Podcast
Questions and Answers
What is the primary goal of the collaborative team of healthcare professionals in managing skin cancer?
What is the primary goal of the collaborative team of healthcare professionals in managing skin cancer?
Surgery and cryotherapy are the only treatment options for nonmelanoma skin cancer.
Surgery and cryotherapy are the only treatment options for nonmelanoma skin cancer.
False
What treatment method is typically used first for malignant melanoma?
What treatment method is typically used first for malignant melanoma?
Surgical excision
Biological therapies for skin cancer may involve the use of __________ and interferon.
Biological therapies for skin cancer may involve the use of __________ and interferon.
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Match the following skin cancer treatments with their description:
Match the following skin cancer treatments with their description:
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Which of the following correctly describes the ABCDE rule used in assessing suspicious lesions?
Which of the following correctly describes the ABCDE rule used in assessing suspicious lesions?
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The majority of malignant melanoma tumors arise from existing nevi.
The majority of malignant melanoma tumors arise from existing nevi.
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What does the 'D' in the ABCDE rule refer to?
What does the 'D' in the ABCDE rule refer to?
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Malignant melanoma is commonly found on the trunk of men and on the lower ________ of women.
Malignant melanoma is commonly found on the trunk of men and on the lower ________ of women.
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Match the key feature of melanoma diagnosis with its description:
Match the key feature of melanoma diagnosis with its description:
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Which of the following diagnostic tests is NOT typically conducted to check for metastasis in suspected melanoma?
Which of the following diagnostic tests is NOT typically conducted to check for metastasis in suspected melanoma?
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Palpation of regional lymph nodes is important for evaluating potential metastasis in melanoma cases.
Palpation of regional lymph nodes is important for evaluating potential metastasis in melanoma cases.
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What type of examination is performed alongside visual examination to evaluate for metastasis in melanoma?
What type of examination is performed alongside visual examination to evaluate for metastasis in melanoma?
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Diagnostic tests for melanoma may include a CT scan of the ________.
Diagnostic tests for melanoma may include a CT scan of the ________.
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Match the following diagnostic tests with their purpose:
Match the following diagnostic tests with their purpose:
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What does the Breslow system specifically measure in melanoma assessment?
What does the Breslow system specifically measure in melanoma assessment?
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Microstaging considers individual skin thickness to be irrelevant for accurate measurement.
Microstaging considers individual skin thickness to be irrelevant for accurate measurement.
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What happens to the melanoma survival rate as the tumor thickness increases?
What happens to the melanoma survival rate as the tumor thickness increases?
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In the Clark system of microstaging, the vertical growth of the lesion is measured from the epidermis to the ________ tissue.
In the Clark system of microstaging, the vertical growth of the lesion is measured from the epidermis to the ________ tissue.
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Match the following systems of microstaging with their descriptions:
Match the following systems of microstaging with their descriptions:
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What margin of normal skin is typically excised around thin melanomas (those smaller than 0.76 mm)?
What margin of normal skin is typically excised around thin melanomas (those smaller than 0.76 mm)?
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Elective lymph node dissection (ELND) has been shown to improve overall survival rates for patients with localized malignant melanoma.
Elective lymph node dissection (ELND) has been shown to improve overall survival rates for patients with localized malignant melanoma.
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What is the primary treatment for malignant melanoma?
What is the primary treatment for malignant melanoma?
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Surgical excision for malignant melanoma includes the full thickness of the skin and __________ tissue.
Surgical excision for malignant melanoma includes the full thickness of the skin and __________ tissue.
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Match the following types of tumors with their excision margins:
Match the following types of tumors with their excision margins:
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Which of the following drugs is NOT a BRAF kinase inhibitor?
Which of the following drugs is NOT a BRAF kinase inhibitor?
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Patients taking vemurafenib should avoid exposure to sun.
Patients taking vemurafenib should avoid exposure to sun.
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What is one serious potential reaction that patients must monitor while taking Interferons?
What is one serious potential reaction that patients must monitor while taking Interferons?
