dermatopathology: melanocytes, mole and. melanoma 2008 pathology grand round at cumc

8/7/2019 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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dermatopathology: melanocytes, mole and. melanoma 2008 pathology grand round at cumc

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