Therapeutics of Melanoma (Weddle) Flashcards
List some risk factors for melanoma.
- genetics (FAMMS or HDNS)
- sunlight/history of intermittent sun overexposure
- immunosuppression
How frequently does the American Academy of Dermatology recommend self-skin exams?
monthly
How often should high-risk patients receive clinical skin exams?
yearly
What type of melanoma is this?
superficial spreading melanoma (initially appears flat but subsequently becomes irregular and asymmetrical)
70% of melanoma cases are _____________.
superficial spreading melanoma
What type of melanoma is this?
nodular melanoma
Where is nodular melanoma most likely to appear?
head, neck, and trunk
What type of melanoma is this?
lentigo maligna melanoma
What type of melanoma is this?
acral lentiginous melanoma
Where is acral lentiginous melanoma most likely to appear on the body?
palms, soles, or under nail beds
What type of melanoma is this?
uveal melanoma
Where does uveal melanoma often metastasize to?
liver
What does the acronym “ABCDE” stand for?
- asymmetric
- irregular borders
- wide variety of colors
- diameter > 6 mm
- evolution of mole
What should be tested if a melanoma is stage IV?
BRAF V600E/K
What is Moh’s surgery?
when surgical margins accommodate anatomical/cosmetic considerations
What treatment strategies should be employed for stage IB/IIA/IIB/IIC melanoma (node negative)?
clinical trial, observation
What is the general regimen for stage III melanoma?
observation, nivolumab, pembrolizumab, or dabrafenib/trametinib (if BRAF mutant) +/- radiation
What is the general regimen for unresectable stage III melanoma with in-transit lesions?
T-VEC, topical imiquimod, consider radiation, isolated limb perfusion
What trial made nivolumab an NCCN category 1 recommendation in the adjuvant setting for stage IIIB/IIIC completely resected melanoma?
Checkmate 238
What did the KEYNOTE-054 Trial assess?
pembrolizumab compared to placebo in stage III resected melanoma
What adjuvant drug would you recommend for completely resected, stage III melanoma with BRAF V600E/K mutation?
dabrafenib + trametinib
What drug is cobimetinib used in combination with for melanoma?
vemurafenib
Which pair of agents can be used to suppress downstream BRAF resistance in melanoma?
encorafenib + binimetinib
When is pembrolizumab use indicated in melanoma?
positive lymph nodes and in unresectable/metastatic melanoma
When would nivolumab + ipilimumab be used in melanoma?
untreated, unresectable stage III or IV
In which melanoma drug might patients notice tumor growth prior to immune activation?
ipilimumab
What are the two most common toxicities associated with ipilimumab?
skin and GI
What ipilimumab toxicities take the longest to reverse or may not reverse at all?
endocrine toxicities
IL-2 use is associated with what life-threatening syndrome?
capillary leak syndrome
