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Flashcards in Melanoma Deck (52):
1

What is melanoma?

Neoplastic disorder produced by malignant transformation of the melanocyte.
Melanocytes are derived from neural crest cells.

2

Which patients are at greatest risk for melanoma?

White patients with blonde or red hair, fair skin, freckling, and history of blistering sunburns, blue or green eyes, actinic keratosis, M > F

3

What are the most common sites for melanoma?

1. Skin
2. Eyes
3. Anus

4

What is the most common site of melanoma in African Americans?

Palms of the hands, soles of the feet (acral lentigenous melanoma)

5

What characteristics are suggestive of melanoma?

Usually a pigmented lesion with an irregular border, irregular surface, or irregular coloration.
Also: darkening of a pigmented lesion, development of pigmented satellite lesions, irregular margins or surface elevations, notching, recent or rapid enlargement, erosion or ulceration of surface, pruritus

6

What are the ABCDs of melanoma?

Asymmetry, Border irregularity, Color variation, Diameter (> 6 mm) and Dark

7

What are the associated risk factor for melanoma?

Severe sunburn before age 18, giant congenital nevi, family history, white, UV radiation, multiple dysplastic nevi

8

How does location of melanoma differ in men and women?

Men get more lesions on the trunk, women on the extremities

9

Which locations of melanoma are unusual?

Noncutaneous regions, such as mucous membranes of the vulva or vagina, anorectum, esophagus, and choroidal layer of the eye

10

What is the most common site of melanoma in men?

Back

11

What is the most common site of melanoma in women?

Legs

12

What are the 4 histologic types of melanoma?

1. Superficial spreading
2. Lentigo maligna
3. Acral lentiginous
4. Nodular

13

What is superficial spreading melanoma?

Occurs in both sun-exposed and non-exposed areas.
Most common melanoma (75%)

14

What is lentigo maligna melanoma?

Malignant cells that are superficial, found usually in elderly patients on the head or neck.
Called Hutchinson's freckled if noninvasive.
Least aggressive type, very good prognosis.

15

What is acral lentiginous melanoma?

Occurs on the palms, soles, subungual areas, and mucous membranes

16

What is nodular melanoma?

Vertical growth predominates, lesions are usually dark.
Most aggressive type, worst prognosis.

17

What is amelanotic melanoma?

Melanoma from melanocytes but with obvious lack of pigment

18

What is the most common type of melanoma?

Superficial spreading

19

What type of melanoma arises in Hutchinson's freckle?

Lentigo maligna melanoma

20

What is Hutchinson's freckle?

Lentigo maligna melanoma in the radial growth phase without vertical extension.
Usually occurs on the faces of elderly women.

21

What is stage IA melanoma?

22

What is stage IB melanoma?

23

What is stage IIA melanoma?

1-2 mm with ulceration or 2-4 mm without ulceration

24

What is stage IIB melanoma?

2-4 mm with ulceration or > 4 mm without ulceration

25

What is stage IIC melanoma?

> 4 mm with ulceration

26

What is stage III melanoma?

Positive nodes

27

What is stage IV melanoma?

Distant metastases

28

What are the common sites of melanoma metastasis?

Nodes, lung, liver, bone, heart, and brain

29

What are the metastatic routes of melanoma?

Both lymphatic and hematogenous

30

How is the diagnosis of melanoma made?

Excisional biopsy or incisional biopsy for very large lesions

31

What is the role of shave biopsy in melanoma?

No role

32

What is the sentinel node biopsy?

Inject Lymphazurin blue dye, colloid with a radiolabel, or both around the melanoma.
The first lymph node in the draining chain is identified as the sentinel lymph node and reflects the metastatic status of the group of lymph nodes

33

When is elective lymph node dissection in melanoma recommended?

Controversial

34

What is the recommended size of the surgical margin for depth of invasion for melanoma in situ?

0.5-cm margin

35

What is the recommended size of the surgical margin for depth of invasion for melanoma

1-cm margin

36

What is the recommended size of the surgical margin for depth of invasion for melanoma 1-4 mm thick?

2-cm margin

37

What is the recommended size of the surgical margin for depth of invasion for melanoma > 4 mm thick?

3-cm margin

38

What is the treatment for digital melanoma?

Amputation

39

What is the treatment of palpable lymph node metastasis?

Lymphadenectomy

40

What factors determine the prognosis for melanoma?

Depth of invasion and metastasis are the most important factors

41

What is the workup to survey for metastasis in the patient with melanoma?

PE, LFTs, CXR

42

What is the treatment of intestinal metastasis of melanoma?

Surgical resection to prevent bleeding or obstruction

43

Which malignancy is most likely to metastasize to the bowel?

Melanoma

44

What is the surgical treatment of nodal metastasis in melanoma?

Lymphadenectomy

45

What is FDA-approved adjuvant therapy for melanoma?

Interferon alpha-2b (stages IIB/III)

46

What is the treatment of unresectable brain metastases in melanoma?

Radiation

47

What is the treatment of isolated adrenal metastasis in melanoma?

Surgical resection

48

What is the treatment of isolated lung metastasis in melanoma?

Surgical resection

49

What is the most common symptom of anal melanoma?

Bleeding

50

What is the treatment of anal melanoma?

APR or wide excision

51

What experimental therapy is available for metastatic disease in melanoma?

1. Monoclonal antibodies
2. Chemotherapy (e.g. decarbazine)
3. Vaccinations

52

What is the median survival with distant metastasis of melanoma?

6 months