STAGE II MELANOMA

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Stage II melanoma

Stage II melanoma
Stage II melanoma
NSG-530-IKC – Advanced Pathophysiology
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Mr. B, a 40-year-old avid long-distance runner previously in good health, presented to his primary provider for a yearly physical examination, during which a suspicious-looking mole was noticed on the back of his left arm, just proximal to the elbow. He reported that he has had that mole for several years, but thinks that it may have gotten larger over the past two years. Mr. B reported that he has noticed itchiness in the area of this mole over the past few weeks. He had multiple other moles on his back, arms, and legs, none of which looked suspicious. Upon further questioning, Mr. B reported that his aunt died in her late forties of skin cancer, but he knew no other details about her illness. The patient is a computer programmer who spends most of the work week indoors. On weekends, however, he typically goes for a 5-mile run and spends much of his afternoons gardening. He has a light complexion, blonde hair, and reports that he sunburns easily but uses protective sunscreen only sporadically Stage II melanoma.
Physical exam revealed: Head, neck, thorax, and abdominal exams were normal, with the exception of a hard, enlarged, non-tender mass felt in the left axillary region. In addition, a 1.6 x 2.8 cm mole was noted on the dorsal upper left arm. The lesion had an appearance suggestive of a melanoma. It was surgically excised with 3 mm margins using a local anesthetic and sent to the pathology laboratory for histologic analysis. The biopsy came back Stage II melanoma.
How is Stage II melanoma treated and according to the research how effective is this treatment?
Post your initial response by Wednesday at midnight. Respond to one student by Sunday at midnight. Both responses must be a minimum of 150 words, scholarly written, APA formatted, and referenced. A minimum of 2 references are required (other than your text). Refer to grading rubric for online discussion.
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Melanoma
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Lois Chappell posted Feb 8, 2021 7:45 PM
                Melanoma is a disease in which cancer cells form in the cells that bring color to  our skin, melanocytes.  Our skin consists of two layers, the dermis, and the epidermis.  Skin cancer begins in the epidermis, which in itself is composed of three distinct layers, squamous cells, basal cells, and melanocytes.  Over the past thirty years, cases of melanoma have increased dramatically (Melanoma Treatment, 2020).  While usually seen in adults, this cancer can also be seen in children tage II melanoma.  Like all cancers, treatment should begin with prevention.  Educating patients and families to prevent and detect skin cancer is essential.  Clinicians can use the history and physical exam, along with the ABCDE ( asymmetry, border, color, diameter, evolving size) screening method to improve outcomes through early detection (Skin Cancer Foundation, 2020).  Treatment of melanoma begins with testing, which may include biopsy, lymph node mapping, CT studies, blood work and additional tests as warranted.   Standard treatment for melanoma includes surgery, chemotherapy, radiation, and immunotherapy.  Newer treatments include vaccine therapy.  Like all cancers, prevention and a healthy lifestyle are essential to best outcomes.           PDQ Adult Treatment Editorial Board.  May 2020.  Melanoma Treatment:  Patient Version.  PDQ Cancer Institute.  Retrieved from           Skin Cancer Foundation.  2020.  Melanoma warning signs, what you need to know about early detection.  Retrieved from  less0 UnreadUnread
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                https://www.skincancer.org/skin-cancer-information/melanoma/melanoma-warning -signs-and-images.
                https://www.ncbi.nlm.gov/books/NBK6950.
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                While most often found in the trunk, head and neck on men, women tend to develop melanoma on the arms and legs.  Risk factors are numerous and include fair complexion, light hair (red or blonde) and eye color (blue, green), exposure to sun or artificial light, genetics, moles, personal history of melanoma, family history of melanoma, history of sunburns with blistering, and being white (Melanoma Treatment, 2020).
