T6 - IE4 - Oncology - Yang - Skin Cancer and Melanoma

Melanoma staging - T (tumor)

main primary tumor how far it has grown within the skin and other factors

Melonoma treatment - early stage (Stage 0-II): wide excision surgery to remove the _______ and the _______ ___ around it

- (remove the) melanoma - normal skin (around it)

Exposure to UV radiation and melanoma is a major risk factor for most skin cancers - UVB rays have slightly _______ energy than UVA rays

- (slightly) more (energy than UVA rays)

UV radiation and skin - DNA damage mechanism: skin melanocytes -> susceptible to UVR-induced DNA strand _________ causes DNA ____________ / ________

- (strand) breaks - (causes DNA) damage / repair

Non-melanoma skin cancer: radiation therapy is only used if lesion is located in a hard-to-treat place such as the ________, the _____ of the nose, or the _____

- (such as the) eyelid - tip (of the nose) - ear

Major risk factors of melanoma - people at highest risk also include those with ________ ___________; a history of ________ sun exposure; including sunburns especially at ______ age; disease or treatments that _______ the immune system and a past history of _____ cancer

- (those with) sun sensitivity - excessive (sun exposure) - young (age) - suppress (the immune system) - skin (cancer)

Non-melanoma skin cancer: treatment is usually _________ _____ systemic therapy is used

- (usually) surgery - NO (systemic therapy)

Melonoma overview: most fatal skin cancer condition; accounts for only ____% of all skin cancer cases but ____ ____% of skin cancer deaths

- 1(% of all skin cancer cases) - > 90(% of skin cancer deaths)

Melonoma overview: ____ most common cancer and the most ______ skin cancer condition

- 6th (most common cancer) - (most) fatal (skin cancer condition)

Melonoma overview: survival Localized stage: ____%; regional stage 62%; and _____% for distant-stage disease

- 98(%) - 18(% for distant-stage disease)

Melanoma staging - T category (TUMOR) - tumor thickness also known as ________ ________ The distance between the _____ layer of the epidermis and the _______ point of the tumor penetration

- Breslow's thickness - upper (layer of the epidermis) - deepest (point of the tumor penetration)

Melanoma therapy - cytotoxic chemotherapy: ChemoTx can be used to treat advanced melanoma, but its _____ often used as the ______ treatment

- NOT (often used) - first (treatment)

Exposure to UV radiation and melanoma is a major risk factor for most skin cancers - UVA rays ____ skin cells and can _______ their DNA Linked to long-term skin damage such as _______, but they are also thought to play a role in some skin cancers.

- age (skin cells) - damage (their DNA) - (such as) wrinkles

UV radiation and skin - DNA damage mechanism: proliferation and cytogenic changes leads to ________ gene expression and thus risk of ________ ______

- altered (gene expression) - (risk of) cutaneous melanoma

Diagnosis of Melanoma: ABCDE rules - A is for ____________; one half of a mole or birthmark does ______ _____ the other

- asymmetry - not match (the other)

Major risk factors of melanoma - the presence of _________, ______, or numerous (more than _____) moles

- atypical - large - (more than) 50

Diagnosis of Melanoma: ABCDE rules - B is for _________; the edges are _________, _______, notched, or ________

- border - irregular - ragged - blurred

Melanoma staging - T category (TUMOR) - ulceration: is a _________ of the skin over the melanoma; melanomas that are ________ tend to have a worse outlook

- breakdown (of the skin) - ulcerated (tend to have a worse outlook)

Diagnosis of Melanoma: ABCDE rules - C is for _________; the color is ______ the same all over and may include shades of ______ or _____, or sometimes with patches of ________ colors (patches of pink, red, white or blue)

- color - (color is) NOT (the same) - brown - black - (patches of) abnormal (colors)

Melanoma therapy - radiation: radiation can also be used to treat melanoma that has ______ _____ after surgery, either in the skin or lymph nodes, or to help treat distant spread of the disease

- come back (after surgery)

Non-melanoma skin cancer: basal cell carcinoma - most _________ type of skin cancer about ___ out of 10 skin cancers are basal cell carcinomas

- common (type of skin cancer) - 8 (out of 10 skin cancers)

Melonoma overview: incidence trends Risen rapidly over the past 30 years. However, the past 5 years of data indicate that rates are _________ or _______ among those younger than 50

- declining - plateauing (among those younger than 50)

Non-melanoma skin cancer: squamous cell carcinoma - more likely to grown into _______ layers of skin and spread to ______ parts of the body than basal cell cancers

- deeper (layers of skin) - other (parts of the body)

Melanoma staging: the ________ the depth, the more _______ the staging

- deeper (the depth) - advance (the staging) Stage IV - melanoma has spread to other organs in the body or areas far from the original site of the tumor

Non-melanoma skin cancer: the exact number of people who _______ or ______ from basal and squamous cell skin cancers each year is ____ ____ for sure

- develop - die (from basal and squamous cell skin cancers) - not known (for sure)

Diagnosis of Melanoma: ABCDE rules - D is for ________; the spot is larger than ____ ________ across or about ~ 1/4 inch - the size of a pencil eraser, although melanomas can sometimes be smaller than this

