President’s Letter ~ May is Skin Cancer Awareness Month. I invited our colleague, Dr. George Monks, to provide an overview of

this disease that has touched so many lives.

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Physicians Advancing Health Care

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a newsletter for the medical communityTulsa Medicine»

MAY 2018

For further information about the following meetings,

tcms@tcmsok.org or 918.743.6184

May 10, 6pmTulsa OB-GYN SocietyTCMS

May 13, All DayHappy Mothers Day

May 17, 3pm-5pmKim Morris, Project TCMS Retirement PartyTCMS

May 29, 6pmTCMS Foundation BoardTCMS

June 7-9ACOG 4 State MeetingBig Cedar, Ridgedale, MO

June 8-9AMA MeetingChicago

June 14, 6pmTulsa OB-GYN SocietyTCMS

June 17, All DayHappy Fathers Day

July 11, 6pmTCMS Board MeetingTCMS

OSMA ANNUAL MEETINGLook for photos & highlights of the

meeting in the June newsletter.

Congratulations to new OSMA officers:

Jean Hausheer, MD, President (Rural)

Larry Bookman, MD, President-Elect (OKC)

George Monks, MD, Vice-President (Tulsa)

Thank you Dr. Boyer for providing this platform to share current data around skin cancer and the importance of screening, George Monks, M.D.There are over 5 million cases of skin cancer diagnosed in the United States each year. This makes skin cancer the most common cancer in our country. Skin cancer is also one of the most preventable forms of cancer. According to the Skin Cancer Foundation, about 90 percent of nonmelanoma skin cancers and 85 percent of melanoma cases are associated with exposure to ultraviolet radiation from the sun. We can start by educating about prevention by raising awareness of the dangers of Ultraviolet Light exposure and encouraging sun-safe habits. Changing behaviors can dramatically reduce so many types of cancer.

Australia has one of the highest rates of melanoma in the world and melanoma is often referred to as ' Australia's national cancer' (melanoma.org.au).One of the most successful health campaigns in Australia's history (sunsmart.com.au) was launched in 1981, when a cheerful seagull in board shorts, t-shirt and hat danced his way across TV screens singing the jingle. ‘Slip, Slop, Slap! It sounds like a breeze when you say it like that Slip, Slop, Slap! In the sun we always say 'Slip, Slop, Slap!' Slip, Slop, Slap! Slip on a shirt, slop on sunscreen and slap on a hat Slip, Slop, Slap! You can stop skin cancer - say: 'Slip, Slop, Slap!'

I wanted to share a few statistics with you From https://www.aad.org/media/stats/conditions/skin-cancer

Incidence rates• Skin cancer is the most common cancer in the United States.• Current estimates are that one in five Americans will develop skin cancer in their lifetime.• It is estimated that approximately 9,500 people in the U.S. are diagnosed with skin cancer

every day.• Research estimates that nonmelanoma skin cancer, including basal cell carcinoma andsquamous cell carcinoma, affects more than 3 million Americans a year.

• The overall incidence of BCC increased by 145 percent between 1976-1984 and 2000-2010,and the overall incidence of SCC increased 263 percent over that same period.o Women had the greatest increase in incidence rates for both types of NMSC.o NMSC incidence rates are increasing in people younger than 40.

• More than 1 million Americans are living with melanoma.• It is estimated that 178,560 new cases of melanoma, 87,290 noninvasive (in situ) & 91,270invasive, will be diagnosed in the U.S. in 2018.o Invasive melanoma is projected to be the fifth most common cancer for men (55,150

cases) and the sixth most common cancer for women (36,120 cases) in 2018.• Melanoma rates in the United States doubled from 1982 to 2011.• Caucasians and men older than 50 have a higher risk of developing melanoma than the

general population.o The incidence in men ages 80 & older is three times higher than women of the same

age.o The annual incidence rate of melanoma in non-Hispanic Caucasians is 26 per

100,000, compared to 4 per 100,000 in Hispanics and 1 per 100,000 in African-Americans.

