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Melanoma: Skin Cancer Prevention and More

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From Queens Library's expert-led panel, Cancer Awareness: What You Need to Know, featuring professionals from New York Hospital Queens, North Shore LIJ, the American Cancer Society, and the Leukemia …

From Queens Library's expert-led panel, Cancer Awareness: What You Need to Know, featuring professionals from New York Hospital Queens, North Shore LIJ, the American Cancer Society, and the Leukemia and Lymphoma Society

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  • The review committee thought it was important to discuss tanning, so there’s a section on tanning and UV rays. ===== A suntan or sunburn are not indicators of good health. Some physicians consider the skin's tanning and burning a response to injury because it appears after the sun's rays have killed some cells and damaged others. Although dark skin has more protective melanin and tans more easily than it burns, remember that tanning is also a sign of sun damage. Dark-skinned children can also develop dangerous sunburns. Tanning and sunburns are just like smoking cigarettes; just one suntan or sunburn can increase your risk of cancer, regardless of skin color .
  • Many skin cancers can be prevented by avoiding, as much as is practical, skin-damaging UVB radiation. Persons who will be out in the sun should apply sunscreen with a protective factor (SPF) of at least 15 to all exposed skin. Properly applied, this SPF level allows a person who would normally begin to burn in 10 minutes of sun to remain exposed for up to 150 minutes without burning. For persons at high risk for skin cancer, sunscreen should be a part of daily hygiene.   The use of protective clothing, such as a hat or long sleeves, is recommended, especially during peak hours of exposure between 10 am and 4 pm. People should also be discouraged from using artificial sources of ultraviolet light, such as those used in tanning salons. The National Institute of Environmental Sciences has recently recognized UVA, utilized in tanning beds, as a known carcinogen.  
  • Sunscreens come in a wide range of sun-protective factors. It is generally acknowledged that people should use sunscreens with at least an SPF of 15. To achieve adequate sun protection, sunscreens must be applied generously and evenly on all exposed skin – including the neck, chest, ears and scalp (in balding individuals) of people wearing t-shirts.   This sunscreen should be re-applied about every 2 hours if the wearer is perspiring or swimming. Those who will be perspiring heavily or swimming should consider using waterproof formulas. Some people complain of sensitivity to sunscreens containing PABA (para-aminobenzoic acid). Many formulas with equally effective sun-protective factor (SPF 15+) are available without PABA. In addition, many companies sell makeup containing sunscreens with an SPF 15+.
  • We also incorporated phrases that are commonly used in the health ed community re: skin cancer prevention and detection, such as Slip, Slop, Slap, and Wrap, and the ABCDE Rule. ===== Keep in mind that sunscreen is not meant to allow you to spend more time in the sun than you would otherwise. That's why it is important to complement sunscreen use with other sun protection options: cover up, wear a hat and sunglasses, and seek shade. SLIP, SLOP, SLAP, AND WRAP can be a helpful way to remember what you need to do: SLIP on a shirt. A regular t-shirt can provide an SPF less than 10, so it’s important to follow all these tips together. SLOP on sunscreen and lip balm with an SPF of 15 or higher…and reapply as often as directed on the product’s instructions SLAP on a hat with a 2 to 3-inch brim all around to protect neck, ears, nose and scalp WRAP on sunglasses to protect the eyes and skin around them.
  • Secondary prevention of skin cancer (identifying and treating premalignant lesions or conditions of the skin) includes monitoring nevi for changes, removing any suspicious nevi, and removing solar keratoses. Secondary prevention is also aided by examining the skin on patients who may be seeking care for other reasons. Patients should also be taught to report any skin eruption that does not heal within a month. Prompt reporting of these lesions can aid in early identification of precancerous or cancerous lesions of the skin.  
  • The Physician Oncology Educational Program of the Texas Medical Association supports the American Cancer Society recommendation for a cancer-related checkup, including skin examination, every three years for people between 20 and 40 years of age, and every year for anyone age 40 and older. The professional examination should include patient education on the prevention of skin cancer.   Monthly self-examinations may be recommended for persons who have: a personal or familial history of skin cancer; precursor lesions such as actinic keratosis or all nevi; and/or sun-damaged skin. Monthly self-examinations of at-risk individuals are a good health habit.
  • Race plays a role in risk for melanoma. The risk of melanoma is about 20 times higher for whites than for African Americans. Whites with red or blond hair and skin that freckles or burns easily are at especially high risk. However, darkly pigmented people can also develop melanoma. The risk of developing malignant melanoma, when there is a first-degree relative with malignant melanoma, is 8 times greater than if there is no family history of melanoma.   Early, severe sun exposure also increases the risk of developing malignant melanoma. Dermatologists stress the importance of sun protection in children because of the increased risk for developing malignant melanoma if a history of childhood sunburn exists. In addition, anyone who has been treated with immunosuppression drugs has an increased risk of developing melanoma.

