Melanoma Prevention, Screening and Diagnosis - Dr. Ana Ciurea
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Transcript of Melanoma Prevention, Screening and Diagnosis - Dr. Ana Ciurea
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Melanoma Prevention, Screening and Diagnosis
Ana Ciurea, MDDepartment of Dermatology
MD Anderson Cancer Center
January 31, 2015
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What is melanoma?
• Uncontrolled growth of abnormal pigment-producing cells (melanocytes)
• It occurs when unrepaired damage to the skin cells triggers genetic defects that lead to formation of malignant tumors
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Did you know?
• Melanoma remains the only preventable cancer for which mortality rate has not declined
• Fastest growing malignancy in the US, incidence increasing 3%/year since 1973
• 76,100 new cases in US, app 9,000 deaths/year in US
• Lifetime risk in the U.S. in 1935 – 1/1500, 2008 –1/58
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Facts
• The steepest rise in incidence rates has been in men > 50 years of age
• For any given stage and across all ages, men have poorer melanoma survival than women
• Skin cancer rates increased in US Hispanics and African-Americans
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Facts
• Most melanomas occur on the skin in sun-exposed areas
• May occur on mucosal surfaces, eye, but skin is MOST frequent site of primary disease
• Can be de novo or from preexisting moles
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Facts
• 99% survival rate for patients whose melanoma is detected early
• Decreases to 15% for those with advanced disease
• Cost: $3.5 billion/year in US
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Facts
• About 90% of skin cancers are associated with exposure to ultraviolet radiation from the sun or indoor tanning
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Risk Factors for Melanoma
• Intense, intermittent sun exposure (blistering sunburns) especially during childhood
• Exposure to ultraviolet radiation from sun and tanning beds
• Fair complexion
• Increased number of moles (>50) or irregular moles
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Risk Factors for Melanoma
• Personal history of melanomas (5 – 6 times risk)
• Heavy hand of heredity
• Immunosuppression (organ transplant recipients, HIV infections)
• African Americans, Hispanics can get skin cancer!
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The Tale of Tanning
• The cumulative damage caused by UV radiation can lead to premature skin aging (wrinkles, lax skin, brown spots, and more), and skin cancer
• Indoor ultraviolet (UV) tanners are 85% more likely to develop melanoma than those who have never tanned indoors
• Average tanning beds emitted 4 x more the UVA radiation, and 2 x the UVB radiation of the midday summer sun in Washington, DC
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The Tale of Tanning
• Tanning beds are linked to 400,000 cases of skin cancer per year in the US
• FDA increased regulatory control over UV lamps for tanning beds
• Reclassified as moderate-to-high risk devices
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Melanoma in Ethnic Minorities The Risk is Real
• Skin cancer rates, in particular melanoma among Hispanics and African-Americans are skyrocketing
• Too little use of sun safety techniques may have contributed to the rapid rise in incidence
• Misconception that people with darker skin are not at risk for skin cancer
• Detection often delayed; advanced stage at the time of diagnosis and greater mortality
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Melanoma Prevention
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Melanoma Prevention
Sun exposure is the most preventable risk factor for all skin cancers including melanoma
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Your Smartest Move: Melanoma Prevention
• Seek the shade when appropriate (10 am – 4 pm)
• Cover up with clothing including a broad-brimmed hat and UV-blocking sun glasses
• Avoid tanning and UV tanning beds – if you want to look tan consider using self-tanning products but continue to use sunscreen
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Your Smartest Move: Melanoma Prevention
• Generously apply a broad spectrum UVA/UVB with sun protection factor (SPF) of 30 to all exposed skin
• For extended outdoor activity use water-resistant, even on cloudy days
• Use extra caution near water, snow and sand
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• Apply sunscreen 30 minutes before going outside
• Reapply every 2 hours or after swimming or excessive sweating
• Keep newborns out of the sun – sunscreens should be used on babies over the age of six months
Your Smartest Move: Melanoma Prevention
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Sunscreens
• Water resistant
• Reapply water-resistant sunscreen (40 min vs 80 min)
• Select a product that protect your lips
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• Examine your skin head-to-toe every month
• Sun hazards in your car – watch out for skin cancers on the left side of the body
• See you doctor every year for a professional skin exam
• Children in melanoma families should be checked by a physician from age 10 on
Your Smartest Move: Melanoma Prevention
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FAQs
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Sunscreens
• Yes, sunscreens are safe to use !
