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Chapter 18. Skin and Melanoma

TS is a 35-year-old man in dermatology clinic today for follow-up visit on a suspicious lesion that was identified last week. Which is the best method in confirming the diagnosis?

a. Obtain a complete clinical examination, and medical history of patient and family members.

b. Obtain complete laboratory studies with hematology, electrolytes, liver function test, and lactate dehydrogenase (LDH).

c. Consider full-thickness excisional biopsy with 1 to 3 mm margin of normal-appearing skin.

d. Consider ordering a chest x-ray and a computerized tomography (CT) scan for confirming diagnosis.

Answer c is correct. Excisional biopsy of the suspicious lesions is the only way to confirm the diagnosis of melanoma. A full-thickness excisional biopsy with 1 to 3 mm margin of normal-appearing skin is the preferred method of choice as it removes the entire lesion.

Answer a is incorrect. A complete clinical examination, and medical history of patient and family members is done to identify and assess potential risk factors, but not enough to confirm the diagnosis of melanoma.

Answer b is incorrect. Laboratory studies including hematology, electrolytes, liver function test, and/or LDH are done to identify and assess the clinical status of patient, NOT to confirm the diagnosis of melanoma.

Answer d is incorrect. Diagnostic tests such as chest x-ray, CT scan, magnetic resonance imaging (MRI), positron emission tomography (PET) scan, and/or bone scan are used to identify and assess for possible local regional lymph nodes involvement or metastases, and are NOT used to confirm the diagnosis of melanoma.

Which of the following molecular targeted marker is relevant for the treatment of metastatic melanoma?

a. EGFR (+) mutation

b. Kras wild-type

c. BRAF V600 (+) mutation

d. VEGF (+) mutation

e. ALK (+) mutation

Answer c is correct. Both BRAF V600E or V600K mutation status have been identified as useful molecular marker for treatment selection in patients with metastatic or unresectable melanoma.

Answer a is incorrect. EGFR mutation status has not been identified as molecular marker for treatment selection in patients with metastatic or unresectable melanoma.

Answer b is incorrect. Kras wild-type has not been identified as molecular marker for treatment selection in patients with metastatic or unresectable melanoma.

Answer d is incorrect. VEGF mutation status has not been identified as molecular marker for treatment selection in patients with metastatic or unresectable melanoma.

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