MELANOMA 101 – Protecting the Skin Your InElizabeth Small, MD, Dermatology

www.SpringfieldClinic.comwww.SpringfieldClinic.com

The Sun Is NOT Your Friend

What is melanoma?

• Melanoma is the uncontrolled growth of melanocytes, the pigment producing cells of the body. Ultraviolet light triggers mutations in the DNA of cells, leading to tumor development

• Melanoma may appear from normal appearing skin or arise from a preexisting mole

Melanocyte diagram

How many cases of melanoma occur annually?

• The Skin Cancer foundation estimates that 123,590 new cases will be diagnosed There will be an estimated 9,180 deaths from melanoma, an increase of 400

• In 1930 the incidence of melanoma was 1 in 5000 people. Now it is 1/50, a 1000% increase.

Who is at risk for melanoma?

• Individuals with red or blonde hair and blue or green eyes

• Those with many greater than 100 moles or nevi

• People with atypical or dysplastic nevi• Immunosuppressed individuals• People who frequent tanning beds• Those with a personal or family history of

melanoma

Risk Factors for Melanoma

• History of blistering sunburns in childhood• Family history of melanoma• History or presence of many moles• History of tanning bed use• Immunosuppression• Prior PUVA therapy• History of previous nonmelanoma skin cancer• Having blonde or red hair and blue or green eyes

• History of breast or thyroid cancer(genetic markers)

What population groups are vulnerable?

• The highest incidence of melanoma is in men over 50

• Caucasians are more susceptible given their lack of melanin protection

• People of color have a worse prognosis

• Their melanomas are usually more advanced at diagnosis

Risk factors for the development of melanoma

• Residing in a sunny environment or one close to the equator.

• Genetic markers like BRAF, p53 or CDKN2A

• BRAF is a “switch” gene which allows cells to turn on and multiply uncontrolled

• P53 is a suppressor gene that allows cells time to repair DNA damage from UV exposure

Where does melanoma occur?

• Sun-exposed skin is the most common site

• In people of color the nails, feet and palms

• Other sites: retinae (back of eyes), sinuses, gastrointestinal tract, genitourinary tract, around hair follicles and the oral mucosa

Skin examination 101

Lumps, Bumps and Growths to biopsy

What a dermatologist looks for

AHA!

Benign Nevi (Mole)

• Symmetrical• Borders are smooth• Colors are uniform• Not normally too

large• No change over time

Benign nevus

Compound nevus

Atypical Moles

Moles are Termed NEVI● Atypical Moles are:

Larger than Normal Moles.

Variable in Color.

Have Irregular Borders.

May Occur in large Numbers.

Present on the Back, Chest,

Abdomen and Leg in Women.

May Occur Anywhere.

Important Risk Factor for Melanoma.

ABCDE Rules of Moles

●Asymmetry

●BorderIrregular scalloped or poorly defined border

● ColorVaried from One Area or OtherShades of Tan Brown & BlackSometimes Red, Blue White

