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

  • 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

  • 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

  • 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

  • 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

  • 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

  • Facts

    About 90% of skin cancers are associated with exposure to ultraviolet radiation from the sun or indoor tanning

  • 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

  • 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!

  • 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

  • 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

  • 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

  • Melanoma Prevention

  • Melanoma Prevention

    Sun exposure is the most preventable risk factor for all skin cancers including melanoma

  • 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

  • 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

  • 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

  • Sunscreens

    Water resistant

    Reapply water-resistant sunscreen (40 min vs 80 min)

    Select a product that protect your lips

  • 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

  • FAQs

  • 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

  • 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

  • Melanoma Screening

  • 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

  • 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

  • 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

  • 1. Superficial Spreading Melanoma

    Trunk of , legs of

    It can occur in a previously benign mole

  • 1. Superficial Spreading Melanoma

  • 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

  • 2. Nodular Melanoma

    2nd most common type

    Uniform dark blue-black, blue-red nodule

    5% lack pigment (amelanoticmelanomas

  • 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


  • 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

  • 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

  • 4. Acral Lentiginous Melanoma

    Black or brown discoloration under the nails or on the soles of the feet or palms of the hands

  • 4. Acral Lentiginous

    Nail unit melanoma melanoma is considered a variant of acral lentiginous

  • Melanoma in Children

    Usually presents as a raised, light-colored or very dark lesion

    Often times bleeds

    Uniform color

  • Primary Malignant Melanomas in Children

    Ceballos PI et al. N Engl J Med 1995;332:656-662.

  • 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

  • ABCDE Signs Caution!

    Children may not present with conventional ABCDE criteria

    Nodular melanoma do not conform to the ABCDE!

  • A - Asymmetry


    The two sides match


    Two halves do not match

  • B - Border


    Smooth, even borders


    Uneven, scalloped or notched edges

  • C - Color


    Often one color


    Variety of colors

  • D - Diameter

    Benign Malignant

    Larger than a pencil eraser, sometimes smaller

  • E - Evolving


    Common moles look the same over time


    Any change in size, shape, color, elevation or symptom

  • The Ugly Duckling Concept

  • 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

  • Nail Unit Melanoma

  • Melanoma Diagnosis

  • 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

  • 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

  • Go with your own glow!

    A healthy glow does not mean a tan it is your skin tone, glowing

    Sarah Brown