Management of Cutaneous Melanoma


Date
Aug 21, 2020 7:45 AM — 8:45 AM
Event
Harvard Dermatology Resident Lecture
Location
Massachusetts General Hospital
132 Parkman St., Boston, MA, 02114, United States

TABLE OF CONTENTS

Overview & Learning Objectives
Clinical Cases

Case 1
Case 2
Case 3
Case 4

Timeline of FDA Approved Therapies for Melanoma

Overview & Learning Objectives

  • Understand the current therapeutic landscape for high-risk localized cutaneous melanoma
  • Review treatment strategies for high-risk regionally metastatic melanoma
  • Discuss management options for patients with metastatic melanoma

Clinical Cases

CASE 1
Synopsis
  • A 71-year-old Male with a history of NMSC presents for follow up to discuss the pathology results of a recent biopsy of a pigmented lesion on his back

Pathology reveals:

  • HISTOLOGIC TYPE: Superficial spreading melanoma
  • PRECURSOR LESION: Not identified
  • MAXIMUM TUMOR THICKNESS: 3.0 mm
  • ANATOMIC LEVEL: At least level IV
  • ULCERATION: Present
  • MITOTIC RATE: 9 per mm2
  • LYMPHOVASCULAR INVASION: Present, Foci suspicious for lymphovascular invasion
  • METHOD OF DETECTION: Hematoxylin and eosin
  • RADIAL GROWTH PHASE: Present
  • VERTICAL GROWTH PHASE: Present
  • TYPE OF VERTICAL GROWTH: Epithelioid
  • MICROSATELLITES: Cannot be assessed
  • PERINEURAL INVASION: Cannot be assessed
  • TUMOR-INFILTRATING LYMPHOCYTES: Present, nonbrisk
  • TUMOR REGRESSION: Absent
  • MARGINS: Extending to inked lateral and deep resection margins

Case 1 Clinical Questions:

  • What is this patient’s T stage?
  • What would be your next steps in work up?
    • What would be your surgical plan?
    • What additional studies (if any) would you order?



CASE 2
Synopsis
  • A 68-year-old Male with a history of HTN, HLD, T3bN1aM0 melanoma presents for follow up to discuss next steps in management.

Relevant Work Up To Date:

  • Tumor:
    • 3.2 mm thick, ulcerated SSM with 5 mitoses, Right mid back
  • Nodal:
    • 1/14 nodes positive for melanoma on sentinel lymph node biopsy
  • Imaging:
    • No evidence of distant disease
  • Molecular Testing:
    • BRAF p.V600E (c.1799T>A): absent
    • BRAF p.V600K (c.1798_1799delGTinsAA): present
      • INTERPRETATION: POSITIVE for variant in BRAF.

Case 2 Clinical Questions:

  • What is this patient’s pathological stage?
  • What are the therapeutic options for this patient?



CASE 3
Synopsis
  • A 58-year-old Female with a history of HTN, HLD, presents with a 3 cm ulcerated pigmented lesion on the right thigh. Physical exam reveals a 6 cm right inguinal mass.

Case 3 Clinical Questions:

  • What are your next steps in management?
  • If regionally metastatic melanoma is confirmed, what management options are available?



CASE 4
Synopsis
  • A 49-year-old Male with a history of pulmonary sarcoidosis presents with BRAF V600 mutated melanoma metastatic to the liver and lungs.

Case 4 Clinical Questions:

  • What therapeutic strategies are available for this patient?
  • Given the patient’s comorbidities, what would be your first-line treatment strategy?



Timeline of FDA-Approved Medications for Melanoma





Interactive Timeline of FDA-Approved Therapies for Melanoma

















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David Michael Miller
Medical Oncologist and Dermatologist

My research interests include clinical and translational research in advanced skin cancers.

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