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Malignant Melanoma

Terms in this set (10)

Personal or FH
High density atypical nevi
Immunosuppression (meds, HIV)
Sun Sensitivity or exposure
What are the Risk Factors?
localized

regional

metastatic
Highest to lowest prognosis
Review pt history and RF

Biopsy of lesion
- excisional - remove whole thing
- punch biopsy - deeper sample that preserves architecture

Lab tests - (CMP and LDH)
Lymph node evaluation
Diagnosis
0 - not spread
1 - Tumor ≤ 1mm
2 - tumor > 1mm
3 - spread through lymph
4 - metastatic
Staging

0
1
2
3
4
Thickness
mitotic rate
tumor ulceration
What prognostic factors indicated worsening disease?
localized - cure
regional - possible cure
metastatic - slow progression and prolong life
What are the goals of therapy?
0,1,2,3 = surgery

3 = can add adjuvant

4 - can add adjuvant
Treatment
Stage 0,1,2,3
Pembrolizumab
Nivolumab
What drugs are for BRAF wild-type and BRAF mutant
two drug combo that both end in -nib


ADE's: pyrexia (chills, night sweats, dehydration), bleeding, thrombus
DI's: CYP interactions and QT prolongation
What drugs are for BRAF V600 or V600K
Talimogene laherparepvec (T-VEC)

ADE's: fatigue, chills, flu-like symptoms
DI's: other antiviral may reduce effectiveness
Unresectable recurrent melanoma in the skin or lymph glands
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