Dr Matthew Strack. Dermatologist Christchurch Dunedin Invercargill
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1 Dr Matthew Strack Dermatologist Christchurch Dunedin Invercargill 14:00-14:55 WS #33: Managing Melanoma - Guidelines and Controversies 15:05-16:00 WS #43: Managing Melanoma - Guidelines and Controversies (Repeated)
2 Melanoma Management Quiz Dr Matthew Strack Dermatologist 360 Papanui Rd Marinoto Clinic, Mercy Hospital Christchurch Dunedin
3 Melanoma in Community Practice Suspected Melanoma Management Excision Guidelines Follow up Issues
4 Q1. % of Melanomas in New Zealand either in situ or <1mm? A. <75% B % C % D. > 95% E. Unknown Letter: Timeliness of melanoma management New Zealand Medical Journal 15th December 2017, Volume 130 Number 1467 Keith Monnington, Sharad Paul, Dirk Venter URL:
5 % of Melanomas in New Zealand either in situ or <1mm? A. <75% B % C % D. > 95% E. Unknown Letter: Timeliness of melanoma management New Zealand Medical Journal 15th December 2017, Volume 130 Number 1467 Keith Monnington, Sharad Paul, Dirk Venter URL:
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7 Q2. You excise a suspected melanoma; histology confirms a benign lesion. Your next action is: A. Ring patient with good news B. Write a formal letter of apology C. Contact your medical insurer for advice D. Depends what you said prior to surgery E. Immediately refund fee for surgery and consider B. or C.
8 You excise a suspected melanoma; histology confirms a benign lesion. Your next action is: A. Ring patient with good news B. Write a formal letter of apology C. Contact your medical insurer for advice D. Depends what you said prior to surgery E. Immediately refund fee for surgery and consider B. or C.
9 1:5-10 Number needed to treat
10 Q3. Recommended excision margins for <1mm Melanoma A. 5mm B. 10mm C mm D. 20mm E. Guidelines not clear or not published F. Depends on other Factors
11 Recommended excision margins for <1mm Melanoma A. 5mm B. 10mm C mm D. 20mm E. Guidelines not clear or not published F. Depends on other Factors
12 Q4. Recommended excision margins for 1-2mm Melanoma A. 5mm B. 10mm C mm D. 20mm E. Guidelines not clear or not published F. Depends on other Factors
13 Recommended excision margins for 1-2mm Melanoma A. 5mm B. 10mm C mm D. 20mm E. Guidelines not clear or not published F. Depends on other Factors
14 Q5. Recommended excision margins for 2-4mm Melanoma A. 5mm B. 10mm C mm D. 20mm E. Guidelines not clear or not published F. Depends on other Factors
15 Recommended excision margins for 2-4mm Melanoma A. 5mm B. 10mm C mm D. 20mm E. Guidelines not clear or not published F. Depends on other Factors
16 Q6. Recommended excision margins for Acral and Subungual Melanoma A. 5mm B. 10mm C mm D. 20mm E. Guidelines not clear or not published F. Depends on other Factors
17 Recommended excision margins for Acral and SubUngual Melanoma A. 5mm B. 10mm C mm D. 20mm E. Guidelines not clear or not published F. Depends on other Factors
18 Q7. Recommended excision margins for In-Situ Melanoma A. 5mm B. 10mm C mm D. 20mm E. No guidelines exist F. Depends on other Factors
19 Recommended excision margins for In-Situ Melanoma A. 5mm B. 10mm C mm D. 20mm E. No guidelines exist F. Depends on other Factors
20 Q8. You suspect a lesion has low risk of melanoma (5% or less). You plan to: A. Excise with 20mm margins B. Ask patient to keep an eye on it C. Refer for second opinion D. Reschedule review in 6 months E. Book incisional or punch biopsy
21 You suspect a lesion has low risk of melanoma (5% or less). You plan to: A. Excise with 20mm margins B. Ask patient to keep an eye on it C. Refer for second opinion D. Reschedule review in 6 months E. Book incisional or punch biopsy
22 Q9. You suspect a lesion has very low risk of melanoma (less than 1%). You plan to: A. Reassure Patient B. Ask patient to keep an eye on it C. Refer for second opinion D. Reschedule review in 6 months E. Book incisional or punch biopsy
23 You suspect a lesion has very low risk of melanoma (less than 1%). You plan to: A. Reassure Patient B. Ask patient to keep an eye on it C. Refer for second opinion D. Reschedule review in 6 months E. Book incisional or punch biopsy
24 Surface Cell Adhesive Sample Analysis
25 Q10. You are confident that a lesion is benign. You plan to: A. Reassure Patient B. Ask patient to keep an eye on it C. Refer for second opinion D. Reschedule review in 6 months E. Book incisional or punch biopsy
26 You are confident that a lesion is benign. You plan to: A. Reassure Patient B. Ask patient to keep an eye on it C. Refer for second opinion D. Reschedule review in 6 months E. Book incisional or punch biopsy
27 Q11. Sentinel Lymph Node Biopsy Threshold: A. In-Situ B. 0.5mm C. 1mm D. 1.5mm E. 2mm and greater
28 Sentinel Lymph Node Biopsy Threshold: A. In-Situ B. 0.5mm C. 1mm D. 1.5mm E. 2mm and greater
29 Liquid Biopsy
30 Q12. You excise a suspected melanoma with measured 5mm margins, it is reported as radial growth phase / melanoma in-situ with 5mm clear margins. Your next action: A. No Re-excision Necessary B. Re-excise with 5mm margins C. Re-excise with 1-2cm margins D. Refer to specialist for re-excision E. Request MRI of area
