Exam 2 - Melanoma Weddle

Question 1

melanocytes synthesize ________ to protect tissues from UV radiation induced damage

Answer 1

melanin

Question 2

70% of melanoma cases; initally appears flat but subsequently becomes irregular and asymmetrical

a. superficial spreading melanoma
b. nodular melanoma
c. lentigo maligna melanoma
d. acral lentiginous melanoma
e. uvual melanoma

Answer 2

a. superficial spreading melanoma

Question 3

15% melanoma cases; appears dark blue-black in color; appears on head, neck and trunk

a. superficial spreading melanoma
b. nodular melanoma
c. lentigo maligna melanoma
d. acral lentiginous melanoma
e. uvual melanoma

Answer 3

b. nodular melanoma

Question 4

-presents on the face of elderly pts
-tan lesion with areas of brown and black
-low propensity to metastasize

a. superficial spreading melanoma
b. nodular melanoma
c. lentigo maligna melanoma
d. acral lentiginous melanoma
e. uvual melanoma

Answer 4

c. lentigo maligna melanoma

Question 5

-frequently presents on the palms, soles, or under nail beds
-lesions often have irregular, convoluted borders
-more common in African-Americans, Asians, and Hispanics

a. superficial spreading melanoma
b. nodular melanoma
c. lentigo maligna melanoma
d. acral lentiginous melanoma
e. uvual melanoma

Answer 5

d. acral lentiginous melanoma

Question 6

-arises from pigmented epithelium of the choroid
-most common ocular melanoma
-often metastasis in liver

a. superficial spreading melanoma
b. nodular melanoma
c. lentigo maligna melanoma
d. acral lentiginous melanoma
e. uveal melanoma

Answer 6

e. uveal melanoma

Question 7

clinical presentation of melanoma acronym

Answer 7

ABCDE
-Asymmetric
-irregular Borders
-wide variety of Colors
-Diameter of > 6 mm
-Evolution of a mole

Question 8

gold standard diagnostic work up of melanoma

Answer 8

biopsy of suspected lesion

Question 9

purpose of a sentinel-node biopsy in melanoma diagnostics

Answer 9

determines if the melanoma has invaded lymph node beds

Question 10

if a melanoma is a clinical or pathologic stage IV, the tumor tissue should be tested for what mutations?

Answer 10

BRAF V600E and K mutations

Question 11

T or F: radiation is used in all melanoma pts

Answer 11

F (could be offered in adjuvant setting for select pts with positive lymph nodes and high risk of relapse)

Question 12

look at melanoma tx overview (slide 20)

Answer 12

okay

Question 13

the Checkmate 238 trial found that toxicities were higher with which adjuvant drug?

a. nivolumab
b. ipilimumab

Answer 13

b. ipilimumab

Question 14

adjuvant dabrafenib/trametinib is used in which stage of melanoma?

a. IB or IIA
b. IIB or IIC
c. III
d. unresectable stage III with in-transit lesions

Answer 14

c. III

Question 15

how long should adjuvant dabrafenib/trametinib be used in stage III melanoma pts?

a. one month
b. three months
c. six months
d. one year
e. for life

Answer 15

d. one year

Question 16

SE of adjuvant dabrafenib/trametinib (3 of them)

Answer 16

-fever
-fatigue
-nausea

Question 17

T or F: immunotherapy can take weeks to see effect

Answer 17

T

Question 18

for metastatic melanoma, what are the 3 combination targeted therapy if BRAF V600 mutant is present?

Answer 18

-dabrafenib/trametinib
-vemurafenib/cobimetinib
-encorafenib/binimetinib

Question 19

unique toxicity of vemurafenib

Answer 19

development of squamous cell carcinoma (up to 26%)

Question 20

encorafenib and binimetinib have less occurrence of which common side effect?

Answer 20

less fevers

Question 21

match these 6 drugs to its partner in combination therapy for BRAF V600 mutation:

vemurafenib
binimetinib
trametinib
encorafenib
dabrafenib
cobimetinib

Answer 21

dabrafenib/trametinib
vemurafenib/cobimetinib
encorafenib/binimetinib

Question 22

BRAF resistance to single agent therapy typically occurs around ___-___ months

Answer 22

6-7 months (so combo therapy preferred)

Question 23

two PD-1 inhibitors for melanoma (slide 39)

Answer 23

nivolumab, pembrolizumab

Question 24

two CTLA-4 inhibitors for melanoma (slide 39)

Answer 24

ipilimumab, tremelimumab

Question 25

two PD-L1 inhibitor drugs for melanoma (slide 39)

Answer 25

atezolizumab, durvalumab

Question 26

T or F: all pts should receive all 4 doses of ipilimumab unless experiencing life threatening toxicities

Answer 26

T (typically the tumor might get worse initially, but will get better over time)

Question 27

immunotherapy response is measured by what? (slide

Answer 27

immune related response criteria (irRC)

Question 28

_____ and _____ toxicities are the most common with ipilimumab

Answer 28

skin; GI

Question 29

which toxicities of ipilimumab take the LONGEST to reverse (and may not reverse)? a. skin b. GI c. liver d. endocrine

Answer 29

d. endocrine

Question 30

T or F: chemo usually cures any pt in the metastatic setting, either single agent or combo therapy

Answer 30

F (rarely cures; response rate ~10%)

Question 31

interleukin 2 role in melanoma (fallen out of favor)

Answer 31

stimulator of cytotoxic T cells, has activity against melanoma cells

Question 32

drug associated with life threatening capillary leak syndrome a. interferon alfa b. interleukin 2 c. pembrolizumab d. dabrafenib/trametinib

Answer 32

b. interleukin 2

Question 33

what is another immunotherapy drug for melanoma that is not IL-2?

Answer 33

interferon alfa

Question 34

melanoma screening: the American Academy of Dermatology recommends a self-exams to check for melanoma how often (not a high risk pt)? a. weekly b. biweekly c. monthly d. yearly

Answer 34

c. monthly

Question 35

how often should high-risk pts be receiving a clinical exam for melanoma? a. weekly b. biweekly c. monthly d. yearly

Answer 35

d. yearly

Question 36

T or F: pts with a strong family history of melanoma should have a clinical exam by a physician

Answer 36

T

Question 37

melanoma prevention: what SPF sunscreen should be used?

Answer 37

15 or greater

Question 38

which drug can be used in stage IIB or IIC melanoma pts? a. nivolumab b. dabrafenib/trametinib c. pembrolizumab d. pemetrexed

Answer 38

c. pembrolizumab

Question 39

T-VEC, topical imiquimod and radiation can be used in this stage of melanoma tx a. IB or IIA b. IIB or IIC c. III d. unresectable stage III with in-transit lesions

Answer 39

d. unresectable stage III with in-transit lesions