Clinical Question 2: Genetics And Oncology

Clinical Question 2 – Genetics, Oncology
Limit your answer to no more than 3 pages, not including references. I will only read your first 3 pages.
A 54 yo woman is diagnosed with malignant melanoma on the posterior neck. The lesion has a horizontal spread of roughly 12 mm although borders are quite irregular. She undergoes surgical resection with wide, grossly clear margins. Pathology report suggests features consistent with an ulcerated lentigo maligna melanoma to a depth of 4 mm.
• Describe two molecular pathways that are often involved in the pathogenesis of malignant melanoma. How does abrogation of each pathway contribute to disease?
One of the pathways that is often discussed in multiple melanoma is the MAPK or the Mitogen activated Protein
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This drug works to break up the MAPK pathway through the interrupting of the BRAF/MET stage. This drug is designed for people that have the BRAF-V600 mutation which is the most common form of mutation in this protein. In this mutation the BRAF is left continuously on and does not need to respond to stimuli. Therefore the cell continuously activates the pathway. The purpose of the drug is to break up the pathway so the cell will stop dividing and enter into programmed cell death. This drug works by attacking cells and blocking the BRAF-V600E mutation only. However, cells or cancers that have a different mutation besides the BRAF-V600 mutation will not be affected by this drug. In a way this is good because it means that the cancer treatment is not going to block normal cell growth inhibition as long as the cells don’t contain the mutation. Ideally testing the cancer to see if it has this genetic mutation before treatment is often …show more content…
To start some of the major concerns when it comes to staging melanoma it is necessary to determine the thickness of the tumor, how far down the tumor has penetrated. Additionally, it is important understand how fast the tumor is dividing and if there is presents of any ulcers. The first part of the analysis is the about determining the size and characteristics of the tumor. After all this is completed it is necessary to assess lymph node involvement. To do this a lymph biopsy is needed to determine if the cancer has spread and to how many lymph nodes. The type of biopsy that is sometimes used is called a sentienal biopsy. The way this works is by injecting a dye in the area from where the cancer was removed. Then the dye is observed to see which lymph channels it has traveled through. Once the lymph nodes have been identified, they are removed and tested to see if they contain the cancer. Even if this test comes back negative it does not mean the patient is cancer free. The next step is to determine if the cancer has metastasis anywhere, the most likely places for melanoma to metastasis to any other part of the skin or to the lungs. A full skin exam is also going to be necessary to determine if the cancer has spread to any other areas of the skin. If there is suspicion of metastasis imaging maybe

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