Term
|
Definition
| Cancer of the melanocytes - in the stratum basale (90%) or middle layer of eye (uvea) |
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Term
| What are risk factors for melanoma? |
|
Definition
- UV light exposure - do not tan!
- Genetics
- Over 25 typical moles, or just 1 atypical mole
- Xeroderma pigmentosum - cannot repair UV damage, melanoma at an early age |
|
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Term
|
Definition
| Benign mole --> Dysplastic nevi (precancerous) --> radial-growth phase --> vertical-growth phase --> Metastatic melanoma |
|
|
Term
| What mutation leads to malignancy in melanoma? |
|
Definition
|
|
Term
| What are histological subtypes of melanoma? |
|
Definition
- Superficial spreading - 70%
- Nodular - 20%
- Acral lentiginous - in AA, hispanic. 5%, palmar/plantar, mucosal
- Lentigo maligna - Thin lesions on sun damaged skin
- Desmoplasmotic - Head/Neck, nonpigmented |
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Term
|
Definition
- T - thickness in mm, a = w/o ulceration, b = with
- N - nodal involvement. Negative = local
- M - metastatic. 10% survival |
|
|
Term
| What are poor prognosis factors for melanoma? |
|
Definition
Male gender
thick lesions
# of nodes
Head/Neck
Ulceration |
|
|
Term
| What is the goal of melanoma tx? |
|
Definition
| Always cure, unless metastatic. Tx of choice is clinical trial |
|
|
Term
| What cytotoxic chemotherapy is used for melanoma? |
|
Definition
Triazenes: non-specific alkylating agents
- Dacarbazine - a prodrug of MTIC. Emesis, wear sunscreen
- Temozolamide - off label, CROSSES BBB. REQUIRED PCP prophylaxis
**+/- surgical excision |
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|
Term
| What targeted therapy is used for melanoma? |
|
Definition
Vemurafenib - BRAF V600E inhibitor, only works on the mutant
Can cause secondary carcinoma and QT prolongation |
|
|
Term
| What immunotherapy is used for melanoma? |
|
Definition
- Interferon alpha 2b - DEPRESSION. Give an SSRI
- Peg-Ifalpha 2b - rarely used, renal dosing
- Aldesleukin - CAPILLARY leak syndrome, AVOID steroids. Only use in very healthy patients
- Ipilimumab - CTLA-4 antagonist. IMMUNE response can be fatal. Severe rxn - high dose steroids |
|
|
Term
| What is the preferred tx for metastatic melanoma? |
|
Definition
- High dose IL-2
- Ipilimumab > Vemurafenib
**Salvage not shown to have response higher than 15% |
|
|
Term
| What agents will be approved soon for melanoma? |
|
Definition
- Dabrafenib - BRAF inhibit w/ CNS penetration
- Trametinib - MEK inhibitor for resistance |
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