Derm - Cutaneous Melanoma

Front 1

CDKN2A mutations

Back 1

Encodes 2 gene products:
p16 - inhibits CDK4, ultimately inhibits cell progression through G1 phase of the cell cycle
p^14ARF - inhibits cellular oncogene MDM2
Accounts for 40% of hereditary melanoma cases; confers a 76% chance of developing melanoma in the US; confers a 15% change of developing pancreatic carcinoma

Front 2

Superficial spreading melanoma

Back 2

Most common subtype; accounts for 70% of all melanomas. Most often diagnosed between the ages of 30 and 50. Occurs at any site, but most frequently on trunk of men and legs of women. Asymptomatic brown to black macule with color variegation and irregular, notched borders. When it enters the radial growth phase, it develops into a papule or nodule. It can arise de novo or in a pre-existing nevus.

Front 3

ABCDE criteria

Back 3

Asymmetry - one half is not identical to the other, Border - irregular, notched, scalloped, ill-defined, Color - varying shades from one area to the next, Diameter - 6 mm or pencil eraser, and Evolving

Front 4

What are the prognostic factors for melanoma?

Back 4

Tumor thickness (Breslow depth) - the single most important prognostic factor for survival and clinical management in localized stage I and II cutaneous melanoma. Survival decreases with increasing tumor thickness.

Ulceration - Confers a higher risk of developing advanced disease and lower survival rate.

Mitosis - Refers to proliferation of primary melanoma; second most powerful predictor of survival, after tumor thickness, for clinically localized disease.

Front 5

Sentinel node mapping

Back 5

Used for identification of the first node in the basin that drains the tumor region using injection of blue dye and radioactive colloid. Used for patients who have T2, T3, T4 melanomas with clinically negative lymph nodes and in select T1b melanomas. 82% identification success rate with 20% rate of occult adenopathy. Not shown to prolong overall survival.

Front 6

What are the current margins based on the thickness of melanoma?

Back 6

Melanoma in situ, non-lentigo maligna pattern: 0.5 cm margins
Melanoma < 1.0 mm: 1.0 cm margins
Melanoma 1-2 mm: 1-2.0 cm margins
Melanoma > 2 mm: 2.0 cm margins

Front 7

Interferon

Back 7

Adjuvant therapy for melanoma patients surgically resected of disease but at high risk of relapse. High dose regimen prolongs disease free survival for stage IIb-III melanoma. Use controversial for clinically node negative patients, or those with occult nodal disease.

Front 8

What is the commonly used surgical margin for melanoma in situ, non-lentigo maligna type?

Back 8

0.5 cm

Front 9

What is the most common site for nodular melanoma?

Back 9

Trunk

Front 10

Sentinel lymph node biopsy is not indicated for which tumor category?

Back 10

Tis