Melanoma: Difference between revisions

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(Created page with "<section begin="dermatology" />* Epidemiology ** Only 2% of skin cancer ** Responsible for most skin cancer-related deaths ** Higher incidence in sun-rich countries like Australia compared to Europe ** Average age at onset ~50 * Risk factors ** Excessive UV exposure ** Fitzpatrick skin type I and II *** Easily burns *** Almost never suntans *** Often have freckles ** Precancerous lesions *** Dysplastic nevi *** Dysplastic nevus syndrome – 100% risk of developing melano...")
 
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<section begin="dermatology" />* Epidemiology
<section begin="oncology" /><section begin="dermatology" />* Epidemiology
** Only 2% of skin cancer
** Only 2% of skin cancer
** Responsible for most skin cancer-related deaths
** Responsible for most skin cancer-related deaths
** Higher incidence in sun-rich countries like Australia compared to Europe
** Higher incidence in sun-rich countries like Australia compared to Europe
** Paradoxically common in Northern Europe
** Average age at onset ~50
** Average age at onset ~50
* Risk factors
* Risk factors
** Excessive UV exposure
** Excessive UV exposure
*** Especially high doses over short period, in contrast to non-melanoma skin cancer
** Fitzpatrick skin type I and II
** Fitzpatrick skin type I and II
*** Easily burns
*** Easily burns
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*** NRAS
*** NRAS
*** p16 family
*** p16 family
* Pathogenesis
* Pathology
** BRAF mutation is found in 50%
** Breslow depth, mitotic rate and presence of ulceration on histology are important prognostic factors
** 2 growth phases:
** 2 growth phases:
** Radial/horizontal growth phase
** Radial/horizontal growth phase
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** On extremities in women
** On extremities in women
* Diagnosis
* Diagnosis
** ABCDE criteria – distinguishing between benign and malignant lesions
** Presumptive clinical diagnoses made with ABCDE criteria – these help distinguish between naevi and melanoma
*** Asymmetry
*** Asymmetry
*** Border irregular
*** Border irregular
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*** Full-thickness biopsy with 1 – 2 mm safety margin
*** Full-thickness biopsy with 1 – 2 mm safety margin
*** Shows atypical melanocytes and atypical architecture
*** Shows atypical melanocytes and atypical architecture
*** Important to look for BRAF mutation in the biopsy
* Prognosis
* Prognosis
** Breslow depth – from the top of the stratum granulosum to the deepest invasive cell
** Breslow depth – from the top of the stratum granulosum to the deepest invasive cell
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*** Can metastasize into unusual locations like the heart and gallbladder
*** Can metastasize into unusual locations like the heart and gallbladder
*** Metastases are black
*** Metastases are black
** Localized disease – cancer confined to primary site
*** 84% of cases
*** 98% 5-year survival
** Regional disease – cancer spread to regional lymph nodes
*** 9% of cases
*** 63% 5-year survival
** Metastatic disease – cancer has metastasized
*** 4% of cases
*** 22% 5-year survival
* Staging
* Staging
** TNM
** TNM
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*** Any melanoma with metastasis is stage IV
*** Any melanoma with metastasis is stage IV
* Treatment
* Treatment
** Surgical excision with safety margin
** Immediate complete excision upon clinical suspicion is the gold standard
*** Melanoma in situ – 0,5 cm safety margin
** A sufficiently large safety margin (1 – 2 cm, depending on Breslow stage) must be used
*** Breslow depth < 1 mm 1 cm safety margin
*** Breslow depth > 1 mm – 1 – 2 cm safety margin
** Non-surgical treatment
** Non-surgical treatment
*** For stage III and stage IV melanoma
*** For stage III and stage IV melanoma
*** Immune checkpoint inhibitors
*** Immune checkpoint inhibitors
**** Anti-CTLA-4 antibodies
**** Commonly used for advanced disease
***** Ipilimumab
**** Anti-CTLA-4 antibodies (Ipilimumab)
**** Anti-PD-1 antibodies
**** Anti-PD-1 antibodies (Nivolumab, Pembrolizumab)
***** Nivolumab
***** Pembrolizumab
*** Inhibitors of mutated proteins
*** Inhibitors of mutated proteins
**** BRAF inhibitor – dabrafenib
**** BRAF inhibitor – dabrafenib, trametinib
**** MEK inhibitor – trametinib<section end="dermatology" />
**** MEK inhibitor – trametinib
*** Chemotherapy is not used<section end="dermatology" /><section end="oncology" />


[[Category:Dermatology]]
[[Category:Dermatology]]