Wk 7 Melanoma

Question 1

Stages of melanoma

Answer 1

Stage 0: confined to epidermis
Stage 1: localized

Question 2

What is Breslow depth?

Answer 2

Measurement in mm of depth of melanoma for staging

Question 3

Melanoma growth patterns

Answer 3

Nodular -> greater mortality

Question 4

What does survival w/ melanoma relate to most?

Answer 4

Lesion depth
-increased depth by mm -> higher T stage

Question 5

Warning signs of melanoma acronym

Answer 5

Asymmetry
Border (irregular)
Color (multiple)
Diameter (>6 mm)
Evolving

Question 6

Melanoma characteristics in darker skin types

Answer 6

Question 7

What is ALM?

Answer 7

Acral lentiginous melanoma

Question 7

Where does ALM appear most often on darker skin?

Answer 7

feet, nail beds, palms
-most common melanoma subtype

Question 8

What are melanocytic nevi?

Answer 8

=Moles
benign neoplasms of melanocytes
-tend to arise in adolescence, peak by late 40s
-start at junction of epidermis and dermis
-w/ age become elevated, lose pigmentation, eventually regress
-junctional -> compound -> intradermal -> regression

Question 9

Do nevi give rise to melanoma?

Answer 9

increase melanoma risk 2-4 fold
-nevus cells in 25-40% of melanomas
-.50% of melanomas arise de novo

Question 10

Images of common melanocytic nevi

Answer 10

Question 11

3 types of nevi

Answer 11

1. congenital
2. blue nevus
3. halo nevus

Question 12

Common nevi in darker skin

Answer 12

Question 13

Examples of when to biopsy or not

Answer 13

Tricky b/c many have features of benign and malignant

Question 14

3D melanoma detection

Answer 14

Question 15

What is dermoscopy?

Answer 15

=multiple objective scoring system
-increased accuracy for experienced users, decreases for inexperienced
-NOT diagnostic but can increase confidence of dx
-can see deeper and diff structures of skin

Question 16

What are signature lesions?

Answer 16

Characteristic patterns in some patients’ nevi
-does a given atypical lesion fit into a characteristic pattern?
-look for the ugly duckling lesion - the one that doesn’t fit with others= suspicious

Question 17

What is seborrheic keratosis?

Answer 17

ABCD not sufficient
-warning sign of melanoma, but not melanoma

Question 18

Compare evolving nevi and melanoma

Answer 18

Nevus - gradual change (no change month-to-month)
-maintains shape and pigment distribution, uniform darkening or lightening, uniform regression

Melanoma - rapid enlargement (>3 mm^2/ year), changes shape and pigment distribution, non-uniform darkening or lightening and regression

Question 19

What is greatest increased risk for melanoma?

Answer 19

Family Hx (10-30x), approx 10% of melanoma patients
~33% of melanoma-prone families have germline variants in CDKN2A

Question 20

What is the only way to document changes in nevi or melanoma?

Answer 20

Photography

-disadvantage - only monitoring known lesions

-most lesions de novo, so might miss new ones

Question 21

What is the only way to document changes in nevi or melanoma?

Answer 21

Photography

-disadvantage - only monitoring known lesions

-most lesions de novo, so might miss new ones

Question 22

What is diagnostic 2-GEP?

Answer 22

=Pigmented lesion assay
-tape-stripping
-collect cellular RNA from adhesive patch over lesions followed by quantitative PCR

-a 2 gene screening test for LINC00518 and PRAME
-both -> high risk (>90%)
-only one gene =moderate (10-50%)
-neither gene = low risk (1%)

Question 23

Primary melanoma tx

Answer 23

Excision
-margins based on tumor depth

Question 24

Primary melanoma tx

Answer 24

Excision
-margins based on tumor depth

Question 25

How does immunotherapy work?

Answer 25

-utilize checkpoint inhibitors, which provide a negative signal to T cell so that it won’t kill a cell
-therapy provides a negative signal to the negative signal, allowing the T cell to kil the cell

Question 26

What are the 2 phases of T cell activation?

Answer 26

1. priming phase: anti-CTLA4
2. Effector phase: anti-PD1

Question 26

Driver mutations in melanoma

Answer 26

BRAF is most common (involved in RAS/MAPK pathway)

Question 27

Targeted therapy for melanoma

Answer 27

-inhibits mutant BRAF
-resistance very common, side effects
-not given as first therapy (give immunotherapy first)

Question 28

What is the best tx option for a patient w/ hx of mutant BRAF+ melanoma who develops distant metastases?

Answer 28

B. Immunotherapy

-BRAF inhibitor + MEK inhibitor = too toxic
-radiation not very effective for melanoma