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45 Cards in this Set
- Front
- Back
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True or False: The etiology of melanoma is fully understood.
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FALSE: not fully understood
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True or False: There is one gene involved in the development and progression of melanoma.
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FALSE: a number of genes are involved
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True or False: Molecular profiling studies have identified several distinct molecular subclasses of melanoma.
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TRUE
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Familial atypical mole syndrome (hereditary dysplastic nevus syndrome) is characterized by a predisposition to develop:
1. 2. 3. 4. 5. |
1. Dysplastic nevi
2. Cutaneous melanoma 3. Only 8-10% of melanoma 4. Polygenic inheritance 5. Familial melanoma gene, CDKN2A located at chromosome 9p21 |
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At which chromosome is familial melanoma gene CDKN2A located?
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Chromosome 9p21
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Germ-line inactivation of ________ gene is a predisposing factor for melanoma.
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Retinoblastinoma (RB)
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What is the lifetime risk for individuals with a history of bilateral retinoblastinoma compared to those without?
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40-80x higher
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What is the most important environmental factor in the pathogenesis of melanoma?
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Sunlight
-incidence associated with latitude and intensity |
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What are the host risk factors for melanoma?
1. Age > ____ 2. History of ______ _______ 3. D_____ n____ 4. Cutaneous melanoma in a _____-_____ _______ 5. Immunodeficiency/___________ 6. High density of common _____ & _______ nevi 7. High degree of ________ 8. Sunburns ______/tans ______ 9. ______ or _____ hair 10. _____, ______ or _____ eyes 11. _______ socioeconomic status 12. ______ vs black race |
1. Age > 15
2. cutaneous melanoma 3. dysplastic nevi 4. first-degree relative 5. immunosuppression 6. common nevi & atypical nevi 7. freckling 8. sunburns easily/tans rarely 9. blonde or red 10. blue, green or grey 11. higher 12. white |
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What are the external risk factors associated with melanoma?
1. _______ _______ sun exposure 2. History of _______ 3. More than ____ painful sunburns before age ____ 4. ______ leisure |
1. Intense intermittent sun exposure
2. History of sunburn 3. More than 4 painful sunburns before age 15 4. Outdoor leisure |
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True or False: Melanoma can be transferred from mother to fetus through the placenta and is an important risk factor of melanoma even if the baby is born without the disease.
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TRUE
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Melanoma often arises from which type of skin cells?
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Epidermal melanocytes (can also come from noncutaneous melanocytes)
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True or False: Primary melanoma only exists in the skin.
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FALSE: Melanoma can arise in any area of the body with melanocytes.
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What is the most common site of melanoma?
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Skin
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What areas of the body can primary melanoma arise in?
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1. Eye (ocular melanoma)
2. Meninges 3. Respiratory tract 4. Colon 5. Gallbladder |
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What is the difference between normal melanocytes and melanoma cells?
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Normal cells require growth factor and melanoma cells do not.
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What is secreted by melanoma cells that may facilitate proliferation?
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Autocrine and paracrine factors.
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With progression of melanoma, cells increase production of:
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certain growth factors and cytokines
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What factors appear to be involved in the progression of melanoma more often than in most other solid tumors?
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Immune factors
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True or False: Spontaneous regression is common in melonoma.
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FALSE: Rare, but well-documented.
-Focal regression in primary melanoma has been reported -Tumor regression appears to be associated with host immunity |
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What provides rationale for immunotherapy in management of metastatic melanoma?
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Humoral and cellular responses of individuals with melanoma who express melanoma-associated antigen
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What is the link between benign nevi and melanoma?
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Dysplastic nevi
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What are the criteria that define dysplastic nevi?
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*ABCD*
1. flat macules with Asymmetry 2. Border irregularity 3. Color variation 4. usually Diameter >5mm |
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What are the 4 major histologic subtypes or growth patterns of primary cutaneous melanoma?
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1. Superfical spreading melanoma
2. Nodular melanoma 3. Lentigo maligna melanoma 4. Acral lentiginous melanoma |
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What is a less common subtype of melanoma?
