OUR CHILDREN WHEN THEY WERE CUTE

THEY’RE STILL KIND OF CUTE

READY TO GO FISHING

“My Dad’s muscles are bigger than

yours!”

Rick’s comment

when meeting John Offerdahl

Ron hated hats.

Now he wears

them all the time

CAN’T SWIM IF YOU DON’T GET YOUR FACE WET

THE SURFER DUDE WHO HATES TO BURN!

WHO NEEDS A SURFBOARD? THE WAVES ARE GOOD ENOUGH

THE PINECREST SWIMMER

EVEN OUR DOGS SWIM

SKIN CANCER TREATMENT CENTERSEstablished 1985

BOARD CERTIFIED DERMATOLOGISTSMOH’S SUGEONS AND PLASTIC SURGEON

KATHRYN ZEOLI, MD SUSANA LEAL-KHOURI, MD

BRIAN BUCALO, MD MAE GUTIERREZ, MD

CHRISTINE HAUGEN, MD

2 LOCATIONS 10067 PINES BLVD, STE A PEMBROKE PINES

2001 EAST COMMERCIAL BLVD, FORT LAUDERDALE

SKIN CANCERA CURABLE

DISEASE

IF YOU SPOT IT

YOU CAN STOP IT

How to perform a skin self-examination

13

Examine your body front and back in the mirror, then look at the right and left sides with your arms raised.

Bend elbows and look carefully at forearms, upper underarms, and palms.

Look at the backs of your legs and feet, the spaces between your toes, and the soles of your feet.

Examine the back of your neck and scalp with a hand mirror. Part hair for a closer look.

SKIN CANCER INCIDENCE 20 YEARS AGO

SKIN CANCER INCIDENCE INCREASING AT ALARMING RATE

4 MILLION NEW CASES PER YEAR & 13MILLION CAUCASIAN AMERICANS HAVE HAD SKIN CANCER

EVERY HOUR ONE PERSON DIES FROM MALIGNANT MELANOMA

1 IN 3 AMERICANS WILL DEVELOP SKIN CANCER

PEOPLE MOST AT RISK!

ULTRAVIOLET (UV) RADIATION

HISTORY OF TANNING

SHOW ME MORE SKIN!

RECOGNIZE SKIN CANCERS

A NEW GROWTH OR ONE THAT DOES NOT HEAL

BLEEDSIS WARTYOR CRUSTYA CHANGE IN AN EXISTING GROWTHTHE A,B,C,D,E FOR MELANOMAS

IF YOU CAN SPOT IT, YOU CAN STOP IT

PRE - SKIN CANCERS

AKA

ACTINIC(CAUSED BY THE SUN)

KERATOSIS

ACTINIC KERATOSIS SCALP

SCALY DARKER IN

COLOR FEEL LIKE

SANDPAPER TENDER

ACTINIC KERATOSIS LOWER LIP

MOST OF THE TIME ARE

CRUSTY OR SCALY AND

WON’T HEAL

ACTINIC KERATOSIS LIP

CAN EVOLVE INTO

SQUAMOUS CELL

CARCINOMAVERY

DANGEROUS ON LIPS

BASAL CELL CARCINOMA

THE MOST COMMON SKIN CANCER

OVER 3 MILLION CASES PER YEAR IN THE U.S.CAUSED BY UV INDUCED DAMAGE TO DNA 1,000/100,000 IN AUSTRALIA, 6/100,000 IN FINLANDMutation of the PTCH (Tumor Suppression)

Gene allows unchecked growth of basal cells

There are other clinical subtypes of BCC: EXAMPLES OF OBVIOUS BCC’S

27

Typical Patient Prone to Skin Cancer

62-year-old man with a growth by his right ear for six months that has increased in size, but it otherwise does not bother him. He also has Actinic Keratosis. In most patients, this BCC would bleed from shaving.

28

Nodular BCC Looks Like a Mole

Most common subtype Presents as a pearly

papule or nodule with rolled border and telangiectasias

Although any part of the body may be involved, the lesions are most frequently found on the head and neck

29

Ulcerated BCC A Sore that Won’t Heal

Presents with features suggestive of BCC including a translucent color, telangiectasia, and a rolled border

In addition, the growth is grossly or microscopically ulcerated, which often results in crusting over the growth

30

Pigmented BCCLooks like a Melanoma

Presents with features typical of a BCC along with globules of dark pigment

The differential diagnosis may include malignant melanoma

31

Morpheaform BCCLooks like a Scar

Presents with features suggestive of BCC including a translucent color, telangiectasia, and a rolled border

In addition, the plaque appears white and bound down or scar-like in areas

32

BCC RIGHT UPPER LIP

ARE YOU SURE?

