Devita, Hellman, and Rosenberg's Cancer

LWBK1006-27 LWW-Govindan-Review December 12, 2011 19:32

380 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

Answer 27.6. The answer is B.

The current National Comprehensive Cancer Network (NCCN) guide-

lines call for physical examination focused on skin and regional lymph

nodes plus any new areas of clinical concern based on patient history.

Routine imaging is limited to annual chest radiography in asymptomatic

patients. Routine surveillance PET-CT scans every 6 months are not indi-

cated in stage I/II melanoma. However, if clinically indicated (i.e., new

symptoms), appropriate imaging is warranted for patients with a history

of stage I-II-IIIA melanoma. For patients at higher risk for recurrence

(stage IIIB to IIIC and surgically resected stage IV), periodic surveillance

imaging is warranted.

Answer 27.7. The answer is D.

Palliative radiation therapy is indicated for these three indications. In

addition, patients with symptomatic cutaneous or subcutaneous metas-

tases can often be palliated by radiation therapy.

Answer 27.8. The answer is C.

Liver metastases are common in recurrent ocular melanoma. More than

90% of patients with metastatic ocular melanoma have liver metas-

tases, often as the initial and sole site of distant disease. Brain metastasis

from ocular melanoma is less frequent (>5%) compared with cutaneous

melanoma and typically occurs late in the disease course. The median

survival for patients with metastatic ocular melanoma is 7 months.

Answer 27.9. The answer is D.

The involvement of four or more regional lymph nodes characterizes N3.

In the absence of distant metastases, patients with N3 disease have stage

IIIC.

Answer 27.10. The answer is B.

Various clinical trials provide convincing evidence for the relapse-free sur-

vival benefit of adjuvant interferon. There are no data to suggest that limb

perfusion, radiation therapy, or high-dose chemotherapy can improve sur-

vival in patients with surgically resected melanoma.

Answer 27.11. The answer is D.

The three clinical situations listed are all accepted indications for surgical

resection in selected patients with metastatic melanoma.

Answer 27.12. The answer is A.

CTLA-4 is a cell surface molecule that regulates T cell activation. Ipili-

mumab blocks the interaction of CTLA-4 (present on activated T cells)

and its ligands CD80 and CD86 (present on dendritic cells/monocytes)

to promote T cell activation and proliferation. Immune-mediated

enterocolitis is indeed the most common serious adverse event seen