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Questions and Answers
Which of the following treatment methods for nonmelanoma skin cancer offers a greater than 90% cure rate?
Which of the following treatment methods for nonmelanoma skin cancer offers a greater than 90% cure rate?
Malignant melanoma is more commonly found on the lower extremities of men than women.
Malignant melanoma is more commonly found on the lower extremities of men than women.
False
What is the primary role of the nurse in the treatment options for skin cancer?
What is the primary role of the nurse in the treatment options for skin cancer?
To help the patient make an informed decision about the best treatment option.
Malignant melanoma requires identification, diagnosis, and _____ for management.
Malignant melanoma requires identification, diagnosis, and _____ for management.
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Match the following treatment methods with their corresponding characteristics:
Match the following treatment methods with their corresponding characteristics:
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What factors influence the effectiveness of radiation therapy for melanoma?
What factors influence the effectiveness of radiation therapy for melanoma?
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Radiation therapy is a suitable treatment for liver and lung metastases.
Radiation therapy is a suitable treatment for liver and lung metastases.
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What type of melanoma does radiation respond better to?
What type of melanoma does radiation respond better to?
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Radiation therapy is often used for palliation of symptoms resulting from metastasis to the ______.
Radiation therapy is often used for palliation of symptoms resulting from metastasis to the ______.
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Match the type of therapy with its primary purpose for melanoma:
Match the type of therapy with its primary purpose for melanoma:
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What is a key instruction for patients taking vemurafenib?
What is a key instruction for patients taking vemurafenib?
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Patients taking encorafenib can consume grapefruit safely.
Patients taking encorafenib can consume grapefruit safely.
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What condition should patients inform their HCP about immediately while on interferon therapy?
What condition should patients inform their HCP about immediately while on interferon therapy?
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Patients taking binimetinib should notify the HCP immediately if they develop symptoms of __________.
Patients taking binimetinib should notify the HCP immediately if they develop symptoms of __________.
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Match the drug with its class:
Match the drug with its class:
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Which of the following adverse reactions requires immediate medical attention for patients taking vemurafenib?
Which of the following adverse reactions requires immediate medical attention for patients taking vemurafenib?
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Interleukins stimulate T cells to attack cancer cells.
Interleukins stimulate T cells to attack cancer cells.
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What should patients be monitored for while receiving oncolytic virus treatment?
What should patients be monitored for while receiving oncolytic virus treatment?
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Patients taking trametinib must notify the HCP if they develop __________ changes.
Patients taking trametinib must notify the HCP if they develop __________ changes.
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Match the following symptoms with their corresponding condition:
Match the following symptoms with their corresponding condition:
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What is the primary function of interferons in cancer therapy?
What is the primary function of interferons in cancer therapy?
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Patients taking cobimetinib need to monitor their calcium levels regularly.
Patients taking cobimetinib need to monitor their calcium levels regularly.
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Name one side effect of monoclonal antibodies that patients need to be aware of.
Name one side effect of monoclonal antibodies that patients need to be aware of.
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It is important for patients receiving __________ therapy to avoid contact with their treatment site to prevent infection.
It is important for patients receiving __________ therapy to avoid contact with their treatment site to prevent infection.
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Match the drug example with its type:
Match the drug example with its type:
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What percentage of melanoma tumors arise from existing nevi?
What percentage of melanoma tumors arise from existing nevi?
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The ABCDE rule is used to determine whether a nevus is benign.
The ABCDE rule is used to determine whether a nevus is benign.
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Name one clinical stage system used for melanoma assessment.
Name one clinical stage system used for melanoma assessment.
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A melanoma tumor with a diameter greater than _____ mm is concerning.
A melanoma tumor with a diameter greater than _____ mm is concerning.
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Match the following instruments used in melanoma staging with their descriptions:
Match the following instruments used in melanoma staging with their descriptions:
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Which of the following is an indicator of melanoma according to the ABCDE rule?
Which of the following is an indicator of melanoma according to the ABCDE rule?
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Elective lymph node dissection (ELND) is universally accepted as beneficial for all melanoma patients.
Elective lymph node dissection (ELND) is universally accepted as beneficial for all melanoma patients.
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What is the preferred treatment for localized malignant melanoma?
What is the preferred treatment for localized malignant melanoma?
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Malignant melanoma may metastasize to any organ or _____ of the body.
Malignant melanoma may metastasize to any organ or _____ of the body.
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Which of the following tests is NOT typically performed to assess the spread of melanoma?
Which of the following tests is NOT typically performed to assess the spread of melanoma?
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The thicker the melanoma tumor, the higher the survival rate.
The thicker the melanoma tumor, the higher the survival rate.
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What type of therapy may be used in conjunction with surgery to treat melanoma?
What type of therapy may be used in conjunction with surgery to treat melanoma?
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Symptoms such as _____ or bleeding of a nevus may indicate melanoma.
Symptoms such as _____ or bleeding of a nevus may indicate melanoma.
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Match the following BRAF kinase inhibitors with their drug examples:
Match the following BRAF kinase inhibitors with their drug examples:
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Which characteristic is NOT associated with the border of a melanoma lesion?
Which characteristic is NOT associated with the border of a melanoma lesion?
