melanoma – prevention, detection and treatment
DESCRIPTION
Sun safety needs to start at an early age in order to reduce the risk for skin cancer. In this lecture, you will learn about prevention, diagnosis, sun safety tips and new treatments for skin cancer to help you and your family reduce your risk.TRANSCRIPT
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