DOESN’T LOOK LIKE

ANYTHING. I THINK IT’S A

MOLE

BASAL CELL CARCINOMA side of nose

BCC LOOKS LIKE A MOLE

BCC LOOKS LIKE A MOLE

SQUAMOUS CELL CARCINOMA

Melanoma: Epidemiology

In 2008, there were approximately 62,480 new cases of melanoma and 8,420 deaths from melanoma in the US

The lifetime risk of melanoma has increased over time

• 1 in 1500 of persons born in the early 1900s• 1 in 65 of persons born in 2005

Melanoma affects all ages• It is the most common cancer among young women

between the ages of 25 and 29

38

Melanoma: Risk Factors

• Fair skin; blue eyes, red or blond hair; freckling• Many nevi (moles)• Atypical (dysplastic) nevi • Personal or family history of melanoma • Sun (UV light) exposure Sunburns Work Outdoors Tanning bed use Recreation Outdoors• Immunosuppression (Cancer Hx, Transplant, HIV)• Genetic syndromes (10%)

39

Melanoma: Clinical Manifestations

May cause symptoms, but usually asymptomatic May develop de novo or arise within a pre-existing nevus Majority located in sun-exposed areas, but also occur in non-

sun-exposed areas, such as the buttock• Also occur on mucous membranes (mouth, genitalia)

Typically appears as a pigmented papule, plaque or nodule.

Demonstrates any of the ABCDEs• It may bleed, be eroded or crusted• History of change

40

SEE SPOT CHANGE SEE YOUR DERMATOLOGIST

SHOULD YOU CHECK YOUR DOG?

YES, DOGS CAN GET MELANOMA

The ABCDEs of Melanoma Suspicious moles may have any of the following features:

ASYMMETRY• With regard to shape or color

BORDER• Irregular or notched

COLOR• Very dark or variegated colors• Blue, Black, Brown, Red, Pink, White

DIAMETER• >6 mm, or “larger than a pencil eraser” • Diameter that is rapidly changing

EVOLVING• Evolution or change in any of the ABCD features

43

Melanoma: ExamplesMust Diagnose Some of These Earlier!

44

Melanoma: Superficial Spreading

Superficial spreading type• Most common type• Involves back in men;

back and legs in women

• Growth of tumor is primarily horizontal rather than down into the dermis

45

Melanoma: Lentigo Maligna

Lentigo maligna type• Occurs on chronically

sun-damaged skin, more common in elderly patients

• Slow progression• Growth of tumor is

primarily horizontal, and not vertical

46

Melanoma: Nodular

Nodular type• Rapid growth• Growth is vertical, giving

tumor an increased Breslow’s depth

• Breslow’s depth = thickness of the primary melanoma measured from the granular layer of the epidermis to the deepest part of the tumor

47

Melanoma: Acral Lentiginous

Acral lentiginous type• More common in people

with darker skin color (Asians and persons of African ancestry)

• Diagnosis is often delayed, so lesions tend to be many centimeters in diameter

48

Melanoma: Amelanotic Amelanotic type

• Morphologic appearance is variable, and the clinical appearance of pigment is subtle or often absent

• As such, the lesion may be confused with a variety of benign lesions, such as psoriasis or dermatitis

• This lesion may also be confused with a variety of malignant lesions, such as squamous cell carcinoma in situ or basal cell carcinoma

• This is a difficult diagnosis to make, which is why it is important to biopsy when unsure of the diagnosis

49

A ASYMMETRY

BORDER IS IRREGULAR

COLOR VARIATION

NEW PIGMENTED LESION ON SCALPASK YOUR HAIRDRESSER TO LOOK

DEBBIE’S SELFIE

DIAMETERDON’T WAIT THIS LONG

MM VERY SMALL NEW GROWTH

EVOLVINGTHE KEY TO EARLY DETECTION

Evolving LesionDYSPLASTIC NEVUS SYNDROME

57

DYSPLASTIC NEVIREBECCAS STORY

TWO OF THESE ARE MELANOMAS

THEY ALL LOOK “UGLY”THE UGLY DUCKLING SIGNS

ONE OF THESE IS A MELANOMA

ANOTHER UGLY DUCKLINGANOTHER MELANOMA

MALIGNANT MELANOMA HAND

MALIGNANT MELANOMA FOOTHE WAS BORN WITH THIS MOLE

MELANOMA NODULARDARKENING OF PIGMENT

MELANOMA EARLY EXCISED WITHOUT “MESSING UP” HER TATOO

MELANOMA CHANGE IN BROWN SPOT ON FACE

MELANOMANOTE SUBTLE CHANGE OF COLOR

MELANOMA SUPERFICIALA SAILOR WHO HAS HAD MANY MELANOMAS

MELANOMA SCALPLENTIGO (OLD AGE SPOT) MALIGNA TYPE

MELANOMA ARMLENTIGO (OLD AGE SPOT) MALIGNA TYPE

MELANOMA AMELANOTIC NODULARIMMUNOSUPPRESSED (LYMPHOMA) PATIENT

MELANOMA AMELANOTIC

MELANOMA – AMELANOTICEVOLVING BUMP. DOESN’T LOOK LIKE ALL THE OTHERS

THIS ONE

NOT THESE

LET’S MAKE

A DEAL

SEEK SHADE

SHADE TENT

AVAILABLE AT WALMART FOR $35

HATS, SUNGLASSES, AND PROTECTIVE CLOTHING

AT LEAST WE MADE THE EFFORT TO HAVE RAQUEL WEAR THAT HAT!

SUN PROTECTIVE CLOTHING?

SUNBLOCK