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Desmoplastic melanoma (more common in older individuals)
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The initial clinical presentation of melanoma is based on:
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*ABCD(H)*
1. lesions Asymmetry 2. Border 3. Color Diameter 4. History (mole change) |
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What characteristic of primary melanoma is associated with likelihood of metastates?
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The size
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What factors are considered by the AJCC in dividing patients into one of the 4 stages of primary melanoma?
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TNM
- Tumor satellite - Extent of lymph node involvement - Presence of metastatic disease |
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What are Clark's Classifications of melanoma?
N: I: II: III: IV: |
N: Epidermidis
I: Dermal-epidermal junction II: Papillary Dermis III: Interface between papillar dermis and reticular dermis IV: Reticular dermis and subcutaneous fat |
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What are tumor-related prognostic factors for melanoma?
1. Tumor _______ 2. Level of tumor ______ 3. _______ _____ of primary tumors 4. Mitotic _____ 5. A_______ 6. Occurrence in _______ 7. ____ of tumor regression 8. Presence of _____-______ _______ |
1. Tumor thickness
2. Level of tumor invasion 3. Anatomic site of primary tumors (increased survival in tumors of extremeties) 4. Mitotic rate (increased rate = decreased survival) 5. Angiogenesis 6. Occurrence in microsatellites 7. Area of tumor regression 8. Presence of tumor-infiltrating lymphocytes (correlated with increased survival) |
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What are patient-related prognostic factors of cutaneous melanoma?
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1. Age
(decreased survival in patients > 60) 2. Gender (Female>male) |
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What is the treatment of choice for localized melanoma?
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Managed and often cured with surgical ablation
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What are the treatment options for regional melanoma?
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-Treated with surgical resection of the primary tumor
- Possibly adjuvant therapy depending on the risk of recurrence (use of adjuvant therapy and interferon-alpha as adjuvant is controversial) |
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What is the standard treatment regimen for disseminated melanoma?
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*NO single standard approach*
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Why is immunotherapy believed to be a possible treatment for melanoma?
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-Melanoma is one of the most immunogenic solid tumors
-Appears to interact with and respond to immune system -Spontaneous regression suggests importance of immune system in disease modulation |
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What immunotherapeutic treatment of melanoma is one of the oldest and most controversial and what are the response rates?
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*Interferon*
-RR in metastatic melanoma ranges 10-30% -OR to interferon-alpha is about %15 |
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Some important information about IL-2 as an immunotherapeutic treatment option for melanoma:
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-glycoprotein produced by activated lymphocytes
-growth factor for T-cells, lymphocytes, NK cells -dose-response relationship btn IL-2 and tumor -RR 15-25% (about the same as interferon) -CR 2-5% |
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What immunotherapeutic option is being evaluated for treatment of melanoma because of its potential to induce tumor-specific immune responses and fewer toxicities than other treatments?
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Vaccines
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What is the only FDA approved chemotherapeutic agent for treating metastatic melanoma?
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*Dacarbazine*
-RR 10-25% -CR uncommon -there does not appear to be a survival benefit relative to other tmts |
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What is the oral prodrug available to treat melanoma and what are its benefits?
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*Temzolomide*
-oral prodrug of dacarbazine -appears to be less ematogenic -can cross into CNS to benefit patients with metastatic melanoma |
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What 2 nitrosureas are active against melanoma and have antitumor activity similar to dacarbazine?
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*Carmustine and Lomustine*
-RR 10-20% |
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What 2 taxanes have demonstrated encouraging results in initial trials of metastatic melanoma?
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*Paclitaxel and Docetaxel*
-RR 15-17% |
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What 2 protein kinases are being evaluated as targeted therapy options for treating melanoma?
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*Sorafenib and Imatinib*
-Sorafenib- ongoing phase II trials being investigated as a single agent with modest activity in refractory metastatic melanoma -Imatinib - phase II showed inactive against metastatic melanoma |
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What combination therapies are being investigated for biochemotherapy options in treatment of melanoma?
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-Combination of chemotherapy and cytokines,aldesleukin &/or interferon
-Rationale is to combine 2 therapies with some biologic activity to increase overall activity and response rates |
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How should sunscreen be applied?
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-Apply 15-30 min before sun
-Reapply every 2 hours, after swimming, after perspiring heavily -Use regularly -Need UVA and UVB protection |