• Skin cancer can affect anyone, regardless of skin color.o Skin cancer in patients with skin of color is often diagnosed in its later stages, when

it’s more difficult to treat.o Research has shown that patients with skin of color are less likely than Caucasian

patients to survive melanoma.o People with skin of color are prone to skin cancer in areas that aren’t commonly

exposed to the sun, like the palms of the hands, the soles of the feet, the groin andthe inside of the mouth. They also may develop melanoma under their nails.

• Before age 50, melanoma incidence rates are higher in women than in men, but by age 65, rates are twice as high in men. o Melanoma in Caucasian women younger than 44 has increased 6.1 percent annually, which may reflect recent trends in indoor tanning.• Melanoma is the second most common form of cancer in females age 15-29. o Melanoma incidence is increasing faster in females age 15-29 than in males of the same age group.

Survival rates• Basal cell & squamous cell carcinomas, the two most common forms of skin cancer, are highly curable if detected early & treated properly.• The five-year survival rate for people whose melanoma is detected & treated before it spreads to the lymph nodes is 99 percent.• Five-year survival rates for regional & distant stage melanomas are 63 percent & 20 percent, respectively.

Mortality rates• The vast majority of skin cancer deaths are from melanoma.• On average, one American dies from melanoma every hour. In 2018, it is estimated that 9,320 deaths will be attributed to melanoma — 5,990 men & 3,330 women. o According to a recent study, men diagnosed with melanoma between the ages of 15 & 39 were 55 percent more likely to die from melanoma than females diagnosed with melanoma in the same age group.• People with SCC have a higher risk of death from any cause than the general population.• An estimated 4,140 deaths from skin cancers other than melanoma & NMSC will occur in the United States in 2018.• The World Health Organization estimates that more than 65,000 people a year worldwide die from melanoma.

Risk factors• Exposure to natural & artificial ultraviolet light is a risk factor for all types of skin cancer.• Approximately 95 percent of melanoma cases are attributable to UV exposure. o Although UV is associated with only one type of cancer, it is the second largest contributor to total cancer cases in men & the fifth largest contributor to total cancer cases in women. o Research indicates that UV light from the sun & tanning beds can both cause melanoma & increase the risk of a benign mole progressing to melanoma.• Increasing intermittent sun exposure in childhood & during one’s lifetime is associated with an increased risk of squamous cell carcinoma, basal cell carcinoma & melanoma. o Research has shown that daily sunscreen use cut the incidence of melanoma, the deadliest form of skin cancer, in half. o People older than 65 may experience melanoma more frequently because of UV exposure they've received over the course of their lives. o Higher melanoma rates among men may be due in part to lower rates of sun protection. • Even one blistering sunburn during childhood or adolescence can nearly double a person's chance of developing melanoma. o Experiencing five or more blistering sunburns between ages 15 & 20 increases one’s melanoma risk by 80 percent & nonmelanoma skin cancer risk by 68 percent.• Exposure to tanning beds increases the risk of melanoma, especially in women 45 & younger. o Researchers estimate that indoor tanning may cause upwards of 400,000 cases of skin cancer in the U.S. each year. o In females 15 to 29 years old, the torso/trunk is the most common location for developing melanoma, which may be due to high-risk tanning behaviors. o Higher melanoma rates among young females compared to young males may be due in part to widespread use of indoor tanning among females.• Risk factors for all types of skin cancer include skin that burns easily; blonde or red hair; a history of excessive sun exposure, including sunburns; tanning bed use; immune system-suppressing diseases or treatments; & a history of skin cancer.• People with more than 50 moles, atypical moles, or large moles are at an increased risk of developing melanoma, as are those with light skin & freckles, & those with a personal or family history of melanoma.• Melanoma survivors have an approximately nine-fold increased risk of developing another melanoma compared to the general population.• Men & women with a history of nonmelanoma skin cancer are at a higher risk of developing melanoma than people without a nonmelanoma skin cancer history. o Women with a history of nonmelanoma skin cancer are at a higher risk of developing leukemia, breast, kidney & lung cancers, & men with a history of nonmelanoma skin cancer are at a higher risk of developing prostate cancer.

