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17 Cards in this Set
- Front
- Back
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Most common site?
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Men - back and h&n, women - legs
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Two major genes involved in melanoma developement? |
p16/CDK4 and CDK6/RB |
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Which subtype of melanoma does not have a radial growth phase? Which subtype is the most common and which one has the worst prognosis? |
no RPG - Nodular melanoma - also worst prognosis. Most common - superficial spreading 70% |
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What is the best prognositc factor for metastatic disease/
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Depth of invasion. Breslow thickness has an impact on local, regional, systemic recurrence and survival! |
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In terms of gender and location - which have better prognoses? |
Women better prognosis. Location (better to worse) - Extremities-->Trunk-->Head & neck --> Acral and mucosal |
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Mitotic rate impacts what? |
Distant mets risk. Not prognostic. |
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Imaging suggested for which stages? |
IIB-IIC consider CXR. Mandatory in IIIB, not sure for stage IIIA (TaN1-2a). Note if LDH elevated extensive staging required |
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Margins required |
T1 - 1cm T2-4 -2cm Tis - 5mm |
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When is SLNB recommended? |
T1b and higher or positive deep margins |
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Melanoma stage IB ? IIB is? Stage III is? |
IB - T1b, T2a IIB - T3b/T4aN0 IIC - T4bN0 IIIA - T1-T4aN1-2a IIIB - T1-T4bN1-2a or T1-4aN1-2b |
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When doyou add Postop RT to a N- lesion? |
Margins, recurrent |
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Differnce between satellites and in-transit mets. Prognostic significance of in-transit or satellite mets |
Satellites - 2-5cm from orginial scar In-transit >5cm (<2cm local recurrence)/. Prognostic - similar to clinical nodal mets |
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Which neck dissection is preformed for positive cervical nodes in melanoma? |
Modified radical neck
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When to add adjuvant RT after lymph node dissection? Improves what? |
ECE, >3cm, >=4 nodes, recurrence (note also two or more axillary, 3 or m,ore groin, 3cm cervica/axillary or 4 cm groin). Improves local control only. |
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IFN alpha given from which stage? what does it improve? |
Stage IIb and up, E1684 imrpoved OS (33%) also PFS. Newer study E1694 (comparing doses of IFN) yielded no OS advantage, only PFS |
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Follow-up for stage III melanoma? |
IIIA - CXR IIIB/C - annual CT, consider brain MRI |
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DTIC response rate in metastatic melanoma? TMZ? does TMZ improve PFS?OS? |
DTIC RR 7%, TMZ 15%. No improvement in PFS, OS. |