31 You excise a suspected melanoma with measured 5mm margins, it is reported as radial growth phase / melanoma in-situ with 5mm clear margins. Your next action: A. No Re-excision Necessary B. Re-excise with 5mm margins C. Re-excise with 1-2cm margins D. Refer to specialist for re-excision E. Request MRI of area
32 Q13. You excise a suspected melanoma with measured 5mm margins, it is reported as 0.7mm invasive melanoma with 5mm clear margins. Your next action: A. No Re-excision Necessary B. Re-excise with 5mm margins C. Re-excise with 1-2cm margins D. Refer to specialist for re-excision E. Request MRI of area
33 You excise a suspected melanoma with measured 5mm margins, it is reported as 0.7mm invasive melanoma with 5mm clear margins. Your next action: A. No Re-excision Necessary B. Re-excise with 5mm margins C. Re-excise with 1-2cm margins D. Refer to specialist for re-excision E. Request MRI of area
34 Q14. You excise a suspected melanoma with measured 10mm margins, it is reported as 1.1mm invasive melanoma with 5mm clear margins. Your next action: A. No Re-excision Necessary B. Re-excise with 5mm margins C. Re-excise with 1-2cm margins D. Refer to specialist for re-excision E. Request MRI of area
35 You excise a suspected melanoma with measured 10mm margins, it is reported as 1.1mm invasive melanoma with 5mm clear margins. Your next action: A. No Re-excision Necessary B. Re-excise with 5mm margins C. Re-excise with 1-2cm margins D. Refer to specialist for re-excision E. Request MRI of area
36 Q15. Melanoma Follow Up A. Patients should be seen by Doctor B. Not shown to Increase Survival C. Recurrences usually detected by patient rather than Doctor D. Frequency/Intervals can be negotiated on a case to case basis E. All of the above
37 Melanoma Follow Up A. Patients should be seen by Doctor B. Not shown to Increase Survival C. Recurrences usually detected by patient rather than Doctor D. Frequency/Intervals can be negotiated on a case to case basis E. All of the above
38 Q16. Recommended Follow up Intervals In-Situ and <1mm Melanoma A. 3-4 monthly for 5years B. 6 monthly for 5 years C. Annually for 5 years D. 3-4 monthly for 3 years then annually until 5 years E. 6 monthly for 2 years then annually until 5 years F. To determine with patient on a case by case basis
39 Recommended Follow up Intervals In-Situ and <1mm Melanoma A. 3-4 monthly for 5years B. 6 monthly for 5 years C. Annually for 5 years D. 3-4 monthly for 3 years then annually until 5 years E. 6 monthly for 2 years then annually until 5 years F. To determine with patient on a case by case basis
40 Q17. Recommended Follow up Intervals 1-4mm Melanoma A. 3-4 monthly for 5years B. 6 monthly for 5 years C. Annually for 5 years D. 3-4 monthly for 3 years then annually until 5 years E. 6 monthly for 2 years then annually until 5 years F. To determine with patient on a case by case basis
41 Recommended Follow up Intervals 1-4mm Melanoma A. 3-4 monthly for 5years B. 6 monthly for 5 years C. Annually for 5 years D. 3-4 monthly for 3 years then annually until 5 years E. 6 monthly for 2 years then annually until 5 years F. To determine with patient on a case by case basis
42 Q18. Sun Protection post Melanoma A. Parabens are not a problem in sunblock anymore B. Vitamin D deficiency may be a problem C. Outdoors workers may need to change job D. Patients should have a general skin check to document sun damage (amongst other things) at time of diagnosis E. All of the above
43 Sun Protection post Melanoma A. Parabens are not a problem in sunblock anymore B. Vitamin D deficiency may be a problem C. Outdoors workers may need to change job D. Patients should have a general skin check to document sun damage (amongst other things) at time of diagnosis E. All of the above
44 New York Times, 3 May 2018 Hawaii Passes Bill Banning Sunscreen That Can Harm Coral Reefs The legislation prohibits the distribution of sunscreens containing chemicals that scientists have found contributes to coral bleaching when washed off in the ocean. oxybenzone octinoxate
45 Q19. Vitamin D issues A. Patients with low vitamin D should have Vitamin D orally B. Vitamin D test is available free of charge at the lab C. Vitamin D supplements are usually necessary D. We do not know the normal or optimum range for vitamin D E. Patients should be encouraged to get out in the sun to make natural vitamin D
46 Vitamin D issues A. Patients with low vitamin D should have Vitamin D orally B. Vitamin D test is available free of charge at the lab C. Vitamin D supplements are usually necessary D. We do not know the normal or optimum range for vitamin D E. Patients should be encouraged to get out in the sun to make natural vitamin D
47 Q20. Side Effects of Excess Vitamin D A. Hypercalcaemia B. Kidney Stones C. Constipation D. ECG / Heart Rhythm Changes E. All of the above
48 Side Effects of Excess Vitamin D A. Hypercalcaemia B. Kidney Stones C. Constipation D. ECG / Heart Rhythm Changes E. All of the above
49 Base Transection with Shave Biopsy Breslow Thickness vs Transection Rate <1mm 45% 1-4mm 75% >4mm 92%
50 New Treatments Spokeswoman: Jimmy Carter no longer needs cancer treatment
51 Matthew Strack
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