NSG-530-IKC ? Advanced Pathophysiology ? Module 3: Discussion ? Must post first. Subscribe 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. 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. Feedback 100 / 100 View Graded Rubric Start a New Thread Discussion Filter by: All Threads Sort by: Most Recent Activity? Least Recent Activity? Newest Thread? Oldest Thread? Author First Name A-Z? Author First Name Z-A? Author Last Name A-Z? Author Last Name Z-A? Subject A-Z? Subject Z-A Melanoma Subscribe 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.???????????? ?????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 4 ViewsViews 4 0 0 RepliesReplies 

0 ? ? ? ? ? ? ? ? https://www.skincancer.org/skin-cancer-information/melanoma/melanoma-warning -signs-and-images. ? ? ? ? ? ? ? ? https://www.ncbi.nlm.gov/books/NBK6950. References ?????????? ?????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 Contains unread posts 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).?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 6 2 2 RepliesReplies 2 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/ References 2 2 RepliesReplies 2 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-,.? References Module 3Subscribe Steven Bartos posted Feb 3, 2021 5:34 PM Contains unread posts 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 5 1 1 RepliesReplies 1 View profile card for Dennies Jones 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. Module 3 DiscussionSubscribe Alfonsina Perez posted Feb 3, 2021 1:34 AM Contains unread posts ??????????? 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 4 1 1 RepliesReplies 1 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). Melanoma Discussion PostSubscribe Jennifer Bryant posted Feb 1, 2021 6:22 PM Contains unread posts 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).???? ???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 3 1 1 RepliesReplies 1 View profile card for Aina Oluwo 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., ???? 984. 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 Contains unread posts 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 3 1 1 RepliesReplies 1 View profile card for Candice Russell 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. Mr. B?s melanomaSubscribe Tallona Boddy posted Feb 2, 2021 7:13 PM Contains unread posts 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 1 1 1 RepliesReplies 1 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. 1 1 RepliesReplies 1 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 ? The Surveillance, Epidemiology, and End Results (SEER) database provides survival statistics for different forms of cancer. 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). Week 3 Discussion PostSubscribed Gisselle Mustiga posted Feb 4, 2021 7:44 AM Contains unread posts 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 2 1 1 RepliesReplies 1 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. 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). Module 3- MelanomaSubscribe Joanne Hogan posted Feb 3, 2021 3:38 PM Contains unread posts References ?? ??Although stage II melanoma can be treated surgically, there is recurrence of this cancer even if patients have negative SLNB post-surgery (Koster et al., 2017). The mortality rate for recurrences of this cancer is 48.5%. The 10-year survival rate in early diagnosed (stage I and stage II) localized melanoma is 95%-40%. The survival rate drops to 68% to 40% if the lymph nodes are affected. According to randomized trial study, an immunotherapy, CpG-B has shown to reduce the recurrence of stage I-II melanoma. Moreover, this treatment has shown more survival rate for patients.

 CpG-B is an immunotherapy injection that is given through intradermal route. The study concluded that CpG-B has the potential to become a safe treatment for stage I and II melanoma. However, long-term randomized trial research is needed in order to make it a standard treatment (Koster et al., 2017). Stage II melanomaSubscribe Melissa Morgan posted Feb 3, 2021 9:35 PM Contains unread posts Melanoma is the most serious form of skin cancer that if not caught early has a low survival rate (Huether, McCance & Brashers, 2020). This is because it can spread quickly and metastasizes to other areas of the body. ?The morbidity and mortality of this disease vary according to the time of detection and accessibility to treatment? (Gao, et al., 2020, p. 1).

 Mr. B has light skin, has a family history of skin cancer, spends his weekends running and gardening, and only uses sunscreen sporadically; these are known risk factors for skin cancer.?Gao, Y., Li, Y., Niu, X., Wu, Y., Guan, X., Hong, Y., Chen, H., & Song, B. (2020). Identification and Validation of Prognostically Relevant Gene Signature in Melanoma.?BioMed Research International, 1?29. https://doi-org.wilkes.idm.oclc.org/10.1155/2020/5323614Motofei, I. G. (2019). Malignant Melanoma: Autoimmunity and Supracellular Messaging as New Therapeutic Approaches.?Current Treatment Options in Oncology,?20(6), 1?15. https://doi-org.wilkes.idm.oclc.org/10.1007/s11864-019-0643-4?less1 UnreadUnread7 ViewsViews 7 1 1 

RepliesReplies 1 View profile card for Caroline Otto Last post?February 5 at 11:33 AM?by Caroline Otto Sun, R., Guo, M., Fan, X., Meng, Q., Yuan, D., Yang, X., Yan, K., & Deng, H. (2020). MicroRNA-148b Inhibits the Malignant Biological Behavior of Melanoma by Reducing Sirtuin 7 Expression Levels.?BioMed Research International, 1?13. https://doi-org.wilkes.idm.oclc.org/10.1155/2020/9568976 Huether, S., McCance, K., and Brashers, V.? (2020).??Understanding Pathophysiology?(7th?ed.).? Elsevier. References Mr. B?s cancer is stage II and is localized. Therefore, treatment of melanoma involves a wide surgical excision of the primary lesion site if there is no evidence of metastatic disease (Huether, McCance & Brashers, 2020). A biopsy of the peripherally draining lymph node may be necessary if Mr. B?s lesion is greater than 1 mm deep (Huether, McCance & Brashers, 2020). ?Lesions on the extremities have the best surgical prognosis? 

