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Melanoma: What you need to know

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Tanning also increases risk of other skin cancer. Tanning = Damage ... Non-Melanoma Skin Cancer. Much more common than ... Tanning booths cause skin cancer ... – PowerPoint PPT presentation

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Title: Melanoma: What you need to know


1
Melanoma What you need to know
  • Carrine A. Burns, MD
  • Dermatology Associates
  • October 27, 2008

2
Melanoma
  • Becoming more common
  • Incidence more than tripled from 1980-2003
  • Incidence increasing fastest in men age55
  • Incidence also rising in children
  • Lifetime risk 1 in 60
  • 62,480 cases in 2008
  • Mortality rates stable or decreasing since 1992
  • 8450 fatalities in 2008

3
Melanoma What is it?
  • Cancer of melanocytes
  • pigment cells
  • Found normally in skin
  • Increased numbers in moles
  • Mutation (damage to DNA) in the melanocyte leads
    to uncontrolled growth

4
Melanoma
  • Risk factors
  • Fair skin
  • Family history
  • Prior sun exposure
  • Blistering sunburns
  • Atypical moles
  • History of prior melanoma
  • Tanning booths

5
Tanning and Melanoma
  • Strong association between tanning bed use and
    melanoma
  • Across all ages, 15 higher risk of melanoma
  • 1st tanning bed use at under age 35 leads to 75
    increased risk of melanoma
  • Tanning also increases risk of other skin cancer

6
Tanning Damage
  • There is no such thing as a safe tan
  • Any tan is a sign of damage to the skin
  • Trying to get a base tan prior to a trip is
    unwise
  • Self tanners or spray on tans are safe but do not
    provide any sun protection

7
Melanoma
  • Multiple subtypes
  • Not all melanomas are dark
  • Childhood melanoma may more often be red or pink
    (amelanotic melanoma)
  • Symptoms - often late
  • Itching,
  • Bleeding,
  • Ulceration

8
Melanoma
  • Needs to be caught early
  • Horizontal phase (spreading out) before
    vertical growth phase (growing in)
  • Months to years
  • Can spread to lymph nodes and other organs
  • Prognosis depends on depth of invasion
  • In Situ (only in top layer of skin) - 100 cure
    rate
  • 4mm invasion into skin-

9
How to detect early?
  • Patient awareness
  • Perform self skin examinations
  • Physician awareness
  • Full body screening of all patients at risk
  • Prevention is key!!

10
What to look for The ABCDE criteria
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The Ugly Duckling sign
19
Melanoma mimics
  • Lots of things can look like a melanoma but
    arent
  • Still need to be seen and diagnosed by a physician

20
Normal moles
  • Nevusmole
  • Develops during childhood or early adulthood
  • Groups of melanocytes
  • Flat at first
  • Tan or brown
  • Smooth borders
  • Most common on trunk

21
Normal moles
  • With time moles change
  • Lose pigment
  • Tan, brown, pink, skin colored
  • Become raised
  • Often end up dome shaped
  • Can have increased hairs

22
Congenital nevus
  • Birthmarks
  • May be small or large
  • Become raised and bumpy
  • Often have increased hairs
  • Need to be watched for changes
  • Need to be removed if changing significantly

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Dysplastic Nevus
  • Abnormal mole
  • Atypical nevus
  • Potential melanoma precursor
  • 30 of melanomas develop from atypical moles
  • Marker of increased risk
  • Flat, some have raised center
  • Often 5mm
  • Irregular border, shape, or color pattern
  • Biopsy of suspicious lesions and frequent skin
    exams

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29
Spitz Nevus
  • Aka Juvenile Melanoma
  • Is NOT malignant
  • Uncommon
  • Can be pink, red or pigmented
  • Complete excision recommended
  • Can be difficult to differentiate from melanoma
    clinically and histologically

30
Non-Melanoma Skin Cancer
  • Much more common than melanoma
  • Basal cell carcinoma
  • Most common form of skin cancer
  • Squamous cell carcinoma
  • Due to sun exposure
  • Rarely life threatening
  • SCC can occasionally spread to lymph nodes
    Usually just needs local treatment
  • Mohs surgery, excision, scraping and burning,
    freezing

31
Basal Cell carcinoma
32
Squamous Cell Carcinoma
33
Melanoma Treatment
  • Excision
  • In Situ 0.5cm margin
  • Depth
  • Depth 1mm 2cm margin
  • Lymph node evaluation
  • Not needed if depth factors
  • Sentinel Lymph Node biopsy
  • Uses dye and radioactivity to find lymph node
    that melanoma would most likely spread to
  • 1mm Breslow
  • Gives prognostic information
  • Helps decide who needs more treatment
  • No proven survival benefit
  • Trials ongoing
  • Therapeutic lymph node dissection
  • Removes all the lymph nodes

34
Melanoma Further treatments
  • For patients with spread to other organs or those
    at high risk
  • No proven effective chemotherapy
  • Interferon alfa-2b
  • FDA approved
  • Evidence mixed
  • Significant side effects
  • Numerous ongoing trials
  • Chemotherapy
  • Vaccine therapy

35
So what can you do???
36
PREVENTION AND EARLY DETECTION!!
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Melanoma Prevention
  • There is no such thing as a healthy tan
  • Tanning booths cause skin cancer
  • In Maine ageparent/guardian to use tanning booth
  • Educate parents
  • Law is often ignored
  • Education around time of proms and events

39
Melanoma Prevention
  • Sun Smart
  • Avoid sun when you are able
  • Especially 10am-4pm
  • Wear protective clothing
  • Hats, sunglasses, shirts
  • Sunscreen
  • DAILY!!! for face and hands (SPF15 or )
  • SPF 30 or 45 for outdoor activities
  • Reapply every 2 3 hours or after swimming or
    sweating
  • Sprays are good for active people

40
Melanoma Early Detection
  • Self Skin examination
  • At least once a month
  • Use mirrors
  • Have someone else check your back
  • Get used to what is there, stable, and normal
  • See a physician for anything new or changing
  • Skin screening by physician
  • Dermatologist if high risk

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