Prevention & Detection• Because exposure to UV light is the most preventable risk factor for all skin cancers, the American Academy of Dermatology encourages everyone to protect their skin from the sun’s harmful UV rays by seeking shade, wearing protective clothing & using a sunscreen with a Sun Protection Factor of 30 or higher. o Because severe sunburns during childhood may increase one’s risk of melanoma, children should be especially protected from the sun.• People should not use tanning beds or sun lamps, which are sources of artificial UV radiation that may cause skin cancer.• Skin cancer warning signs include changes in size, shape or color of a mole or other skin lesion, the appearance of a new growth on the skin, or a sore that doesn't heal. If you notice any spots on your skin that are different from the others, or anything changing, itching or bleeding, the American Academy of Dermatology recommends that you make an appointment with a board-certified dermatologist. • The American Academy of Dermatology encourages everyone to perform regular skin self-exams to check for signs of skin cancer. o About half of melanomas are self-detected.• A dermatologist can make individual recommendations as to how often a person needs a skin exam from a doctor based on individual risk factors, including skin type, history of sun exposure & family history.• Individuals with a history of melanoma should have a full-body exam by a board-certified dermatologist at least annually & perform regular self-exams to check for new & changing moles.

Cost• About 4.9 million U.S. adults were treated for skin cancer each year from 2007 to 2011, for an average annual treatment cost of $8.1 billion. o This represents an increase over the period from 2002 to 2006, when about 3.4 million adults were treated for skin cancer each year, for an annual average treatment cost of $3.6 billion.• The annual cost of treating nonmelanoma skin cancer in the U.S. is estimated at $4.8 billion, while the average annual cost of treating melanoma is estimated at $3.3 billion.• Researchers estimate that there were nearly 34,000 U.S. emergency department visits related to sunburn in 2013, for an esti mated total cost of $11.2 million.

The next big thing Infrared SunscreenWhat are infrared rays?We all know that ultraviolet (UV) rays from the sun can cause real damage to your skin—UVA rays are a main cause of photo-aging (dark spots, fine lines and wrinkles, loss of skin elasticity), while UVB rays are what cause sunburns (not to mention skin cancer). The solar energy reaching Earth's surface includes visible light, ultraviolet and infrared radiation.

Infrared radiation is felt as heat, and is given off by all objects. Much of the energy from the Sun arrives on Earth in the form of infrared radiation. At ground level, this consists of 44% visible light, 3% ultraviolet (with the Sun at the zenith (directly overhead), but less at other angles), and the remainder infrared. (Sunlight: Composition and Power - Wikipedia)IR stands for Infrared light—the red part of the visible spectrum that we can’t see with our eyes. While IR does come directly from the sun, it can also be felt as heat from your oven, electric blanket, an overheated laptop, or a remote control. I see patients with Erythema ab igne (EAI), a skin rash associated with chronic IR exposure (heating pads on the back, standing in front of a space heater, electric blankets, etc).

Why is infrared protection important?IRA rays penetrate skin more deeply than either UVA or UVB rays, passing through the epidermis and dermis into the subcuta-neous layer. These rays generate free radicals that cause collagen breakdown and accelerate skin aging. The heat produced by infrared rays can also lead to inflammation in the skin, which over time plays a role in premature signs of aging.Since so much infrared energy comes into contact with your skin every day, sunscreens that offer infrared protection are the best defense against sunburn, premature photoaging and skin cancer.

Patients on immunosuppressive medications are more at risk for skin cancer. Those who have had a organ transplant, should have a skin exam at least once a year (and a monthly self skin exam).