●Diameter

● EvolvingChanging in color, size and/or shape

Dysplastic Nevus

• Asymmetry• Border

– Irregular scalloped or poorly defined border

• Color – Varied from One Area or Other

– Shades of Tan Brown & Black

– Sometimes Red, Blue White

• Diameter• Evolving

– Changing in color, size and/or shape

Dysplastic Nevus

• Asymmetry• Border

– Irregular scalloped or poorly defined border

• Color – Varied from One Area or Other

– Shades of Tan Brown & Black

– Sometimes Red, Blue White

• Diameter• Evolving

– Changing in color, size and/or shape

• Asymmetry• Border

– Irregular scalloped or poorly defined border

• Color – Varied from One Area or Other

– Shades of Tan Brown & Black

– Sometimes Red, Blue White

• Diameter• Evolving

– Changing in color, size and/or shape

Dysplastic Nevus

• Asymmetry• Border

– Irregular scalloped or poorly defined border

• Color – Varied from One Area or Other

– Shades of Tan Brown & Black

– Sometimes Red, Blue White

• Diameter• Evolving

– Changing in color, size and/or shape

• Asymmetry• Border

– Irregular scalloped or poorly defined border

• Color – Varied from One Area or Other

– Shades of Tan Brown & Black

– Sometimes Red, Blue White

• Diameter• Evolving

– Changing in color, size and/or shape

Dysplastic Nevus

• Asymmetry• Border

– Irregular scalloped or poorly defined border

• Color – Varied from One Area or Other

– Shades of Tan Brown & Black

– Sometimes Red, Blue White

• Diameter• Evolving

– Changing in color, size and/or shape

• Asymmetry• Border

– Irregular scalloped or poorly defined border

• Color – Varied from One Area or Other

– Shades of Tan Brown & Black

– Sometimes Red, Blue White

• Diameter• Evolving

– Changing in color, size and/or shape

Dysplastic Nevus

• Asymmetry• Border

– Irregular scalloped or poorly defined border

• Color – Varied from One Area or Other

– Shades of Tan Brown & Black

– Sometimes Red, Blue White

• Diameter• Evolving

– Changing in color, size and/or shape

Dysplastic Nevus

• Asymmetry• Border

– Irregular scalloped or poorly defined border

• Color – Varied from One Area or Other

– Shades of Tan Brown & Black

– Sometimes Red, Blue White

• Diameter• Evolving

– Changing in color, size and/or shape

Melanoma Facts

123,590 Melanomas will be Diagnosed this Year.

– 70,230 Invasive • Women – 30,220• Men – 40,100

– 54,000 in Situ•Melanomas account for 30% of Skin Cancers.•Melanomas cause more than 75% of Skin Cancer Deaths.

– Women 30,340 and – Men 5,750 with invasive melanoma

Melanoma Facts

• 1 in 51 People will be diagnosed with Melanoma in their lifetime.

• Melanoma is the most Common Form of Cancer in Young Adults 25 – 29 Years olds.

• Second Most Common for 15 - 29 Year Olds.• ONE Blistering Sunburn in Childhood

DOUBLES the chances of developing Melanoma.

Most Melanomas: Caucasian Males over 50 years old.

Melanoma Facts

• Melanoma is Highly Curable if Diagnosed EARLY.

• Lymph Node involvement is a POOR Prognostic Sign.

• Melanoma on the scalp neck back nail has a worse prognosis due to late detection or multiple lymph node drainage sites

Types of Melanoma

• Lentigo Malignant melanoma

• Superficial spreading melanoma

• Nodular melanoma

• Acral lentiginous melanoma

• Metastatic melanoma

• Melanoma of other sites

Lentigo Maligna Melanoma

• Represents 10-15% of all melanomas

• Occurs on sundamaged skin of elderly individuals

• Usually present for years, starts as “freckle”, grows slowly then develops multiple shades of color

• Very difficult to surgically excise due to location and age of patient

Lentigo maligna melanoma

Lentigo Maligna melanoma

Lentigo maligna melanoma

Image from A.D.A.M. Health Solution Images

Superficial spreading melanoma

• Most common type of melanoma

• Represents 70% of melanomas

• Occurs on the back neck and trunk in men

• In women on the back and legs

Image from DermNetNZ.org

Image from DermNetNZ.org

Image from DermNetNZ.org

Image from DermNetNZ.org

Nodular melanoma

• Accounts for 15% of melanomas

• Occurs in older individuals

• Usually on the back

• Causes most of the deaths from melanoma

• Worst prognosis

Image from DermNetNZ.org

Image from DermNetNZ.org

Image from DermNetNZ.org

Image from DermNetNZ.org

Acral lentiginous melanoma

• Represents 5% of melanomas

• Most common type 50% in Asians and people of color

• Occurs on the sole of foot, palm, under the nails or mucosal surface

• Appears as a bruise or splotch on the skin

Image from DermNetNZ.org

Image from DermNetNZ.org

Image from DermNetNZ.org

Image from A.D.A.M. Health Solution Images

Diagnosis

• Recognition of abnormal growth

• Biopsy

• Surgical excision with or without sentinel lymph node biopsy

Prognostic features

• Depth in mm

• Presence or absence of ulceration

• Age of patient

• Site of melanoma

• Presence of mitoses in biopsy

• No specific molecular markers yet for aggressiveness of a particular melanoma

Treatment

• Surgical excision

• If lymph node involvement consider interferon treatment

• Once melanoma has spread, options are limited and not as effective as in other types of cancer

• Early recognition and excision is KEY to saving lives

Be Sun SMART

• Sunscreen – SPF 30 or Higher

• Wear Protective Clothing

• Wide Brimmed Hat

• Avoid direct sun between 10am – 4pm

• Careful of reflectance – Sand, Water, Snow

• Get Vitamin D through Diet or Supplements

• Do Not Go to Tanning Beds

Be Sun SMART

Check your birthday suit on your birthday