Stage II Melanoma discussion Week 3Subscribe
Aina Oluwo posted Feb 3, 2021 7:21 PM
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Stage 11 MelanomaAccording to Melanoma Research Alliance (2021), the staging of melanomas can be divided into three that is; Stage IIA Melanoma: this is when the tumor is more than 1.0 millimeter and less than 2.0 millimeters thick with ulceration (broken skin) or more than 2.0 and less than 4.0 millimeters without broken skin. Mr. B’s tumor measurements, which are 1.6 x 2.8cm, falls under stage IIA. In Stage IIB Melanoma, the tumor is more than 2.0 millimeters and less than 4.0 millimeters thick with broken skin (ulceration) or more than 4.0 millimeters without ulceration. Stage IIC Melanoma, the tumor is more than 4.0 millimeters thick with broken skin (ulceration) Stage II melanoma. In cases whereby the SLNB found cancer, doctors do recommend additional treatment (Adjunct Therapy) with an immune checkpoint inhibitor or targeted therapy drugs, which helps to lower the chances of the melanoma coming back (The American Cancer Society, 2019). Huether, S. E., McCance, K. L., & Brashers, V. L. (2020). Understanding pathophysiology (7th ed.). Elsevier.The American Cancer Society. (2019, August 14). Treatment of melanoma by stage. American Cancer Society. Retrieved February 1, 2021, from https://www.cancer.org/cancer/melanoma-skin-cancer/treating/by-stage.htmlless2 UnreadUnread6 ViewsViews
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View profile card for Aina Oluwo
Last post February 8 at 12:00 AM by Aina Oluwo
Ward, W. H., Lambreton, F., Goel, N., Yu, J. Q., & Farma, J. M. (2017, December 21). Clinical presentation and staging of melanoma – cutaneous melanoma – ncbi bookshelf. Cutaneous Melanoma: Etiology and Therapy. Retrieved February 1, 2021, from https://www.ncbi.nlm.nih.gov/books/NBK481857/
Melanoma Research Alliance. (2021, January 1). Stage 2 melanoma. Retrieved February 1, 2021, from https://www.curemelanoma.org/about-melanoma/melanoma-staging/stage-2/
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View profile card for Melissa Morgan
Last post February 7 at 8:52 PM by Melissa Morgan
PDQ Adult Treatment Editorial Board. Melanoma Treatment (PDQ®): Health Professional Version. (2021). In: PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-,. 
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Steven Bartos posted Feb 3, 2021 5:34 PM
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In stage II melanoma, it is considered a locally invasive cancer as it has not spread to other parts of the body. Research by Garbe et al. (2016) concluded that surgical excision is the primary interventional treatment for melanoma. However, risk still remains that melanoma may reoccur even after surgery, so it’s not completely effective. Stage II melanoma is broken down into three subdivisions: stages IIA, IIB, and IIC, going from IIA – IIC respectively as the thickness of the melanoma increases. As far as overall survival rates are concerned, stage IIA has a five-year survival rate of 80%, but for stage IIC this decreases to 53% (Lee et al., 2017). ReferencesKoster, B.D., van den Hout, M., Sluijter, B., Molenkamp, B., Vuylsteke, R., Baars, A., van Leeuwen, P., Scheper, R., van del Tol, M., van den Eertwegh, A., de Gruijil, T. (2017) Local adjuvant treatment with low-dose CpG-B offers durable protection against disease recurrence in clinical stage I-II melanoma: Data from two randomized phase II trials. Clinical Cancer Research, 23(19), 5679 – 5685. https://doi.org/10.1158/1078-0432.CCR-17-0944more1 UnreadUnread5 ViewsViews
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Last post February 7 at 9:21 AM by Dennies Jones
Lee, A.Y., Droppelmann, N., Panageas, K.S., Zhou, Q., Ariyan, C.E., Brady, M.S., Chapman, P.B., & Coit, D.G. (2017). Patterns and timing of initial relapse in pathologic stage II melanoma patients. Annals of Surgical Oncology, 24(4), 939 – 946. http://dx.doi.org.wilkes.idm.oclc.org/10.1245/s10434-016-5642-0
Garbe, C., Peris, K., Hauschild, A., Saiag, P., Middleton, M., Basthold, L., Grob, J.J. Malvehy, J., Newton-Bishop, J., Stratigos, A.J., Pehamberger, H., & Eggermont, A.M. (2016) Diagnosis and treatment of melanoma. European consensus-based interdisciplinary guideline – update 2016.  European Journal of Cancer, 63(1), 201 – 217. https://doi.org/10.1016/j.ejca.2016.05.005
Research on adjuvant immunotherapy has shown that this can have some benefit specifically to stage 2 melanoma. It is used after primary treatments such as surgery to lessen the chance of the cancer returning. Interferon (IFN)-α is an immunotherapy agent that was shown to be effective in some randomized trials at improving survival rates (Garbe et al., 2016). In another study, Koster et al. (2017) looked at stage I – II melanoma patients and performed randomized trials to determine whether or not a localized adjuvant low dose CpG-B treatment offers benefit after the tumor is removed. These were phase II trials, but the study found that this specific treatment presented as safe, boosted immunity, was associated with lower rates of melanoma re-occurrence, and improved survival rates.