Transcript

  • 1. Beware of the Sun A Melanoma May ResultMitchell Chorost, M.D.NY Hospital Queens – Cancer Center
  • 2. Case example:• Patient comes into your office and concerned about a mole on his arm• Noticed mole has enlarged and looks different, but not sure how long its been there• The question we ask ourselves is: “is this lesion a benign mole or a malignant melanoma?
  • 3. Diagnosis ?
  • 4. Is it OK to Get a Tan or Sunburn? Everyone, regardless of skin color, can sunburn! A suntan or sunburn are not indicators of good health. Tanning and sunburns are just like smoking cigarettes; just one suntan or sunburn can increase your risk of cancer, regardless of skin color.
  • 5. Primary Prevention of Skin CancerAvoid Exposure to Ultraviolet Radiation• Use sunscreen > SPF 15• Wear hats and other protective clothing• Schedule outdoor activities before 10am and after 4pm• Avoid all indoor tanning activity including tanning salons
  • 6. Primary Prevention of Skin CancerProper Use of Sunscreens• Apply generously and evenly• Reapply every 2 hours - if perspiring - if swimming• Consider waterproof formulas
  • 7. How Do I Protect My Skin?“Slip, Slop, Slap, & Wrap”SLIP on a shirt SLOP on sunscreen and lip balm with an SPF of 15 or higher WRAP on sunglasses to protect the eyesSLAP on a hat with a 2 to 3-inch and skin around them brim all around to protect neck, ears, nose and scalp
  • 8. Secondary Prevention of Skin CancerScreening and Early Detection• Inspect moles for changes• Remove suspicious moles• Remove actinic keratoses and other precancerous lesions
  • 9. Recommendations for Skin Cancer Screening• Skin examinations by a physician, as part of every cancer-related checkup• Monthly self-examinations are recommended for persons with: - personal history of skin cancer - family history of skin cancer - precursor lesions - sun damaged skin
  • 10. Risk Factors for Melanoma• Light pigmentation• Family history of malignant melanoma• >3 sunburns during childhood• >3 years outdoor occupation during childhood• Immunosuppression Source: Balch, et al, 1992.
  • 11. ABCDs•Asymmetry•Border•Color•Diameter
  • 12. A symmetry One half does not match the other half.
  • 13. B order irregularity •The edges are ragged, notched, or blurred.
  • 14. C olor•The pigmentation is not uniform. •Shades of tan, brown, or black •A mottled appearance.
  • 15. D iameter •Greater than ¼ inch. •Any sudden or continuing increase in size is of special concern.
  • 16. E volution •Changing characteristics of the mole independent of the size or color.
  • 17. Work-up • FDG-PET • sensitivity 17% in study with SLN biopsy • some use in distant disease
  • 18. Additional Therapy• Radiation• Chemotherapy• Vaccines• Immunotherapy • Targeted therapy - help the immune system kill cancer cells • Vemurafenib (BRAF inhibition) • Ipilimumab (An antibody CTLA-4 on T cells)
  • 19. A New Paradigm in Cancer Treatment Haber, Gray, Baselga Cell 2011
  • 20. See SpotSee Spot ChangeSee Doctor…………….Or, See Spot Kill!
  • 21. Knowledge is Power. And Hope.