(Huether, McCance & Brashers, 2020, p. 1034). ?Except for melanoma in situ, the surgical procedure is generally not enough when it is performed as monotherapy, local recurrence, and/or metastases develop in most patients after a variable period of time? (Motofei, 2019, p. 2). Mr. B has stage II melanoma, so after surgical removal of the lesion, treatment will likely involve either radiation therapy, chemotherapy, immunotherapy, oncolytic viruses, or targeted molecular therapy (Huether, McCance & Brashers, 2020). Mr. B is 40 years old, his lesion is located in his left arm (which has a better surgical prognosis than other areas of the body), is stage II, and the cancer has not metastasized. Whether this treatment will be effective depends on if all the cancerous cells were removed during surgery, and the recurrence or metastasizes of the cancer in the future. ?

However, despite promising progress in surgical resection, radiotherapy, and chemotherapy of melanoma, long-term survival remains extremely low due to recurrence and metastasis? (Sun, et al., 2020, p. 1). Weekk 3 discussion, Stage II Melanoma Subscribe Beth Certain posted Feb 3, 2021 10:54 PM According to the Skin Cancer Foundation (2020), melanoma is diagnosed when suspicious looking tissue is biopsied to determine if cancer cells are present. This is done by sending the biopsy to the lab for analysis. Once the disease is diagnosed, and the type of melanoma has been identified, the next step is identifying the stage of the disease. 

Mr. B has been diagnosed with stage II melanoma. There are actually three subgroups of melanoma. The melanoma Research Alliance explains the following:Stage IIB Melanoma: A tumor in this stage is more than 2.0 millimeters and less than 4.0 millimeters thick with broken skin or more than 4.0 millimeters without ulceration.Because we only know Mr. B?s melanoma is stage II and there isn?t any information on the subgroups, the treatment for stage 2 melanoma is removing the tumor surgically. This procedure is a minor surgery using a wide, local incision, which usually cures local melanoma. Your doctor may suggest a sentinel lymph node biopsy to determine if the melanoma has spread to the nearest lymph node.

 If melanoma is detected in the biopsy, your doctor may recommend a complete ?lymph node dissection (this removes all lymph nodes in a specific area of the body, surgically); however, this is not recommended in all instances? (Melanoma Resource Alliance, N.D.).Clinical trials allow patients access to treatments that have the potential to be more beneficial but have yet to be approved by the U.S. FDA. Clinical trials expand the understanding of the disease and improve future treatments for all patients. According to the Melanoma Research Alliance, Stage II Melanoma has an intermediate to high risk for recurrence or metastasis with appropriate treatment. As of 2018, there is a 98.4% of a 5-year survival rate for local melanoma to include Stage II. Once there is no evidence of disease following treatment, monthly self-exams should be performed of the skin and lymph nodes. 

The patient should have full-body skin exams by a trained dermatologist yearly for the rest of the patient?s life. Exams by your doctor should also be in the treatment plan, usually every 6-12 months for the first 5 years. Imaging tests can also be used to monitor for the recurrence of cancer.Melanoma Research Alliance (N.D.).?Stage II Melanoma. Retrieved fromThe Skin Cancer Foundation. (June, 2020).?Melanoma Stages. Retrieved from?less0 UnreadUnread 13 ViewsViews 13 0 2 RepliesReplies 2 View profile card for Gisselle Mustiga Last post?February 5 at 11:04 AM?by Gisselle Mustiga https://skincancer.org/skin-cancer-information/melanoma/the-stages-of-melanoma/ https://www.curemelanoma.org/about-melanoma/melanoma-staging/stage. February 2, 2021 References Some melanomas have certain features that increase the chance of metastasis and or recurrence. The doctor will determine what type of additional treatment may be needed to help delay or prevent cancer from returning. Adjuvant therapy is used to reduce the risk of melanoma returning. Stage IIC Melanoma: The melanoma tumor is more than 4.0 millimeters thick with broken skin. 

tage IIA Melanoma: A melanoma tumor more than 1.0 millimeter and less than 2.0 millimeters thick (approximately the size of a new crayon point), with broken skin, or 2.0 to less than 4.0 millimeters without broken skin. Stage II Melanoma?s and Adjuvent therapySubscribe Caroline Otto posted Feb 5, 2021 10:35 AM Contains unread posts The treatment for Stage 2 Melanoma is primarily treated once it has been staged, because if there are other skin melanomas found; the overall treatment will depend on the stage each of them are in.If the melanoma has spread into the lymph node, a complete lymph node dissection would be performed; but this may not be a treatment option in all cases.If a melanoma is suspected of returning, the physician may recommend ?adjuvant therapy? which aids in preventing the melanoma from returning. 

This is usually done after surgery.Interferon (Intron and Sylatron) ? This used to be the golden child of treatment, however over the past couple of years, the use of this medication has been discouraged due to the many toxic effects it has on the body and impact on survival.Ipilimumab (Yervoy) ? Was the first immune checkpoint inhibitor ever studied in the adjuvant setting.Dabrafenib + Trametinib (Tafinlar + Mekinist)Adjuvent therapy is rapidly changing the way Melanoma is treated and is now considered the standard of care for many patients. Since this therapy is still in its infancy with limited research participants, its overall role in high-risk 2 and stage