2018 Oklahoma Senate Bill 950 is a bill that the Medical students from our state championed. It requires public schools to permit students to apply sunscreen. This bill has been passed by the House and Senate and has been sent to the Governors desk. This followed another Medical Student backed bill the previous year, which Sen. Ervin Yen co-authored Senate Bill 765, which made it illegal for any child under 18 to use a tanning bed. This bill went into effect in November of 2017. These represent two great advocacy bills and our medical students should be commended.

Your Tulsa County Medical Society & Oklahoma State Medical Association bill date for dues is changing. For your convenience the payment period has been extended. You will now receive your first 2019 Dues Invoice in July of

2018 and your second notice in October 2018. The due date of January 1, 2019 will not change.

• Why is the dues bill date changing? Some members expressed concern about many professional memberships being billed late in the calendar year, resulting in financial hardships. Other members found it difficult to renew or join in the middle of an academic year. This decision came from the OSMA Membership Task Force.• What is the dues cycle? The dues cycle will remain the same – January 1 through December 31 of each calendar year. We will simply begin billing earlier.• Is the price of dues changing? No.• TCMS is offering an Easy Pay option (split into three monthly payments). For more information email tcms@tcmsok.org or call 918.743.6184.• How do I pay my dues? Pay online at http://tcmsok.org/online-payment/online-dues/• Who do I contact for questions? Please contact Joetta Cunningham at 918.743.6184 or joetta@tcmsok.org• When is the due date? The FINAL DUE DATE IS STILL March 1, 2019 for the 2019 Membership Year. The change in billing is a convenient option for those who prefer to renew earlier.

THANK YOU FOR SUPPORTING TCMS.

KIM MORRIS, PROJECT TCMS PROGRAM MANAGER WILL RETIRE 5-31-18…JOIN US IN WISHING KIM “HAPPY RETIREMENT” ON MAY 17, 3-5 PM AT TCMS.

Kim began her job with the TCMS Foundation as Program Manager for Project TCMS on June 1, 2011. For the past 7 years, Kim has done a terrific job leading our program and she will be missed. Kim has cultivated close

friendships with all of our Project TCMS partners and patients, for whom she has also served as an advocate. I am so happy for Kim as she begins this new chapter in her life and enjoys more time with Dick, her husband of 40

years who is a retired Fire Captain and her 20-month-old grandson, Grayson, who is the light of her life.

Please feel free to stop by TCMS anytime between 3 and 5 pm for refreshments and to share some time and well wishes with Kim. ~ Mona Whitmire, Executive Director

Tulsa County Medical Society5315 South Lewis AvenueTulsa OK 74105-6539

ADDRESS SERVICE REQUESTED

TulsaMedicine

The OU-TU School of Community Medicine, Department of Internal Medicine is seeking faculty physicians for our ambulatory practice in Tulsa. Our outpatient setting provides care coordination for a broad range of pa-tients and was the first in the area to receive NCQA Patient-Centered Medical Home Tier Three recognition. We are recruiting candidates interested in a career in ambulatory Internal Medicine. Responsibilities include clinical care, as well as supervising and teaching residents and medical students. We provide faculty development programs for all faculty members to develop and improve teaching skills.

Applicants must hold an MD or DO degree, be Board Certified in Internal Medicine, and be eligible for Oklahoma licensure.

Tulsa is situated on the Arkansas River at the foothills of the Ozark Mountains in northeastern Oklahoma, a region of the state known as Green Country. Tulsa’s cost of living is low and the city features a vibrant arts community with a ballet, opera, symphony orchestra and two world-class art museums.

You can read more about the School of Community Medicine at: http://www.ou.edu/content/tulsa/community_medicine.html

Interested applicants should send their CV to: Jennifer-vogt@ouhsc.edu

The University of Oklahoma is an EO/AA Institution http://www.ou.edu/eoo/. Individuals with disabilities and protected veterans are encouraged to apply.

