Dermatopathology: Melanocytes, Mole and. Melanoma 2008 Pathology Grand Round at CUMC
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Transcript of Dermatopathology: Melanocytes, Mole and. Melanoma 2008 Pathology Grand Round at CUMC
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Creighton University School of MedicineDepartment of Pathology
GRAND ROUNDS
Melanocyte, Mole, Melanoma: Back to the basics
by Deba Sarma, MDTuesday, July 22, 2008
12:00 1:00 p.m.
Morrison Seminar Room
Dr. Sarma has listed no financial interest/arrangement that would be considered a conflict of interest.
Objectives: At the end of the presentation the participant should be able to:
1. Explore the relationship between melanocytes, moles and melanoma.2. Summarize the risk factors for melanoma.
3. Review the preventive measures against melanoma.
The Creighton University School of Medicine designates this educational activity for a maximum of
1.5 AMA PRA Category 1 Credit(s). Physicians should only claim credit commensurate with the
extent of their participation in this activity.
The Creighton University School of Medicine is accredited by the Accreditation Council forContinuing Medical Education to provide continuing medical education for physicians.
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News Headline
Melanoma cases surge among young
women
The incidence of the deadly skin cancer increased by 50%
between 1980 and 2004, a study finds. Use of tanning salons is
cited as one possible reason.
Los Angeles Times. July 11, 2008
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On the campaign trail, few mentions of McCains bout
with melanomaThe N Y Times March 9, 2008
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Melanocytes
Mole
Melanoma
DebaDeba PP SarmaSarma, MD, MD
CUMC PathologyCUMC Pathology
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Melanocytes
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Melanocyte
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Nevus = Mole
Spot, Beauty markSpot, Beauty mark
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Life of a nevus
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Congenital nevus
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Common nevi
Junctional
Compound
Dermal
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Dysplastic nevus
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Dysplastic nevus
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Types
Melanoma in situMelanoma in situ
Melanoma (Invasive melanoma)Melanoma (Invasive melanoma)
Melanoma
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LentigoLentigo malignamaligna melanomamelanoma
Superficial spreading melanomaSuperficial spreading melanoma
Nodular melanomaNodular melanoma
AcralAcral lentiginouslentiginous melanomamelanoma
DesmoplasticDesmoplastic melanomamelanoma
Melanoma
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Lentigo maligna melanoma
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Superficial spreading melanoma
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Nodular melanoma
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Acral lentiginous melanoma
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Estd new cancer cases, USA, 2008
American Cancer Society
Male: Female:
1. Prostate (25%) 1. Breast (31%)
2. Lung (15%) 2. Lung (14%)
3. Colorectum (10%) 3. Colorectum (10%)4. Bladder (7%) 4. Uterus (5%)
5. NH Lymphoma (5%) 5. NH Lymphoma (4%)
6. Melanoma (5%) 6. Thyroid (4%)
7. Kidney (4%) 7. Melanoma (4%)
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Estd new melanoma cases, 2008
American Cancer Society, 2008
USA : total 116,500USA : total 116,500
( In situ 54,000 Invasive 62,500 )( In situ 54,000 Invasive 62,500 )
NEBRASKA: 380 ( Invasive melanomaNEBRASKA: 380 ( Invasive melanoma))
Estd deaths from melanoma, 2008
USA 8500USA 8500
NEBRASKA 50NEBRASKA 50
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Risk factors
Uncontrollable:
Skin type (race)
History of melanoma
Moles and atypical molesAge: 70 +
Gender: M > F
Controllable:
UV radiation ( sunlight, tanning booths and lamps)
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Skin types
V VIIV
I II III
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History of melanoma
FirstFirst--degree relatives: Father, mother, brother, sister,degree relatives: Father, mother, brother, sister,
childchild
Personal history of melanomaPersonal history of melanoma
Melanoma pt.: Family history in 10%.Melanoma pt.: Family history in 10%.
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Common acquired nevi,
atypical nevi
Normal nevi Abnormal neviNormal nevi Abnormal nevi
Age: 2Age: 2--30 New mole after 3030 New mole after 30
Number: 20Number: 20--30 Number: >5030 Number: >50
Atypical mole: >5Atypical mole: >5
Familial dysplastic mole syndromeFamilial dysplastic mole syndrome
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Sun
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Protection from UVA UVB
Seek shade, avoid outdoors: 10am to 4pm
Protective clothing
Wraparound sunglasses, broad-brimmed hats Sunscreen, broad spectrum, at least 15 SPF
No tanning booth or sun lamp
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Melanoma Prevention
Moles: Professional screening
Self-examination
New mole after 30
Changing mole
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Danger signs
ABCD
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CML Melanoma
12 months: 3/1/07-3/1/08
Total cases: 56 Male: 36 Female: 20Total cases: 56 Male: 36 Female: 20
Age: 27Age: 27--9595
Male: 50: 29Male: 50: 29
Female: 50: 13Female: 50: 13
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Melanoma sites
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Sites
Head & neck: 20 ( Male 18, Female 2)
Upper limb: 4 ( Male 2, Female 2)
Lower limb: 12 ( Male 2, Female 10) Trunk: 20 ( Male 14, Female 6)
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Types
Melanoma in-situ: 20
Lentigo maligna 8, Pagetoid 12
Superficial spreading melanoma: 23 Lentigo maligna melanoma: 4
Nodular melanoma: 5
Desmoplastic melanoma: 2
Recurrent melanoma: 2
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Five-year survival rate
Overall 90%Overall 90%
Localized 99%Localized 99%
With regional spread 45%With regional spread 45%
Good news: 80% localized at diagnosisGood news: 80% localized at diagnosis
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Editorials 1985-2008
Ackerman AB. No one should die of malignant
melanoma. J Am Acad Dermatol. 1985 Jan; 12: 115-6.
Kittler H. Early recognition at last. Arch Dermatol.2008 April;144: 533-4.
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