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8 Cards in this Set
- Front
- Back
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Melanoma
% of all cancer cases? risk factors: |
5% of all cancer cases
1) family history (melanoma, dysplastic nevus) 2) dysplastic nevi 3) sunburns 4) fair skin (2-3x risk) 5) UV exposure, both A or B, including tanning beds. |
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Melanoma
Diagnoses- ABCDE next step: |
Asymmetry – ½ vs the other
Border – ragged, notched Color – uneven Diameter – larger than a pencil eraser or growth Evolving required biopsy- Clark level or Breslow depth |
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Clark level
levels: (5) Breslow Depth advantages: (2) |
1 epidermis – in situ disease
2 invasion of papillary dermis 3 through papillary but not into reticular dermis 4 invasion of reticular dermis 5 invasion of deep tissue Breslow: -more predictive of nodal involvement, better correlation with survival: <1mm >95% survival, 1-2mm 80-96% 2.1-4mm 60-75% >4mm 37-50% |
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Melanoma:
Primary therapy: (2) adjuvent therapy- when used: Rx: |
1) Wide excision
In situ – 1 cm margins in all directions Invasive – 2 cm margins -May require skin grafting 2) Sentinel Node Biopsy Considered with 1-2 mm invasion (or greater) Predictive of outcome If (+) consider full nodal dissection Adjuvent tx:Only in node (+) disease or invasion >4mm. 1) Hi dose IFN (survival benefit at 6 yrs but not 12, Follow-up study – no benefit) Pooled analysis of 3 studies: ↑DFS, no benefit in overall survival.) |
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How to treat "in transit lesions"?
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melanomas on way to lymph node...
If limited in number and/or scope: excise, + sentinal lymph node biopsy. |
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How to tx metastatic melanoma:
systemic treatments: (4) |
Single or localized: consider excision
1) Tx systemically for a short time and reassess 2) If no significant progression then excise. 1) Dacarbazine 2) Temozolomide 3) Taxol based regimen (eg Carbo/taxol) 4) IL-2 |
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Side-effects of IL-2 treatment in metastatic melanoma:
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Highly toxic
-capillary leak syndrome |
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OncoVex
what is it? |
Vaccine for metastatic melanoma
28% partial response rate in Phase II trials 16% complete response Seemingly durable – 4 years Now in Phase III trials |