Faculty PhysiciansDepartment of Internal Medicine

The University of Oklahoma

Journal of General Internal MedicineSize: 1/2 Page H (7 x 5)Issue: MayDue: 3/15 by 2pmCost: about $1,800.00 (b&w) about $3,100.00 (color) (includes sales tax which is why it’s “about”)

The OU-TU School of Community Medicine, Department of Internal Medicine is seeking faculty physicians for our ambula-tory practice in Tulsa. Our outpatient setting provides care coor-dination for a broad range of patients and was the first in the area to receive NCQA Patient-Centered Medical Home Tier Three recognition. We are recruiting candidates interested in a career in ambulatory Internal Medicine. Responsibilities include clini-cal care, as well as supervising and teaching residents and med-ical students. We provide faculty development programs for all faculty members to develop and improve teaching skills. Applicants must hold an MD or DO degree, be Board Certified in Internal Medicine, and be eligible for Oklahoma licensure. You can read more about the School of Community Medicine at:

http://www.ou.edu/content/tulsa/community_medicine.html

Interested applicants should send their CV to: Jennifer-vogt@ouhsc.edu

The University of Oklahoma is an EO/AA Institution http://www.ou.edu/eoo/. Individuals with disabilities and protected veterans are encouraged to apply.

Faculty PhysiciansDepartment of Internal Medicine

The University of Oklahoma

Ok. State Med. Assoc. - Journal of MedicineSize: 1/4 Page V (3.375 x 4.5)Issue: MayDue: 4/2 by 2pmCost: $517.66 (b&w) $752.96 (color)

The OU-TU School of Community Medicine, Department of Internal Medicine is seeking faculty physicians for our ambulatory practice in Tulsa. Our outpatient setting provides care coordination for a broad range of patients and was the first in the area to receive NCQA Patient-Centered Medical Home Tier Three recognition. We are recruiting candidates interested in a career in ambulatory Internal Medicine. Responsibilities include clinical care, as well as supervising and teaching residents and medical students. We provide faculty development programs for all faculty members to develop and improve teaching skills. Applicants must hold an MD or DO degree, be Board Certified in Internal Medicine, and be eligible for Oklahoma licensure.

You can read more about the School of Community Medicine at: http://www.ou.edu/content/tulsa/community_medicine.html

Interested applicants should send their CV to: Jennifer-vogt@ouhsc.edu

The University of Oklahoma is an EO/AA Institution http://www.ou.edu/eoo/. Individuals with disabilities and protected veterans are encouraged to apply.

Faculty PhysiciansDepartment of Internal Medicine

The University of Oklahoma

Tulsa County Medical SocietySize: 1/2 Page (5.25 x 4.125)Issue: MayDue: April 15th by 2pm (space is limited; the sooner the better)Cost: $882.38 (includes color)

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INTEGRITY, DEDICATION, EXPERTISE AND RELIABILITYWhether you are preparing to transfer hard-earned savings to the next generation, retire or sell your practice, we can help you achieve your goals. Our professionals are experienced in developing financial road maps.

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401(K) SOLUTIONSJust as we have done for many leading Oklahoma medical practices, we can design a plan to meet your employees’ needs and wishes while optimizing your retirement savings.

• Our plans provide options with strong investment performance and attractive fees.

• We offer personalized, dedicated service. You and your employees will not wind up in a phone tree or endless maze for assistance from someone hundreds of miles away from Oklahoma. Our representatives are located in our headquarters in Tulsa.

• We serve as discretionary trustee, allowing us to assume much of the responsibility borne by you as the employer.

ESTATE PLANNING ADVISORYEstate planning is a crucial part of your family’s overall financial well-being. We work with your legal and tax advisors to make sure your assets will be protected and transferred according to your wishes.

Now is the time to talk about how to protect and grow your assets.

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