Melanoma

Question 1

Melanoma N a?

Answer 1

a is ALWAYS OCCULT
N1a One clinically occult LN
N2a 2 or 3 occult
N3a 4 or more occult

Question 2

Melanoma Nb

Answer 2

N1b One clinically detected lymph node
N2b 2 or 3 clinically detected
N3b 4 or more

Question 3

Melanoma Nc?

Answer 3

N1c No clinical or occult lymph nodes, 1 satellite or in-transit lesions
N2 c One clinically detected or occult with satellite
N3c 2 or more clinically detected or occult

Question 4

Melanoma M stage?

Answer 4

M1- skin soft tissue
M2- lung
M3- non CNS visceral
M4- CNS

Question 5

In transit versus satellite lesions?

Answer 5

Satellite lesions are less than 2 cm from the primary tumor

Question 6

Desmoplastic melanoma?

Answer 6

> 90 % desmoplasia
Exhibits neurotropism
Less SLN positive
More TMB
Higher local recurrence
Radiation sensitive

Question 7

MSLT 1?

Answer 7

WLE with nodal observation alone vs
WLE + SNLB and CLND if positive
MSS primary outcome
Intermediate thick 1.2-3.5 mm was primary aim subgroup
Improved MSS and OS in intermediate thickness positive LN
melanoma
Nodal recurrence 19.5 and 37.5 int and thick with observation

Question 8

MSLT 2

Answer 8

• CLND vs nodal observation for positive SLN
• **Non sentinel node positivity 11.5% at CLND **and 26% at 5 yrs with observation
• 80% nodal basins with initail SLN positive disease free at 10 years

Question 9

Melanoma unknown primary stage?

Answer 9

Stage 3

Question 10

Node positivity with in-transit disease?

Answer 10

2/3rds

Question 11

Chemo agent used for ILI?

Answer 11

Melphalan

Question 12

TVEC?

Answer 12

HS-1 virus with GM-CSF
Every 2 weeks
Activity in 30% non injected sites

Question 13

Checkmate 238 melanoma?

Answer 13

Ipi vs Nivo for resected advanced melanoma
Nivo superior

Question 14

Keynote 054 Melanoma?

Answer 14

Pembro vs placebo for Stage 3 melanoma
Pembro superior RFS

Question 15

Keynote 716 melanoma?

Answer 15

Pembro for high-risk stage 2 melanoma, reduces RFS

Question 16

PRADO trial melanoma?

Answer 16

Neoadjuvant ipi/nivo in stage 3b-d melanoma, 2 cycles, index node marked
Index node removed after immuno
Major path resp (<10% residual) no further tx
Partial resp (10 - 50) LN dissection
No resp- resection and adjuvant immuno/target
61% major path response rate (near pCR)
Lower RFS and DMFS if major resp

Question 17

OpACIN-neo?

Answer 17

Optimal dosing of dual immuno in macroscopic stage 3
1mg/kg ipi and 3mg/kg nivo for 2 cycles optimal

Question 18

Melanoma stains?

Answer 18

S-100 and HMB-45 positive

Question 20

Melanoma non sentinel node positivity during CLND after positive SNLB?

Answer 20

8 to 25 % ( 11% in MSLT 2)
At 10 years 80.2 % of lymph node basins free of disease in Nodal observation