Melanoma NM

Question 1

Melanoma T

Answer 1

Question 2

Melanoma N

Answer 2

Question 3

Melanoma M

Answer 3

Question 4

Non cutaneous mucosal melanoma

Answer 4

Mucosal surface of GIT or vagina or urethra
1.3%
Surgery + radio

Question 5

Non cutaneous ocular melanoma

Answer 5

Uveal, choroidal
5.5%
Surgery + radio

Question 6

Cutaneous melanoma %

Answer 6

95%

Question 7

Melanoma risk

Answer 7

Xeroderma pigmentosum
Familial atypical mole melanoma sy
Sun exposure
Fair skin phenotype
History of nevi

Question 8

Prognosis for localised tumor <1 mm

Answer 8

> 90% 5-year survival

Question 9

Prognosis for localised tumor >1mm

Answer 9

50-90% 5-year survival

Question 10

Recurrence

Answer 10

50% regional LN
30% distant MTS
20% local (stage I or II)

Question 11

Distant MTS

Answer 11

Skin
Lung
Brain
Bone
Liver, spleen
GIT

Question 12

US

Answer 12

Regional LN in stage Ib-IIIa

Question 13

FDG

Answer 13

Distant MTS
> CT in extracerebellar MTS
Not generally accepted as a standard imaging modality for all stages
High sensitivity for IIIb/IIIc

Question 14

CT, MRI and FDG in early stage

Answer 14

Very low accuracy
False-positive
Useful for stage III and IV

Question 15

SLNB indication

Answer 15

After histological confirmation and wide local excision + 1-2 cm margins
Beyond stage IB >T1b
Clinically LN negative
Breslow 1-4mm

Question 16

MRI

Answer 16

Higher spatial resolution
Better in intracranial, bone marrow, hepatic, soft tissue involvement
Whole body MR - best for multiple cutaneous melanoma, even >PET

Question 17

Clinically occult LN MTS

Answer 17

Non palpable and difficult to identify with US
20% of patients with melanoma >1 mm

Question 18

Most common sites of MTS

Answer 18

Regional LN

Question 19

SLNB should be offered

Answer 19

Thin (<1 mm) and high risk (ulceration, mitotic rate >1 mm^2 or >50% regression)
Also for >4 mm or unknown thickness

Question 20

Contra SLNB

Answer 20

Poor general health status
Local or systemic spread
Prior extensive surgery

Question 21

Stage IB

Answer 21

T1b
T2a

Question 22

Melanoma lab

Answer 22

Increased LDH
Predictor of survival / outcome in stage IV

Question 23

Therapy

Answer 23

Inhibitor BRAF - - shrinkage of lesion
Monoclonal AB targeting CTLA4 and PD1

Question 24

FDG response to treatment

Answer 24

Rapid uptake reduction - - good response
No early reduction - - refractory disease
Flare response to immunotherapy, but early detection of toxicity
For anti-PD1 later imaging better assessment

Question 25

Predicted lymphatic drainage

Answer 25

98% lower limbs 88% upper limbs 56% anterior thorax 39% posterior trunk Unpredictable in head and neck

Question 26

SLNB technic

Answer 26

1 cm from melanoma intradermally Raise a wheal Volume 0.1-0.2 ml to avoid lymphatic collapse 5-120 MBq

Question 27

10% rule

Answer 27

All LN counting 10% or higher than ex vivo hottest SLN should be harvested

Question 28

Multiple basins

Answer 28

Torso, head, neck Less favourable survival

Question 29

Most important prognostic factor

Answer 29

Tumor thickness Location Ulceration Mitotic rate Positive LN LDH Older age

Question 30

ABCDE criteria

Answer 30

A - assymetry B - border irregularity C - color D - diameter >6mm E - evolution over time

Question 31

Margins

Answer 31

Stage 0 - 0.5 cm Stage I - 1-2 cm

Question 32

PET positive prediction

Answer 32

Mitotic rate >3 mm^2 T4 Lymphadenopathy Bleeding

Question 33

PET recommended

Answer 33

Positive SLNB High risk

Question 34

False positive FDG to cytokine therapy

Answer 34

Increased metabolism in normal lymph tissue (tonsils, LN)

Question 35

FDG pseudo progression

Answer 35

immune infiltrates

Question 36

Breslow <4 mm

Answer 36

>75% no LN

Question 37

LN in subcapsular region

Answer 37

Most commonly involved in MTS Not frozen section Immunohistochemistry