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Patients taking encorafenib should avoid __________ during treatment.
Patients taking encorafenib should avoid __________ during treatment.
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Match the following drugs with their primary mechanism of action:
Match the following drugs with their primary mechanism of action:
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Which of the following signs should patients notify their healthcare provider about immediately while on Interleukins?
Which of the following signs should patients notify their healthcare provider about immediately while on Interleukins?
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Monitoring liver function is necessary for patients on BRAF inhibitors.
Monitoring liver function is necessary for patients on BRAF inhibitors.
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What condition involving blood clots should patients on BRAF inhibitors be monitored for?
What condition involving blood clots should patients on BRAF inhibitors be monitored for?
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The risk of new skin malignancies is increased when taking __________.
The risk of new skin malignancies is increased when taking __________.
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Which of the following is not a monitoring requirement for patients on Aldesleukin?
Which of the following is not a monitoring requirement for patients on Aldesleukin?
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Which of the following symptoms should patients notify their healthcare provider about when taking MEK inhibitors?
Which of the following symptoms should patients notify their healthcare provider about when taking MEK inhibitors?
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Monoclonal antibodies augment T-cell activation against melanoma cells.
Monoclonal antibodies augment T-cell activation against melanoma cells.
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Name one infection symptom that patients should report while taking oncolytic virus therapy.
Name one infection symptom that patients should report while taking oncolytic virus therapy.
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Patients taking trametinib should notify their healthcare provider immediately if they develop symptoms of __________.
Patients taking trametinib should notify their healthcare provider immediately if they develop symptoms of __________.
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Match the MEK inhibitors with their respective brand names:
Match the MEK inhibitors with their respective brand names:
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What is a primary function of MEK enzymes in relation to melanoma?
What is a primary function of MEK enzymes in relation to melanoma?
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Patients receiving cobimetinib should monitor for symptoms of autoimmune reactions.
Patients receiving cobimetinib should monitor for symptoms of autoimmune reactions.
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What type of symptoms should patients taking monoclonal antibodies monitor for?
What type of symptoms should patients taking monoclonal antibodies monitor for?
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Patients should avoid direct contact with the treatment site for a minimum of __________ after each oncolytic virus treatment.
Patients should avoid direct contact with the treatment site for a minimum of __________ after each oncolytic virus treatment.
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Which of the following is a potential risk when using oncolytic virus therapy?
Which of the following is a potential risk when using oncolytic virus therapy?
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Which of the following agents have been used to treat melanoma?
Which of the following agents have been used to treat melanoma?
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Monoclonal antibodies are used alone in the treatment of melanoma.
Monoclonal antibodies are used alone in the treatment of melanoma.
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Name one biological agent that has been investigated for melanoma treatment.
Name one biological agent that has been investigated for melanoma treatment.
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The __________ Calmette-Guérin is known for its use as a treatment option for melanoma.
The __________ Calmette-Guérin is known for its use as a treatment option for melanoma.
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Match the following biological agents with their descriptions:
Match the following biological agents with their descriptions:
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Study Notes
Skin Cancer Treatment
- A collaborative team of healthcare professionals (HCPs) is crucial for early detection and prompt intervention in skin cancer patients.
- Nurses play a vital role in guiding patients towards informed treatment decisions based on their individual needs.
- Treatment options for non-melanoma skin cancer include:
- Surgery
- Curettage and electrodessication
- Cryotherapy
- Radiotherapy
- These modalities boast a cure rate exceeding 90%.
- Other treatment methods include:
- Chemotherapy
- Immunotherapy
- Radiation therapy
- Biological therapies utilizing interleukin-2 and interferon, alongside therapeutic vaccines containing melanoma antigens, are occasionally employed.
- Regular post-treatment examinations are imperative to monitor for potential recurrence.
Malignant Melanoma Management
- Early identification, diagnosis, and tumor staging are paramount in managing malignant melanoma.
- Surgical excision is the primary treatment for treatable tumors.
