Protecting the Skin You’re In: Melanoma 101

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After the dreary months of winter, the sun’s rays can feel warm, invigorating and even therapeutic. So, why not soak in as much as possible? Unfortunately, the UV rays released in sunlight are actually damaging to us, causing skin cancers, like melanoma.

Whether you simply enjoy being outdoors or you’re a self-proclaimed “sun worshiper,” it’s important to understand the consequences of over-exposure to the sun. Dr. Elizabeth Small discussed melanoma --- the deadliest of all skin cancers --- and learn how you can protect yourself and the skin you’re in.

Published in: Health & Medicine, Lifestyle
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  • Irregular color asymmetry borders are smooth could be evolving no hx here
  • Typical familial atypical nevus syndrome pt with multiple atypical nevi on back Lesions all show irregular color, border slight asymmetry tho size is not that large
  • Irregular borders and colors diameter greater than end of pencil
  • Protecting the Skin You’re In: Melanoma 101

    1. 1. MELANOMA 101 – Protecting the Skin Your In Elizabeth Small, MD, Dermatologywww.SpringfieldClinic.com
    2. 2. The Sun Is NOT Your Friend
    3. 3. 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
    4. 4. Melanocyte diagram
    5. 5. How many cases of melanoma occurannually? • 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.
    6. 6. 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
    7. 7. 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)
    8. 8. 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
    9. 9. Risk factors for the development ofmelanoma • 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
    10. 10. 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
    11. 11. Skin examination 101Lumps, Bumps and AHA! Growths to biopsy What a dermatologist looks for
    12. 12. Benign Nevi (Mole) • Symmetrical • Borders are smooth • Colors are uniform • Not normally too large • No change over time
    13. 13. Benign nevus
    14. 14. Compound nevus
    15. 15. 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.
    16. 16. ABCDE Rules of Moles ●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
    17. 17. 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
    18. 18. Dysplastic Nevus• Asymmetry • Asymmetry• Border • Border – Irregular scalloped or poorly – Irregular scalloped or poorly defined border defined border• Color • Color – Varied from One Area or Other – Varied from One Area or Other – Shades of Tan Brown & Black – Shades of Tan Brown & Black – Sometimes Red, Blue White – Sometimes Red, Blue White• Diameter • Diameter• Evolving • Evolving – Changing in color, size and/or – Changing in color, size and/or shape shape
    19. 19. Dysplastic Nevus• Asymmetry • Asymmetry• Border • Border – Irregular scalloped or poorly – Irregular scalloped or poorly defined border defined border• Color • Color – Varied from One Area or Other – Varied from One Area or Other – Shades of Tan Brown & Black – Shades of Tan Brown & Black – Sometimes Red, Blue White – Sometimes Red, Blue White• Diameter • Diameter• Evolving • Evolving – Changing in color, size and/or – Changing in color, size and/or shape shape
    20. 20. Dysplastic Nevus• Asymmetry • Asymmetry• Border • Border – Irregular scalloped or poorly – Irregular scalloped or poorly defined border defined border• Color • Color – Varied from One Area or Other – Varied from One Area or Other – Shades of Tan Brown & Black – Shades of Tan Brown & Black – Sometimes Red, Blue White – Sometimes Red, Blue White• Diameter • Diameter• Evolving • Evolving – Changing in color, size and/or – Changing in color, size and/or shape shape
    21. 21. 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
    22. 22. 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
    23. 23. 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
    24. 24. 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.
    25. 25. 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
    26. 26. Types of Melanoma • Lentigo Malignant melanoma • Superficial spreading melanoma • Nodular melanoma • Acral lentiginous melanoma • Metastatic melanoma • Melanoma of other sites
    27. 27. 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
    28. 28. Lentigo maligna melanoma
    29. 29. Lentigo Maligna melanoma
    30. 30. Lentigo maligna melanomaImage from A.D.A.M. Health Solution Images
    31. 31. 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
    32. 32. Image from DermNetNZ.org
    33. 33. Image from DermNetNZ.org
    34. 34. Image from DermNetNZ.org
    35. 35. Image from DermNetNZ.org
    36. 36. Nodular melanoma • Accounts for 15% of melanomas • Occurs in older individuals • Usually on the back • Causes most of the deaths from melanoma • Worst prognosis
    37. 37. Image from DermNetNZ.org
    38. 38. Image from DermNetNZ.org
    39. 39. Image from DermNetNZ.org
    40. 40. Image from DermNetNZ.org
    41. 41. 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
    42. 42. Image from DermNetNZ.org
    43. 43. Image from DermNetNZ.org
    44. 44. Image from DermNetNZ.org
    45. 45. Image from A.D.A.M. Health Solution Images
    46. 46. Diagnosis • Recognition of abnormal growth • Biopsy • Surgical excision with or without sentinel lymph node biopsy
    47. 47. 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
    48. 48. 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
    49. 49. 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
    50. 50. Be Sun SMART Check your birthday suit on your birthday

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