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Study Notes
Skin Cancer Care
- Requires a collaborative team of healthcare professionals to promote early detection and prompt intervention.
- Nurses play a crucial part in helping patients make informed decisions about treatment options.
Nonmelanoma Skin Cancer Treatment
- Focuses on removing all malignant tissue through methods like surgery, curettage and electrodessication, cryotherapy, or radiotherapy.
- These methods have a cure rate exceeding 90%.
- Other treatment options include chemotherapy, immunotherapy, and radiation therapy.
Malignant Melanoma Treatment
- Starts with identification, diagnosis, and tumor staging.
- If treatable, the tumor is removed through surgical excision.
- Chemotherapy, immunotherapy, and radiation therapy are also used to treat malignant melanoma.
Malignant Melanoma Detection
- Most commonly found on the trunk of men and the lower extremities of women.
- Patients should undergo a complete physical examination, including a total skin assessment.
- Only 20–30% of melanoma tumors arise from existing nevi.
ABCDE Rule for Melanoma Assessment
- Asymmetry: One half of the nevus does not match the other half.
- Border Irregularity: Edges are ragged or notched.
- Color Variation: Includes shades of brown, black, red, white, and/or blue.
- Diameter: Greater than 6 mm (size of a pencil eraser) or dark in color.
- Evolving: Any change in shape, size, or color of a nevus or area of the skin or any new symptom, such as crusting or bleeding of a nevus or area of the skin, may indicate melanoma.
Malignant Melanoma Diagnostic Tests
- Along with visual examination of all skin surfaces, palpation of regional lymph nodes, the liver, and the spleen should be performed to evaluate for metastasis if a melanoma is suspected or identified.
- Diagnostic tests include:
- Microscopic examination
- Biopsy
- Liver function tests
- CT of the liver
- CBC
- Serum blood chemistry profile
- Chest x-ray
- Bone scan
- CT or MRI of the brain
Microstaging
- Describes the level of invasion of a malignant melanoma and the maximum tumor thickness.
- The Clark system of microstaging measures vertical growth of the lesion from the epidermis to the subcutaneous tissue.
- The Breslow system measures the vertical thickness from the granular level of the epidermis to the deepest level of tumor invasion.
- The thickness of the melanoma impacts survival rate, with thicker tumors having lower survival rates.
Clinical Staging
- Traditionally uses a three-stage system.
- The American Joint Committee on Cancer has adopted a four-stage system that includes tumor thickness, level of invasion, lymph node involvement, and evidence of metastasis.
Surgical Excision
- The preferred treatment for malignant melanoma.
- A wide excision, including the full thickness of the skin and subcutaneous tissue, is performed when a biopsy identifies the lesion as a melanoma.
- Thinner melanomas (smaller than 0.76 mm) require 0.5 to 1.0 cm margins of normal skin excised around the tumor.
- Thicker tumors require a 1- to 3-cm margin excision due to risks of local recurrence or satellite lesions.
- Standard surgical treatment for clinically suspicious lymph node involvement includes excision of the primary lesions as well as surgical dissection of the involved lymph nodes.
- Elective lymph node dissection (ELND) remains controversial, with studies not showing a survival benefit.
- Surgery is also used for palliative management of isolated metastasis.
Pharmacologic Therapy
- Immunotherapy is used alongside surgical procedures.
- Newer sensitive tests help detect melanoma spread to lymph nodes and identify patients who may benefit from immunotherapy after surgery.
- Numerous spontaneous remissions in melanoma patients have led to interest in immunotherapeutic interventions.
Immunotherapy Medications
- BRAF Kinase Inhibitors: Inhibit the mutated BRAF enzyme that promotes tumor cell proliferation. Examples include dabrafenib, encorafenib, and vemurafenib.
- Interferons: Inhibit cell growth. Examples include interferon alfa-2b and peginterferon alfa-2b.
- Interleukins: Stimulate T cells, B cells, and NK cells to attack cancer cells. Example: aldesleukin.
- MEK Inhibitors: Inhibit the activity of mitogen-activated extracellular kinase (MEK) 1 and 2, enzymes that promote melanoma growth. Examples include binimetinib, cobimetinib, and trametinib.
- Monoclonal Antibodies: Bind to cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), resulting in augmented T-cell activation against melanoma cells. Examples include ipilimumab, nivolumab, and pembrolizumab.
- Oncolytic Virus: Genetically modified attenuated herpes simplex virus (HSV 1) that infects and kills melanoma cells. Example: talimogene.
Radiation Therapy
- Response rates vary and depend on the site of the tumor, its thickness, the type of melanoma, and the patient's health.
- Melanoma responds to higher doses of radiation.
- Often used for palliation of symptoms resulting from metastasis to the brain, lymph nodes, bone, the gastrointestinal tract, skin, or subcutaneous tissue.
- Liver and lung metastases are not treated with radiation therapy due to the risk of organ dysfunction.
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Description
This quiz covers the essential aspects of skin cancer care, focusing on early detection, treatment options, and the roles of healthcare professionals. Learn about nonmelanoma and malignant melanoma treatments, including surgical and non-surgical methods, with an emphasis on patient involvement in the treatment decision process.