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Alfonsina Perez posted Feb 3, 2021 1:34 AM
Contains unread posts Stage II melanoma
            Melanomas are defined as malignant tumors that come from melanocytic cells (Garbe et al., 2016). Melanoma tumors are mostly found in the skin but can also be found in the eyes and meninges (Garbe et al., 2016). The primary treatment for stage II melanoma is an excisional biopsy (Garbe et al., 2016). In an excisional biopsy, the entire tumor is removed with a wide local incision, as opposed to an incisional biopsy when only a portion of the tumor is removed (Garbe et al., 2016). Whenever possible, an excisional biopsy is the preferred method of tumor removal in the case of melanomas. In cases when the tumors have metastasis or the risk of metastasis or recurrent of cancer may be a risk, adjuvant therapies may be recommended and these include chemotherapy and radiation (Garbe et al., 2016). Another part of the treatment for stage II melanoma is to do a sentinel lymph node biopsy to see if any cancer cells have spread to the lymph nodes (Hieken et al., 2019). ReferencesBrożyna, A. A., Guo, H., Yang, S., Cornelius, L., Linette, G., Murphy, M., . . . Carlson, J. A.(2017). TRPM1 (melastatin) expression is an independent predictor of overall survival inclinical AJCC stage I and II melanoma patients. Journal of Cutaneous Pathology, 44(4),328-337. doi:10.1111/cup.12872Garbe, C., Peris, K., Hauschild, A., Saiag, P., Middleton, M., Bastholt, L., . . . EuropeanAssociation of Dermato-Oncology (EADO). (2016). Diagnosis and treatment ofmelanoma. european consensus-based interdisciplinary guideline – update 2016.European Journal of Cancer (1990), 63, 201-217. doi:10.1016/j.ejca.2016.05.005Hieken, T. J., Kane,John M., I.,II, & Wong, S. L. (2019). The role of completion lymph nodedissection for sentinel lymph node-positive melanoma. Annals of SurgicalOncology, 26(4), 1028-1034. doi:http://dx.doi.org.wilkes.idm.oclc.org/10.1245/s10434-018-6812-zless1 UnreadUnread4 ViewsViews
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View profile card for Jennifer Bryant
Last post February 6 at 6:10 PM by Jennifer Bryant
 
               Patients survival rate after treatment with the various modalities is highly dependent on the stage of the melanoma when diagnosed and the promptness of treatment. Brozyna et al., (2017), found that with surgical intervention patients have a survival rate of 88%. It is important to remember that the like hood of survival is highly dependent on the size of tumor, depth and whether there is metastasis present (Brozyna etal., 2017).
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Jennifer Bryant posted Feb 1, 2021 6:22 PM
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In this case study, Mr. B had a suspicious mole excised and pathohistology reported the tumor as Stage II Melanoma. This means the cancer cells are in both the epidermis and the dermis. Wide local excision of the tumor is the current standard of care. Alternative surgical techniques include Mohs micrographic surgery, a targeted, tissue preserving option. Recurrences due to inadequate excision, resulting in true local recurrence rates of 9% to 15% of the head and neck and 3% on the trunk and proximal extremities (Tolkachjov et al, 2017) Stage II melanoma.        Stang, A.,  Roesch, A., Selma Ugurel, S., (2018) Melanoma, The Lancet, 392(10151), 971-      Hruza, G. J., M.D., Roenigk, R. K., M.D., Harmon, C. B., M.D. (2017). Understanding     Clinic Proceedings, 92(8), 1261-1271.less1 UnreadUnread3 ViewsViews
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Last post February 6 at 12:15 PM by Aina Oluwo
     mohs micrographic surgery: A review and practical guide for the nondermatologist. Mayo
Tolkachjov, S. N., M.D., Brodland, D. G., M.D., Coldiron, B. M., M.D., Fazio, M. J., M.D.,
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Schadendorf, D., van Akkooi, A., Berking, C., Griewank, K. G., Gutzmer, R., Hauschild, A.,
American Cancer Society, 2021 Cancer Facts and Figures, 2021.
References
The hard, enlarged, non-tender mass the left axillary region should be biopsied. Lymph node biopsy is recommended for primary melanomas with a tumor thickness of at least 1.0 mm (Schadendorf et al., 2018). The 5 year survival rate for all stages of skin cancer is 93%. When detected early, such as the case of Mr B, a localized tumor that has not spread beyond the skin where it started, the 5 year survival rate is 99% (American Cancer Society, 2021). Ongoing screening and surveillance should occur due to increased risk factors: family history, personal history, light skin and ongoing UV exposure. Mr. B must be educated in prevention with sunscreen, protective clothing and limited sun exposure.