- Chemotherapy, immunotherapy, and radiation therapy are also utilized in treating malignant melanoma.
Malignant Melanoma Location
- Malignant melanoma frequently develops on the trunk of men and lower extremities of women.
Melanoma Development
- Only 20-30% of melanoma tumors originate from pre-existing moles (nevi).
- The remaining melanoma cases can arise anywhere on the body.
ABCDE Rule for Suspicious Lesions
- Asymmetry: One half of the mole 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: Changes in shape, size, color, or new symptoms like crusting or bleeding may indicate melanoma.
Melanoma Diagnosis & Tests
- Melanoma is a serious skin cancer
- If melanoma is suspected, the doctor will perform a physical exam, including palpation of lymph nodes, the liver, and the spleen
- Palpation is a key step to evaluate for metastasis, meaning cancer spreading to other parts of the body.
- Biopsy of a suspicious lesion is crucial for diagnosis.
- Malignant melanoma can metastasize (spread) to any organ or tissue.
- Different tests are used to figure out if the cancer has spread.
- These tests include liver function tests, CT of the liver, CBC, serum blood chemistry profile, chest x-ray, bone scan, and CT or MRI of the brain.
Microstaging
- Microstaging assesses the depth of melanoma invasion
- Two methods are used, the:
- Clark System: This system measures the vertical growth from the epidermis to the subcutaneous tissue, but is prone to variations in skin thickness
- Breslow System: This system adjusts the Clark system by measuring the vertical thickness from the epidermis granular layer to the tumor's deepest invasion, offering a more precise measure
- Survival rates for melanoma decrease as the thickness of the tumor increases
Malignant Melanoma Treatment
- Surgical excision is the preferred treatment for malignant melanoma.
- A wide excision is performed that includes the full thickness of the skin and subcutaneous tissue.
- For thin melanomas (smaller than 0.76 mm) margins of 0.5 to 1.0 cm of normal skin are excised around the tumor.
- Thick tumors require a 1- to 3-cm margin excision because they are at risk for local recurrence or satellite lesions.
- Regional lymph nodes are the most common sites for metastasis of malignant melanoma.
- 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) in the treatment of localized malignant melanoma remains controversial.
- Studies have not indicated any survival benefit for patients treated with ELND.
- Surgery is indicated for palliative management of isolated metastasis.
- Removal of metastatic tumors in the brain, liver, lung, GI tract, or subcutaneous tissue may relieve symptoms and prolong life.
BRAF Kinase Inhibitors
- Examples: dabrafenib (Tafinlar), encorafenib (Braftovi), vemurafenib (Zelboraf)
- Inhibit BRAF enzyme, a mutated enzyme promoting tumor cell proliferation
- Monitor CBC, LFTs, serum electrolytes, cardiovascular status, and for signs of DVT, PE, bleeding, hypersensitivity, skin lesions, vision changes, or eye pain
- Instruct patients to avoid grapefruit and grapefruit juice while taking encorafenib
- Instruct patients to wear sunscreen and avoid sun exposure while taking vemurafenib
- Inform patients of the increased risk of new skin malignancies and to notify the HCP immediately of suspicious lesions
- Instruct patients to immediately notify the HCP if they develop symptoms of bleeding, liver dysfunction, changes in heart rhythm, eye pain or other visual changes, fever, or thromboembolism
- Instruct patients taking vemurafenib to immediately stop the medication and notify the HCP if they experience an allergic reaction or severe skin reaction
Interferons
- Examples: interferon alfa-2b (Intron A), peginterferon alfa-2b (PegIntron, Sylatron)
- Bind to receptors to inhibit cell growth
- Monitor cardiovascular status, for symptoms of pancreatitis, signs of neuropsychiatric disorders, and symptoms of colitis
- Instruct patients to immediately notify the HCP if they experience signs of infection, lower back or side pain, painful or difficult urination, signs of bleeding, suicidal thoughts or attempts, new or worsening anxiety, depression, agitation, or aggressive or violent behavior
Interleukins
- Example: aldesleukin (Proleukin)
- Stimulate T cells, B cells, and NK cells to attack cancer cells