- diameter - (larger than) 6 millimeters equivalent to pencil eraser size

Melanoma staging - late stages (Stage T4N*M*): melanoma has metastasized to lymph nodes ______ from the primary tumor or to _________ organs

- distant (from the primary tumor) - internal (organs) Lung > Liver > Brain > Bone > GI tract

Non-melanoma skin cancer: Keratocanthomas - are ______-______ tumors that are found on sun-exposed skin

- dome-shaped (tumors)

Diagnosis of Melanoma: ABCDE rules - E is for _________; the mole is ________ in size, shape, or color

- evolving - (mole is) changing

Non-melanoma skin cancer: squamous cell carcinoma - commonly appears on the sun-exposed areas of the body such as the _____, ______, _____, _______ and ____ of the hands

- face - ears - neck - lips - backs (of the hands)

Major risk factors of melanoma - _____ exposure to ___________ (______) radiation, from sunlight or use of indoor tanning, this is a major risk factor for ALL types of skin cancer

- high (exposure) - ultraviolet (UV)

Melonoma overview: survival Although melanoma is ________ curable when detected in its early stages, compared to other skin cancers it is more likely to _______ to other parts of the body

- highly (curable when detected in its early stages) - (more likely to) spread (to other parts of the body)

Melonoma treatment - STAGE III and IV: immunotherapy such as _______ _______ ______; usually improves ________ ______

- immune checkpoint inhibitors - (improves) patient's survival

Non-melanoma skin cancer: surgery - ________ of lesions with _________ diagnosis; often, _____ ________ treatment is needed

- incision (of lesions) - pathological (diagnosis) - no additional (treatment is needed)

Non-melanoma skin cancer: squamous cell carcinoma - ______ common; occurs in ____ out of 10 skin cancers are squamous cell carcinoma

- less (common) - 2 (out of 10 skin cancers) Less common between the two; basal cell carcinoma and squamous cell carcinoma. Melanoma is rarer only 1% of skin cancers but the most fatal

Skin cancer is the ____ ________ diagnosed cancer in the US

- most commonly (diagnosed cancer) 3 main types of skin cancer

Melanoma staging - N (lymph nodes): spread to ______ lymph nodes (bean-sized ___________ of immune system cells to which cancers often spread _________)

- nearby (lymph nodes) - collections (of immune system cells) - (spread) first

Melanoma therapy - radiation: is ____ ______ used to treat melanoma on the skin, although it's sometimes used if surgery is _____ an option for some reason

- not often (used) - not (an option) i.e., location, contraindication

Melanoma staging - late stages (Stage T3N*M0): a tumor has metastasized or spread beyond the ________ tumor site Can be determined by examining a biopsy of the node nearest the tumor, known as the _______ node

- original (tumor site) - sentinel (node)

Melanoma therapy - radiation: may be used _______-________ Radiation is given after surgery in the area where lymph nodes were removed, especially if many of the nodes is ________ with melanoma cells

- post-surgery - positive (with melanoma cells)

UV radiation and skin - DNA damage mechanism: DNA damage causes __________, _________ changes or _________

- proliferation - cytogenetic (changes) - apoptosis Proliferation and cytogenic changes leads to altered gene expression and thus risk of cutaneous melanoma

UV radiation and skin - DNA damage mechanism: _________ and _________ _____ leads to altered gene expression and thus risk of cutaneous melanoma

- proliferation - cytogenic changes (lead to altered gene expression)

Melonoma treatment - STAGE III and IV: targeted therapy has ______ response but patients often ________ ________

- rapid (response) - quickly relapsed

Melanoma therapy - radiation: palliative care to _______ symptoms caused by the spread of the melanoma, especially to the _____ or _______

- relieve (symptoms) - brain - bones pain; shrink the tumor slow down its growth -> control symptoms

Non-melanoma skin cancer: basal cell carcinoma - recurrence occurs in the ______ ______ after removal

- same place (after removal)

Non-melanoma skin cancer: Keratocanthomas - many keratoacanthomas _______ or even ____ _____ on their own over time WITHOUT any treatment

- shrink - (even) go away

Melanoma staging - T category (TUMOR) Considered one of the most _________ factors in predicting the _________ of the disease

- significant (factors) - progression (of the disease)

Non-melanoma skin cancer: basal cell carcinoma - these cancers usually develop on ____-______ areas, especially the _____ and ______

- sun-exposed (areas) - head - neck

Exposure to UV radiation and melanoma is a major risk factor for most skin cancers - UVA rays - most _______ _____ give off large amounts of UVA rays

- tanning beds (give off large amounts of UVA rays)

Non-melanoma skin cancer: topical treatment is used if the lesion is located only in the ______ layer of the skin

- top (layer of the skin) Topical diclofenac, fluorouracil, and ingenol mebutate

Melanoma staging - T category (TUMOR) is based on _______ _______; _______ and ______ rate

- tumor thickness - ulceration - mitotic (rate)

