cutting edge paper #2
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Melanoma arises from
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melanocytes, skin pigment cells
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Though melanomas account for only 5% of all skin cancers,
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they are responsible for over 75% of skin cancer fatalities
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In 2009
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the incidence rate of melanoma was 68,720 in the United States
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treatment for advanced, metastasized melanoma.
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No current standard treatment
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Diagnosis:
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Biopsy/Tissue Analysis and Lymph Node Biopsy
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Biopsy/Tissue Analysis exampples
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Fine Needle Aspirate (FNA) Shave Biopsy Punch Biopsy Incisional Biopsy Excisional Biopsy
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Shave biopsy.
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A doctor uses a tool similar to a razor to remove a small section of the top layers of skin (epidermis and a portion of the dermis).
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Punch biopsy.
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A doctor uses a circular tool to remove a small section of skin including deeper layers (epidermis, dermis and superficial fat).
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Prognosis
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Breslow's Depth and Clark's Level
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Breslow's depth
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was used as a prognostic factor in melanoma of the skin. It is a description of how deeply tumor cells have invaded. 1.2 mm, that is stage 2. greater than 3mm, is stage 5.
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Clark's level
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is a staging system, used in conjunction with Breslow's depth, which describes the level of anatomical invasion of the melanoma in the skin.
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examples of clark's level invasion
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Level 1 : Melanoma confined to the epidermis (melanoma in situ) Level 2 : Invasion into the papillary dermis Level 3 : Invasion to the junction of the papillary and reticular dermis Level 4 : Invasion into the reticular dermis Level 5 : Invasion into the subcutaneous fat.
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Usual events with melanoma patients
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Multiple comorbidities Undergone surgical excision therapy Recurrence of melanoma following surgery
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methods in research paper
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Intralesional IL-2 Imiquimod Retinoid cream (either .1% tazarotene or .1% tretinoin)
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Steps of event for treatment with Retinoid cream min research paper
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first the Toll Like Receptor 7 in dendritic cells is activated by imiquimod. Second, the dendritic cell presents the antigen to T cell, which are upregulated by IL-2. Third, the T cells which contain the antigen, secrete Interferon-gamma. Fourth, the Interferon-gamma activates macrophages. Lastly, the macrophage consume the immunogenic melanoma cells.
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Effects of intralesional IL-2, topical imiquimod, and topical retinoid application:
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increase the Number of circulating activated T cells. increase CD4/CD8 ratio. increase the Ability of Natural Killer cells to secrete Interferon-gamma. IFN-γ activates macrophages.
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The aldara treatment
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is significant in its 100% complete response rate for all treated tumors. Treat patients with significant comorbidities. and is the First report of intralesional high-dose IL-2 as part of a primary therapeutic regimen for cutaneous melanoma metastases.
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Monoclonal antibodies
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are monospecific antibodies that are made by identical immune cells that are all clones of a unique parent cell, in contrast to polyclonal antibodies which are made from several different immune cells.
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comorbidities
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the simultaneous presence of two chronic diseases or conditions in a patient.
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The sentinel nodes
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are the first few lymph nodes into which a tumor drains.
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Sentinel node biopsy
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involves injecting a tracer material that helps the surgeon locate the sentinel nodes during surgery. The sentinel nodes are removed and analyzed in a laboratory.
