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Heme/Onc > Malignant Melanomas > Flashcards

Malignant Melanomas Flashcards

1
Q

What are the RFs for malignant melanoma?

A

PH and FH of cutaneous melanomas
High density of common and atypical nevi
Immunodeficiency/immunosuppression
Sun sensitivity or exposure

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2
Q

What are the clinical presentations of malignant melanoma?

A

Questionable lesions

Possible signs of metastasis

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3
Q

What are the ABCDEs of nevi?

A 
Asymmetry
Border irregularity
Color 
Diameter
Enlargment/evolution
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4
Q

How are malignant melanomas diagnosed?

A

Review of patient history to identify RFs
Biopsy
Total dermatologic examination
Lymph node evaluation
May do additional imaging studies if metastasis suspected

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5
Q

How are malignant melanomas staged?

A

TNM

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6
Q

What factors affect the T in TNM system?

A

Tumor thickness
Mitotic rate: higher rate indicates cancer more likely to grow and spread
Ulceration: breakdown of skin over the melanoma. Worse prognosis with more ulceration

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7
Q

What is stage 0 melanoma?

A

Melanoma in situ

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8
Q

What is stage I melanoma?

A

Tumor < 1-2 mm in thickness

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9
Q

What is stage II melanoma?

A

Tumor > 2 mm in thickness

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10
Q

What is stage III melanoma?

A

Clinically positive nodes and/or separate distinct lesions

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11
Q

What is stage III in-transit ?

A

Spread through lymph and begins to grow > 2cm away from the primary but before reaching the nearest lymph node

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12
Q

What is stage IV melanoma?

A

Distant metastatic disease

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13
Q

What are the prognostic factors for melanoma?

A

Tumor thickness
Mitotic rate
Tumor ulceration

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14
Q

What are the treatment goals of localized melanoma?

A

Cure

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15
Q

What are the treatment goals of regional disease?

A

Possible a cure if able to do surgery +/- adjuvant chemo

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16
Q

What are the treatment goals of metastatic disease?

A

Slow progression
Prolong life
Improve QOL
Relieve acute sx

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17
Q

What is the primary treatment for stages 0-I?

A

Wide excision +/- sentinel lymph node biopsy (SNLB) with thicker disease

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18
Q

Is adjuvant therapy needed in stages 0-I?

A

No

19
Q

What is the primary treatment for stage II?

A

Wide excision +/- SLNB

20
Q

What is the adjuvant treatment for stage II melanoma?

A

Interferon alfa in select cases but not routinely used

21
Q

What is the primary treatment for stage III melanomas?

A

Wise excision + lymph node dissection

22
Q

What are the adjuvant treatment options for stage III melanoma?

A 
None/observation
Radiation
Nivolumab/HD ipilimumab
Dabrafenib/trametinib (if BRAF V600 mutations)
Interferon alfa
23
Q

What is the primary treatment of stage IV melanomas?

A

Surgery if resectable
Systemic chemotherapy
+/- palliative radiation therapy

24
Q

What systemic therapies are first line options if the patient has wt BRAF V600?

A

Nivolumab
Pembrolizumab
Nivolumab + ipilimumab

25
Q

What are the systemic therapies that are first line if the patient has a BRAF V600 mutation?

A 
Nivolumumab
Pembrolizumab 
Nivolumab + ipilumab
Dabrafenib + trametinib
Vamurafenib + cobimetinib
26
Q

What are the PD-1 inhibitors?

A

Nivolumab

Pembrolizumab

27
Q

How do PD-1 inhibitors work?

A

Block interaction between PD-1 and PD-L1 which normally deactivates T cells

28
Q

What are AEs of PD-1 inhibitors?

A 
Rash
Pneumonitis
Colitis
Hepatitis
Nephritis
Renal dysfunction
Hypothyroidism
Hyperthyroidism
29
Q

What is the CTLA-4 monoclonal antibody?

A

Ipilimumab

30
Q

What was the first anti-cancer drug for advanced melanoma to demonstrate overall survival?

A

Ipilimumab

31
Q

What are the GI AEs of ipilimumab?

A

Diarrhea
Colitis
Blood in stool

32
Q

What is the treatment for the GI AEs of ipilumumab?

A

If moderate-severe = corticosteroids

33
Q

What are the AEs for skin AEs d/t ipilumumab?

A

SJS

Maculopapular rash

34
Q

How do we treat skin AEs d/t ipilumumab?

A

Topical or oral steroids

35
Q

What are the liver AEs d/t ipilumumab?

A

LFT elevation

36
Q

How do we treat AEs of liver d/t ipilumumab?

A

If severe = steroids

37
Q

Which anti-cancer drugs are MEK inhibitors?

A

Tramatinib

Cobimetinib

38
Q

What are the AEs for Debrafenib/trametinib and Vemurafenib/cobimetinib combinations?

A

Pyrexia
Cutaneous malignancies
Bleeding
Thromboembolic events

39
Q

What is pyrexia associated with?

A

Chills
Night sweats
Dehydration
Electrolyte abnormalities

40
Q

What is talimogene laherparepbvec indicated for?

A

unresectable recurrent melanoma in the skin or lymph glands

41
Q

How is talimogene administered?

A

Intralesional Injection

42
Q

How does talimogene work?

A

Virus relicates within cancer cell and secretes GM-CSF, which attracts dendritic cells and T cells

43
Q

What are the AEs of talimogene?

A

Injection site reactions
Fatigue
Chills
Flu-like sx

Heme/Onc (20 decks)

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