Question 1

Which statement about Malignant Melanoma is true?&#10;A) MM occurs in Caucasian and Hispanic populations, but not African Americans&#10;B) MM is the most common cancer among women between the ages of 25 through 29&#10;C) The lifetime risk of MM has decreased&#10;D) Sporadic MM is more aggressive than Familial MM

Accepted Answer

Malignant Melanoma remains the most common cancer among women between the ages of 25 and 29, making B the correct answer. The lifetime risk of Malignant Melanoma has increased, the incidence rate of Malignant Melanoma among African Americans in 1 in 1,000, and Familial Malignant Melanoma is more aggressive than Sporadic Malignant Melanoma, most likely due to higher gene penetrance.

Question 2

Which lesion is a well-documented (commonly seen) precursor to familial patterns of Malignant Melanoma?&#10;A) Actinic Keratosis&#10;B) Basal Cell Carcinoma&#10;C) Atypical Nevi&#10;D) Blue Nevi

Accepted Answer

Most studies concur that AMS and DNS are associated with FAMMM syndrome and present in almost 15% of the general population.

Question 3

A finding of how many nevi, and how many dysplastic nevi is significantly associated with family history of Malignant Melanoma?&#10;A) >50 nevi, >5 dysplastic nevi&#10;B) >80 nevi, >3 dysplastic nevi&#10;C) >100 nevi, >6 dysplastic nevi&#10;D) >120 nevi, >10 dysplastic nevi

Accepted Answer

A finding of more than 100 nevi or six or more dysplastic nevi is significantly associated with a family history of MM.

Question 4

Which statement is NOT true about family history as it relates to MM?&#10;A) Risk assessment by family history is the most reliable indicator of risk of MM&#10;B) Patient with more than 2 family members with MM are more likely to develop MM themselves.&#10;C) The greatest familial risk indicator is a parent affected by multiple primary melanomas&#10;D) Familial melanoma is the most common form of Malignant Melanoma

Accepted Answer

Sporadic MM is far more common (80%) than Familial MM (20%).

Question 5

What is preferred method of biopsy for a suspected MM lesion?&#10;A) Shave biopsy&#10;B) Cryotherapy&#10;C) Punch biopsy&#10;D) Excisional biopsy

Accepted Answer

Excision biopsy is the recommended method for suspected malignant melanomaas it enables diagnosis, staging of the tumor, and determines future investigation, treatment, and prognosis. Other methods of biopsy, such as punch and shave, are not recommended as they do not allow complete histological staging.

Question 6

What diameter size is suspicious for MM?&#10;A) >2 mm&#10;B) >10 mm&#10;C) >13 mm&#10;D) >6 mm

Accepted Answer

A diameter size of 6mm or greater is suspicious for MM, as indicated by the ABCDE Rule.

Question 7

What are the approaches used in the initial staging of MM?&#10;A) Wide local excision, lymph node mapping, various imaging studies and laboratory assays&#10;B) Punch biopsy, sentinel node biopsy, PET scan&#10;C) MOHS surgery, removal of all lymph nodes in the area, genetic testing&#10;D) Narrow local excision, lymph node mapping, various imaging studies and laboratory assays

Accepted Answer

Approaches used in staging include wide local excision, lymph node mapping, various imaging studies, and laboratory assays. Other methods of biopsy, such as punch and shave, are not recommended as they do not allow complete histological staging.

Question 8

Using the Clark scale, which level is used to classify MM that has spread into the subcutaneous tissue?&#10;A) I&#10;B) II&#10;C) IV&#10;D) V

Accepted Answer

Clark's levels are used to classify thin tumors in terms of how deep the cancer has spread into the skin. Tumors may be confined to the epidermis (Clark's level I), spread into different depths of the dermis (Clark's levels II, III, and IV), or spread into subcutaneous tissue (Clark's level V).

Question 9

Which diagnostic test is used to detect smaller tumors all over the body that are not identifiable through other imaging studies?&#10;A) CT&#10;B) PET&#10;C) MRI&#10;D) CXR

Accepted Answer

The detection of smaller metastases requires a full-body positron emission tomography (PET) scan. This imaging procedure detects glucose uptake by cancer cells-such cells have a faster metabolic rate than noncancerous cells. It should be noted that PET scans are able to detect smaller tumors (micrometastases) that are not identifiable through other imaging studies, so B is the correct answer.

Question 10

What is the first stage of MM where should you consider sentinel lymph node biopsy?&#10;A) I&#10;B) II&#10;C) III&#10;D) IV

Accepted Answer

Standard treatment of stage II melanoma comprises wide excision of skin around the tumor site. Sentinel lymph node biopsy is optional at this stage because deeper tumors have an increased risk of spreading to a lymph node. Treatment of stage I melanoma involves surgical removal of both the lesion and a margin of unaffected skin. The amount of unaffected skin removed depends on the thickness of the melanoma. No more than 2 cm of normal skin needs to be removed from all sides of stage I melanoma, as wider margins have not been found to improve overall survival. Stage III melanoma requires the same surgical treatment of the primary lesion as accorded to stage II melanoma, along with lymph node dissection. Stage IV melanoma has a very poor prognosis, given that melanoma cells have spread to distant areas of the body at this stage. Surgery may be performed to debulk the tumors and relieve symptoms depending on the location. Metastases that cannot be removed may be treated with regional radiation or adjuvant chemotherapy.

Deck 23: Familial Malignant Melanoma