melanoma – prevention, detection and treatment

MelanomaPrevention, Detection, Treatment

Stephanie Badalamenti MD-PhD

Dermatologist SMG

West Orange , NJ

May 1, 2013

Melanoma

• Define Melanoma• Magnitude of Problem• Prevention• Detection • Diagnosis/Staging• Treatment

What is Melanoma

What is Melanoma

Melanoma SurvivalStage at Diagnosis Stage Distribution 5 yr survial

Localized (primary site) 84% 98.2%

Regional spread(nodes) 9% 62.4%

Distant spread organs 4% 15.1%

What is Melanoma

Melanoma

• Define Melanoma• Magnitude of Problem• Prevention• Detection • Diagnosis• Treatment

Magnitude of Problem

Melanoma

• 120,000 detected each year• 8,700 death per year

Magnitude of Problem

• Most early detectable cancers: colorectal, breast, cervical and prostate have demonstrated substantial declines over the past 3 decades melanoma mortality rates have continued to rise

Melanoma

• Define Melanoma• Magnitude of Problem• Prevention• Detection • Diagnosis/Staging• Treatment

Melanoma Risk Factors

• Sun Exposure (Ultra Violet Radiation)• Family history of Melanoma• Dypslastic nevi • More than 50 moles• Age/Gender• Skin type• Occupation• Socioeconomic Status

Energy

Sunshine Rays

Ultraviolet light

Modifiable Risk FactorsSunshine/ Ultraviolet Radiation

• Tanning Salons

• Sunshine

Tanning Salon

Tanning Salons• 40-50% of 16-17 year old girls • 2.3 Millions adolescents yearly• More tanning salons per city then Starbuck or

McDonalds• Increase risk of Melanoma 75% • Legislation was passed NJ April 1, 2013

Banning tanning under age 17

Natural Sunlight

Natural Sunlight

• 5 sunburns doubles your risk of melanoma• Cumulative and intermittent sun exposure• High Altitudes increase exposure• Reflection off sand and snow increase

exposure

Minimize Sunlight

• Avoid Sun 10-4 pm Slip• Sun Protective Clothing Slap• Sunscreen Slop

Seek Shade

Seek Shade

Sun Protective Clothing

Sunscreen

Sunscreen

Sunscreen

• 1-2 ounce• 30 minutes prior exposure• Reapplied every 2 hours• SPF 30- 50

sunscreens

• Creams• Sprays

Sun protection

• Slip• Slap• Slop

Does modifying sun exposure work?

Increases use of sun protection Decrease sunburns Decrease thickness of melanoma

Melanoma

• Define Melanoma• Magnitude of Problem• Prevention• Detection • Diagnosis/Staging• Treatment

Detection• Increase the detectors

General Public• Spot the Spot• ABCDE’s• High Risk Patient

• Improve the detectors Technology

• Dermoscopy• Full Body Photography

Melanoma ABCDE’s

Asymmetry

Benign Mole — Symmetrical

Melanoma Asymmetrical

Melanoma — Asymmetrical

Border

Benign Mole — Even Edges

Melanoma — Uneven Edges

Melanoma — Uneven Edges

Color

Benign Mole — One Shade

Melanoma — Two or More Shades

Melanoma — Two or More Shades

Diameter

Benign Mole — 6mm or Smaller

Melanoma — Larger than 6mm

Melanoma — Larger than 6mm

Evolving

Melanoma — a Mole that Changes

Screening High Risk Patients

• New or Changing Mole ABCDE’s• History of Melanoma• Family history Melanoma• Tanning salon users• Older men• All new patients

Screening

• American Caner Society Every 3 years between 20-40 years Every year over 40 year

Improving the Detectors

• Dermatologist are the best at finding melanoma

Dermoscopy

Dermoscopy

Full Body Photograph

Melanoma

• Define Melanoma• Magnitude of Problem• Prevention• Detection • Diagnosis/Staging• Treatment

Biopsy

Excisonal Biopsy

Skin sample

Skin tissue processed

Dermatopathologist

Dermatopathologist

Essential• Tumor thickness• Ulceration• Mitotic rate• Margins• Anatomic Level• Microsatellitosiss

Optional• Angiolymphatic Invasion• Histologic Subtype• Neurotropism• Regression• T stage• Tumor infiltrating

lymphoctes and vertical growth phase

Staging

Sentinal node biopsy

Melanoma

• Define Melanoma• Magnitude of Problem• Prevention• Detection • Diagnosis/Staging• Treatment

Melanoma Survival

Stage at Diagnosis Stage Distribution 5 yr survial

Localized (primary site) 84% 98.2%

Regionalspread(nodes) 9% 62.4%

Distant spead 4% 15.1%

Unkown 4% 75.8%

Surgical Treatment

Summit Medical Group• Prevention• Detection

Well informed patients Well trained dermatologist

• Diagnosis Dermatopathologist

• Treatment Integrated team dermatologists, surgeons, oncologists

Surgical Treatment

Surgical Treatment

Surgical Treatment

Surgical treatment

• If melanoma is found in the sentinal lymph node the lymph nodes in that section may be removed

Medical Treatment

• Radiation Therapy• Chemotherapy• Biologic therapy

Ipilimumab/ Yervoy Vemurafenib/ Zelboraf

• 5% vs 48%

11 Possible Medications

Melanoma

• Define Melanoma• Magnitude of Problem• Prevention• Detection • Diagnosis/Staging• Treatment

SMG Dermatology

• Monib Zirvi MD-PhD• Hari Nadiminti MD• Sam Kim MD• Gabe Gruber MD• Emily Altman MD • Naheed Abbasi MD MPH

Melanoscan

Dermoscopy Advances

Confocal Microscopy

Confocal Microscopy