• No published studies show that sunscreen is toxic to humans or hazardous to human health including hormonal problems or increased risk of skin cancer
• Nanoparticles used in sunscreens prevent active ingredients from leaving a white residue on the skin; not absorbed through the skin
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Vitamin D Supplementation
• Vitamin D should be obtained from diet and supplements that includes foods naturally rich in vitamin D, foods/beverages fortified with vitamin D, and/or vitamin D supplements
• Vitamin D should not be obtained from unprotected exposure to ultraviolet (UV) radiation
• A blood test that measures one's vitamin D level is widely available
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Melanoma Screening
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Presentation of Melanoma –Your Skin Tells the Story
• Moles, brown spots and growths on the skin are usually harmless, BUT NOT ALWAYS
• Usually brown-black or multicolored plaques
• Raised patches or nodules with irregular outlines
• May crust or bleed
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Many Faces of Melanoma
• Four Basic Types
• Three of them begin in situ — meaning they occupy only the top layers of the skin and become invasive in time
• The fourth is invasive from the start
• Invasive melanomas are more serious, as they have penetrated deeper into the skin and may have spread to other areas of the body
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1. Superficial Spreading Melanoma
• The most common type – 70%
• It grows along the top layer of the skin for a fairly long time before penetrating more deeply
• First sign is the appearance of a flat or slightly raised discolored patch of various colors that has irregular borders and is somewhat asymmetrical in form
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1. Superficial Spreading Melanoma
• Trunk of ♂, legs of ♀
• It can occur in a previously benign mole
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1. Superficial Spreading Melanoma
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2. Nodular Melanoma
• Usually invasive at the time of diagnosis
• It is recognized when it becomes a bump
• The most frequent locations are the trunk, legs, and arms, mainly of elderly people, as well as the scalp in men
• The most aggressive of the melanomas
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2. Nodular Melanoma
• 2nd most common type
• Uniform dark blue-black, blue-red nodule
• 5% lack pigment (amelanoticmelanomas
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3. Lentigo Maligna
• Melanoma in-situ of sun-damaged skin
• Appears similar to the superficial spreading type
• Flat or elevated tan, brown, black, blue-gray
• Often large • Occurs on sun-exposed
surfaces
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3. Lentigo Maligna
• Lentigo maligna is the most common form of melanoma in Hawaii
• When this cancer becomes invasive, it is referred to as lentigo maligna melanoma
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4. Acral lentiginous melanoma
• Spreads superficially before penetrating more deeply
• Can often advance more quickly than superficial spreading melanoma and lentigomaligna
• The most common melanoma in African-Americans and Asians, and the least common among Caucasians
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4. Acral Lentiginous Melanoma
Black or brown discoloration under the nails or on the soles of the feet or palms of the hands
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4. Acral Lentiginous
Nail unit melanoma melanoma is considered a variant of acral lentiginous
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Melanoma in Children
• Usually presents as a raised, light-colored or very dark lesion
• Often times bleeds
• Uniform color
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Primary Malignant Melanomas in Children
Ceballos PI et al. N Engl J Med 1995;332:656-662.
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The Melanoma Alphabet: ABCDE signs
• The first five letters are a guide to warning signs of melanoma
• A – asymmetry
• B – border irregularity
• C – color variation
• D – diameter
• E – evolving or changing
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ABCDE Signs – Caution!
• Children may not present with conventional ABCDE criteria
• Nodular melanoma do not conform to the ABCDE!
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A - Asymmetry
Benign
• The two sides match
Malignant
• Two halves do not match
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B - Border
Benign
• Smooth, even borders
Malignant
• Uneven, scalloped or notched edges
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C - Color
Benign
• Often one color
Malignant
• Variety of colors
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D - Diameter
Benign Malignant
• Larger than a pencil eraser, sometimes smaller
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E - Evolving
Benign
• Common moles look the same over time
Malignant
• Any change in size, shape, color, elevation or symptom
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The “Ugly Duckling Concept”
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ABCDEF of Nail Melanomas
• A - age (20-90 years of age)
• B – brown, black, breadth (> 3mm)
• C – change (recent or rapid increase in size)
• D – digit involved ( thumb haluxindex finger
• E – extenstion of the black or brown pigment lateral to the nail
• F – family history of melanoma
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Nail Unit Melanoma
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Melanoma Diagnosis
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Melanoma Diagnosis
• First step: skin exam
• Skin biopsy to confirm any irregularities
• Once a skin cancer is diagnosed, additional tests may be initiated to evaluate for spread
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Conclusions
• Year-round sun protection (sun passes through the clouds!)
• Regular self-skin examinations
• Avoid tanning beds (base tans are bad for you)
• Annual visits to dermatologists regardless of the skin tone
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Go with your own glow!
“ A healthy glow does not mean a tan … it is your skin tone, glowing”
Sarah Brown
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THANK YOU!