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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 | ||
* | * 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 – | ** 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 | ||
** | ** Immediate complete excision upon clinical suspicion is the gold standard | ||
** | ** A sufficiently large safety margin (1 – 2 cm, depending on Breslow stage) must be used | ||
** 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 | ||
**** Anti-CTLA-4 antibodies (Ipilimumab) | |||
**** Anti-PD-1 antibodies | **** Anti-PD-1 antibodies (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]] | ||