoma (Weddle)

Question 1

List some risk factors for melanoma.

Answer 1

• genetics (FAMMS or HDNS)
• sunlight/history of intermittent sun overexposure
• immunosuppression

Question 2

How frequently does the American Academy of Dermatology recommend self-skin exams?

Answer 2

monthly

Question 3

How often should high-risk patients receive clinical skin exams?

Answer 3

yearly

Question 4

What type of melanoma is this?

Answer 4

superficial spreading melanoma (initially appears flat but subsequently becomes irregular and asymmetrical)

Question 5

70% of melanoma cases are _____________.

Answer 5

superficial spreading melanoma

Question 6

What type of melanoma is this?

Answer 6

nodular melanoma

Question 7

Where is nodular melanoma most likely to appear?

Answer 7

head, neck, and trunk

Question 8

What type of melanoma is this?

Answer 8

lentigo maligna melanoma

Question 9

What type of melanoma is this?

Answer 9

acral lentiginous melanoma

Question 10

Where is acral lentiginous melanoma most likely to appear on the body?

Answer 10

palms, soles, or under nail beds

Question 11

What type of melanoma is this?

Answer 11

uveal melanoma

Question 12

Where does uveal melanoma often metastasize to?

Answer 12

liver

Question 13

What does the acronym “ABCDE” stand for?

Answer 13

• asymmetric
• irregular borders
• wide variety of colors
• diameter > 6 mm
• evolution of mole

Question 14

What should be tested if a melanoma is stage IV?

Answer 14

BRAF V600E/K

Question 15

What is Moh’s surgery?

Answer 15

when surgical margins accommodate anatomical/cosmetic considerations

Question 16

What treatment strategies should be employed for stage IB/IIA/IIB/IIC melanoma (node negative)?

Answer 16

clinical trial, observation

Question 17

What is the general regimen for stage III melanoma?

Answer 17

observation, nivolumab, pembrolizumab, or dabrafenib/trametinib (if BRAF mutant) +/- radiation

Question 18

What is the general regimen for unresectable stage III melanoma with in-transit lesions?

Answer 18

T-VEC, topical imiquimod, consider radiation, isolated limb perfusion

Question 19

What trial made nivolumab an NCCN category 1 recommendation in the adjuvant setting for stage IIIB/IIIC completely resected melanoma?

Answer 19

Checkmate 238

Question 20

What did the KEYNOTE-054 Trial assess?

Answer 20

pembrolizumab compared to placebo in stage III resected melanoma

Question 21

What adjuvant drug would you recommend for completely resected, stage III melanoma with BRAF V600E/K mutation?

Answer 21

dabrafenib + trametinib

Question 22

What drug is cobimetinib used in combination with for melanoma?

Answer 22

vemurafenib

Question 23

Which pair of agents can be used to suppress downstream BRAF resistance in melanoma?

Answer 23

encorafenib + binimetinib

Question 24

When is pembrolizumab use indicated in melanoma?

Answer 24

positive lymph nodes and in unresectable/metastatic melanoma

Question 25

When would nivolumab + ipilimumab be used in melanoma?

Answer 25

untreated, unresectable stage III or IV

Question 26

In which melanoma drug might patients notice tumor growth prior to immune activation?

Answer 26

ipilimumab

Question 27

What are the two most common toxicities associated with ipilimumab?

Answer 27

skin and GI

Question 28

What ipilimumab toxicities take the longest to reverse or may not reverse at all?

Answer 28

endocrine toxicities

Question 29

IL-2 use is associated with what life-threatening syndrome?

Answer 29

capillary leak syndrome