Stage II MelanomaSubscribe
Jazmin Jerez-Rivera posted Feb 2, 2021 2:41 PM
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Melanoma is cancer found in the melanocytes of the skin. Huether et. al. states, “Melanoma the most lethal form of skin cancer, can occur at many sites (2020, p. 280). Evidence suggests that occasional sun exposure leading to sunburn can increase the risk of melanoma. According to the American cancer society surgery to remove the cancerous area is the standard for treating stage II melanoma. Research by Domingues et. al. indicates that tumor excision “includes safety margins of 0.5 cm for in situ melanomas, 1 cm for tumors with a thickness of up to 2 mm, and 2 cm for tumors thicker than 2 mm” (2018, p. 35). There are also recommendations for a sentinel lymph node biopsy to check if the melanoma has spread to lymph nodes in the surrounding area. If cancer cells are found, then the lymph nodes in the area will be surgically removed. Other considerations are chemotherapy, targeted therapy and immunotherapy (Dominges et. al., 2018).ReferencesImmunoTargets and therapy, 7, 35–49. https://doi.org/10.2147/ITT.S134842https://www.cancer.org/cancer/melanoma-skin-cancer/treating/by-stage.html#written_byElsevier.less1 UnreadUnread3 ViewsViews
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Last post February 5 at 8:18 PM by Candice Russell
Huether, S. E., McCance, K. L., Brashers, V. L. (2020). Understanding Pathophysiology (7 Ed.).
American Cancer Society. (2019). Treatment of Melanoma Skin Cancer, by Stage.
Domingues, B., Lopes, J. M., Soares, P., & Pópulo, H. (2018). Melanoma treatment in review Stage II melanoma.
Mr. B’s melanomaSubscribe
Tallona Boddy posted Feb 2, 2021 7:13 PM
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Mr. B was diagnosed with a Stage II melanoma. Mr. B’s cancer was first suspected at his annual physical exam with his primary care physician.  Mr. B’s physician initially excised the suspicious mole and sent it to pathology.  Along with a suspicious mole, the physician also noted a non-tender mass in Mr. B’s left axillary region. The American Cancer Society (n.d.) states an additional step for the treatment of Stage II melanoma is to have a sentinel lymph node biopsy (SLNB) performed. Due to Mr. B’s noted non-tender mass in his axillary a SLNB should be discussed with Mr. B to determine if there are cancerous cells in his lymph nodes.  Melanoma Research Alliance (n.d.) states that the prognosis for stage II melanoma does have a high rate of recurrence or metastasis.  In 2018 the 5 year survival rate of localized melanoma (which includes stage II) is 98.4%.  ReferencesMelanoma Research Alliance. (n.d.). Stage 2 melanoma. https://www.curemelanoma.org/about-melanoma/melanoma-staging/stage-2/.less1 UnreadUnread1 ViewsViews
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View profile card for Jazmin Jerez-Rivera
Last post February 5 at 7:56 PM by Jazmin Jerez-Rivera
Utjés, D., Malmstedt, J., Teras, J., Drzewiecki, K., Gullestad, H. P., Ingvar, C., Eriksson, H., & Gillgren, P. (2019). 2-cm versus 4-cm surgical excision margins for primary cutaneous melanoma thicker than 2 mm: long-term follow-up of a multicentre, randomised trial. Lancet (London, England), 394(10197), 471–477. https://doi.org/10.1016/S0140-6736(19)31132-8
American Cancer Society. (n.d.). Treatment of melanoma by stage. https://www.cancer.org/cancer/melanoma-skin-cancer/treating/by-stage.html.
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View profile card for Tallona Boddy
Last post February 5 at 3:28 PM by Tallona Boddy
Treatment of melanoma by stage. (n.d.). American Cancer Society | Information and Resources about for Cancer: Breast, Colon, Lung, Prostate, Skin. Retrieved February 2, 2021,  https://www.cancer.org/cancer/melanoma-skin-cancer/treating/by-stage.html
Stark M. S. (2017). Melanoma treatment guided by a panel of microRNA biomarkers. Melanoma management, 4(2), 75–77. https://doi.org/10.2217/mmt-2017-0006
Stage 1 & stage 2 melanomas | Mount Sinai – New York. (n.d.). Mount Sinai Health System. Retrieved February 2, 2021, https://www.mountsinai.org/locations/waldman-melanoma-center/what-is/stage-1-and-2-melanoma
           doi: 10.15586/codon.cutaneousmelanoma.2017.ch7
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The Surveillance, Epidemiology, and End Results (SEER) database provides survival statistics for different forms of cancer Stage II melanoma. SEER tracks 5-year survival rates for melanoma skin cancer, based on how far the cancer has spread. SEER groups cancer into localized, regional, and distant stages. In stage II melanoma, not spread beyond the skin, is considered localized. The five-year relative survival rate in localized SEER staging is 99% (Treatment of melanoma by stage, n.d.) In the regional stage, cancer that has spread to nearby structures or lymph nodes, the 5-year survival rate is 66% (Treatment of melanoma by stage, n.d.). The more advanced the cancer, the survival rates continue to decrease. Continued surveillance is important, even after completed treatment, due to high risk of reoccurrence and development of another melanoma. Self-skin assessment is recommended.