Melonoma treatment - early stage (Stage 0-II): ______ _______ _____

- wide excision surgery to remove the melonoma and the normal skin around it

Melanoma staging - T category (TUMOR) - ulceration: has a _______ outlook because bleeding allows it to go through the ____________ and causes it to _______ to other cells with the chance of __________

- worse (outlook) - (go through the) bloodstream - invade (to other cells) - (chance of) metastasis

Melanoma staging - late stages (Stage T4N*M*): melanoma has metastasized to lymph nodes from the primary tumor or to internal organs

Lung > Liver > Brain > Bone > GI tract

Breslow thickness

Measures depth of melanoma 5 levels

___________ is the most commonly diagnosed cancer in the United States A. breast cancer B. prostate cancer C. leukemia D. lung cancer E. hepatoma F. skin cancer

Skin cancer Skin cancer is the most commonly diagnosed cancer in the United States

Non-melanoma skin cancer: treatments

Surgery Radiation (only in hard to treat areas) Topical (only if top layer of skin)

Melanoma staging - staging system most often used for melanoma is the American Joint Commission on Cancer (AJCC) TNM system, which is based on 3 key patients of information

T - Tumor N - lymph nodes M - Metastasis

Melanoma staging - interpretation

T1N0M0 -> usually means early stage; only 1 tumor, 0 lymph node spread; 0 metastasis T3N5M1 -> LATE or advanced stage; tumor has grown to 3; 5 lymph node spread; and 1 metastasis to another organ

Melanoma staging - M (metastasis)

based on whether the melanoma has metastasized (spread) to distant organs

Non-melanoma skin cancer: topical treatment

diclofenac fluorouracil ingenol mebutate

Melanoma staging - N (lymph nodes)

spread to nearby lymph nodes (bean-sized collections of immune system cells, to which cancers often spread first)

Melonoma treatment - STAGE III and IV

surgery + adjuvant systemic cytotoxic chemotherapy targeted therapy immunotherapy ± radiation therapy

Melonoma treatment - STAGE III and IV: surgery + adjuvant systemic cytotoxic chemotherapy

wide excision along with lymph node dissection

Exposure to UV radiation and melanoma is a major risk factor for most skin cancers - UVB rays Damages skin cells' DNA ______, and are the main rays that cause ________

- (Damages skin cells' DNA) directly - (cause) sunburns

Melanoma therapy - cytotoxic chemotherapy: NOT usually as effective for __________ as it is for some other types of cancer due to ______ drug resistance and ________ concentration at the lesion

- (NOT usually as effective for) melanoma - (due to) high (drug resistance) - achieved (concentration at the lesion)

Melanoma therapy - cytotoxic chemotherapy: NOT usually as _______ for melanoma as it is for some other types of cancer

- (NOT usually as) effective High drug resistance; achieved concentration at the lesion

Exposure to UV radiation and melanoma is a major risk factor for most skin cancers - UVB rays also thought to cause _____ _____ _____

- (cause) most skin cancers

Non-melanoma skin cancer: do NOT use ________ _______

- (do NOT use) systemic chemotherapy Treatment is usually surgery

Non-melanoma skin cancer: basal cell carcinoma - grow ________; _____ to spread

- (grow) slowly - rare (to spread)

Non-melanoma skin cancer: Keratoacanthomas - may start out growing _______, but their growth usually _______ ____

- (growing) quickly - (usually) slows down Many keratoacanthomas shrink or even go away on their own over time without any treatment

Non-melanoma skin cancer: treatment options and recommendations depend on several factors, including the ____ and ________ of the skin cancer; possible ______ _______; patient's _________ and overall _______

- (including the) size - location - (possible) side effects - preferences - (overall) health

Non-melanoma skin cancer: radiation therapy is only used if lesion is located in a _____-___-____ place such as the eyelid, the tip of the nose, or the ear

- (located in a) hard-to-treat (place)

Exposure to UV radiation and melanoma is a major risk factor for most skin cancers - UVC rays have more energy than the _______ _____ of UV rays Don't get through our _______ and are _____ in sunlight; NOT normally a cause of _____ cancer

- (more energy than the) other types - (through our) atmosphere - NOT (in sunlight) - skin (cancer)

Major risk factors of melanoma - a personal or _______ _______ of melanoma

- (personal or) family history (of melanoma)

Melanoma staging - T category (TUMOR) - mitotic rate: rate is the portion of the cancer cells in the process of __________ A higher mitotic rate means that the cancer is more likely to ______ and ______

- (process of) dividing - (more likely to) grow - spread

Melanoma therapy - radiation: palliative care to relieve the _____; _______ the tumor or ______ down its growth to ______ the symptoms

- (relieve the) pain - shrink (the tumor) - slow (down its growth) - relieve (the symptoms)

Diagnosis of Melanoma: ABCDE rules

A - Asymmetry B - Border C - Color D - Diameter E - Evolving

Melonoma treatment - STAGE III and IV: targeted therapy

BRAF/MER inhibitors (in patients carrying mutant BRAF) rapid response but quickly relapsed

Skin cancer overview: 3 main types of skin cancers

Basal cell carcinomas Squamous cell carcinomas Melanomas (melanocytes)