- Monitor CBC with differential, platelet count, electrolytes, and kidney, liver, and thyroid function
- Monitor cardiovascular status continuously during transfusion
- Monitor for capillary leak syndrome (hypotension, hypovolemia, edema, ascites, pleural effusion), respiratory status, weight daily, and skin for the development of rash or blisters
- Monitor for signs of infection
- Instruct patients to notify the HCP if they develop symptoms of infection, liver dysfunction, unusual bleeding or bruising, or increased fatigue
MEK Inhibitors
- Examples: binimetinib (Mektovi), cobimetinib (Cotellic), trametinib (Mekinist)
- Inhibit the activity of mitogen-activated extracellular kinase (MEK) 1 and 2, which are enzymes that promote melanoma growth
- Monitor LFTs, CPK, and creatinine levels
- Monitor cardiovascular function and for symptoms of DVT, PE, interstitial lung disease or pneumonitis, bleeding
- Monitor for development of new skin lesions if patient receiving cobimetinib
- Monitor for symptoms of colitis and GI perforation if patient receiving trametinib
- Instruct patients taking binimetinib to notify the HCP immediately if they develop symptoms of heart failure, DVT or PE, vision changes, interstitial lung disease, hepatotoxicity, rhabdomyolysis, or bleeding
- Instruct patients taking cobimetinib to notify the HCP immediately if they experience skin changes, vision changes, or symptoms of bleeding, cardiomyopathy, rhabdomyolysis, or liver injury
- Instruct patients taking trametinib to notify the HCP immediately if they develop symptoms of heart failure, vision changes, dyspnea, progressive or intolerable rash, hypertension, skin changes, hyperglycemia, or bleeding
Monoclonal Antibodies
- Examples: ipilimumab (Yervoy), nivolumab (Opdivo), pembrolizumab (Keytruda)
- Bind to cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), resulting in augmented T-cell activation against melanoma cells
- Monitor LFTs and thyroid function tests
- Monitor for symptoms of enterocolitis, hepatotoxicity, and dermatitis, motor and sensory deficits, adrenal insufficiency or hyper- or hypothyroidism, and immune-mediated reactions
- Inform patients of the risk of immune-mediated reactions due to the action of the medication and that they may be severe and fatal; notify the HCP immediately if symptoms occur
- Instruct patients to notify the HCP immediately if they develop symptoms of enterocolitis, hepatitis, skin reactions, neuropathies, endocrinopathies, pneumonitis, nephritis, or encephalitis
Oncolytic Virus
- Example: talimogene (Imlygic)
- Genetically modified attenuated herpes simplex virus (HSV 1) that infects and kills melanoma cells
- Monitor for flulike symptoms or pain at the treatment site
- Inform patients that this virus can be spread to other areas of the body or to their close contacts; female patients of childbearing age should not receive this medication if pregnant and should not breastfeed
- Educate patients to avoid direct contact between the treatment site, dressings, or body fluids and close contacts; wear gloves for dressing changes; keep treatment sites covered for a minimum of 1 week after each treatment and replace dressing if it becomes loose or falls off; place used dressings in a sealed plastic bag for disposal; and do not touch or scratch treatment site
- Instruct patients to immediately notify the HCP if they develop any symptoms of herpes infection, eye pain, discharge, blurred vision or sensitivity to light, weakness in arms or legs, extreme drowsiness, or mental confusion
Melanoma Treatment Agents
- Interferons, interleukins, monoclonal antibodies, bacillus Calmette-Guérin, transfer factors, and tumor vaccines are used, with varying success rates.
- These agents are investigated for efficacy when used alone, in combination with chemotherapy, or with each other.
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Description
Test your knowledge on the treatment options and management strategies for skin cancer, focusing on both non-melanoma and malignant melanoma. This quiz covers the role of healthcare professionals in patient care, as well as various treatment modalities and their effectiveness. Assess your understanding of post-treatment protocols and the importance of early detection.