Surgery is the main treatment option in melanoma, if done during early stages, surgery can cure melanoma. Joyce (2017) stated, “surgery remains the mainstay of treatment of primary melanoma, and in the majority of cases it is curative” (p. 92). Wide excision, surgery that removes the melanoma, as well as some of the normal skin around it, is the standard form of treatment for stage II. The width of the excision depends on the thickness and location of the melanoma. If there is lymph node involvement a sentinel lymph node biopsy (SLNB) may be recommended. Treatment of melanoma by stage. (n.d.) states “If an SLNB is done and does not find cancer cells in the lymph nodes then no further treatment is needed, although follow-up is still important” (p. 24). If cancer is found in SLNB, additional treatment with an immune checkpoint inhibitor or targeted therapy drugs may be recommended.
            The type of treatment will depend on the stage and location of the melanoma. Three factors used to determine staging of melanoma, consist of the TNM system. T category determines the tumor thickness and the presence or absence of ulceration. N category determines if regional lymph nodes are involved. M determines if distant metastasis has taken place. The American Joint Committee on Cancer (AJCC) made significant revisions to the melanoma TNM staging system. Balch et al. (2003) stated “the new staging system better reflects independent prognostic factors that are used in clinical trials and in reporting the outcomes of various melanoma treatment modalities” (p. 43) Stage II melanoma.
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Gisselle Mustiga posted Feb 4, 2021 7:44 AM
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Melanoma is a skin disease that occurs when cancerous or malignant cells are formed in the melanocytes.  The number of individuals with this disease has continued to increase in the United States over the last three decades (Huether et al., 2020). Melanoma is quite common in adults compared to children and adolescents. Some of the notable signs of melanoma include a mole, which tends to changes in size, changes in skin pigmentation, and the presence of other satellite moles. The disease can be examined through skin exams, biopsy, and physical exams. It occurs in five stages;  Stage 0, also known as melanoma in situ, to stage IV. Each stage has preferred and most effective treatment methods. However, it should be noted that melanoma can recur after treatment.ReferencesPDQ Adult Treatment Editorial Board, (2020). Melanoma Treatment (PDQ®), Patient Version. PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute. https://www.ncbi.nlm.nih.gov/books/NBK65950/less1 UnreadUnread2 ViewsViews
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View profile card for Hilary Szpara
Last post February 5 at 2:44 PM by Hilary Szpara
Ward, W. H., & Farma, J. M. (2017). Cutaneous Melanoma: Etiology and Therapy [Internet]: Chapter 7; Surgical Management of Melanoma. Brisbane (AU): Codon Publications. https://www.ncbi.nlm.nih.gov/books/NBK481850/#:~:text=Surgery%20remains%20the%20best%20option,care%20for%20localized%20cutaneous%20melanoma.
Huether, S. E., McCance, K. L. & Brashers, V. L. (2020). Understanding Pathophysiology 7 th ed. Elsevier Mosby. https://www.sendspace.com/file/19s130
Stage II melanoma tends to extend beyond the skin’s outer layer (epidermis), thus reaching the dermis.  The most effective and best method for treating stage II melanoma is surgery. This involves performing minor surgeries of wider local excisions to get rid of the melanoma and the surrounding normal skin tissues (PDQ Adult Treatment Editorial Board, 2020). This is then followed by skin grafting, which involves taking skins from other parts of the body to replace the removed one Stage II melanoma. The procedure is essential in covering the wound caused by the surgery. Moreover, sentinel lymph node biopsy is recommended in checking the spread of melanoma to the nearby lymph nodes. Close follow-up is also essential in monitoring the patient’s outcomes. This treatment method has a 5-year survival rate of 92%, making it the best option for localized melanoma (Ward & Farma, 2017).
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Joanne Hogan posted Feb 3, 2021 3:38 PM
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     Although stage II melanoma can be treated surgically, there is recurrence of this cancer even if patients have negative SLNB post-surgery (Koster et a

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