3. 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
13. 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.
15. 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
20. RECOGNIZE SKIN CANCERS
A NEW GROWTH OR ONE THAT
DOES NOT HEAL
BLEEDS
IS WARTY
OR CRUSTY
A CHANGE IN AN EXISTING
GROWTH
THE A,B,C,D,E FOR MELANOMAS
26. 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 FINLAND
Mutation of the PTCH (Tumor Suppression)
Gene allows unchecked growth of basal cells
27. There are other clinical subtypes of BCC:
EXAMPLES OF OBVIOUS BCC’S
27
28. 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
29. 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
30. 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
31. Pigmented BCC
Looks like a Melanoma
Presents with features
typical of a BCC along
with globules of dark
pigment
The differential
diagnosis may include
malignant melanoma
31
32. Morpheaform BCC
Looks 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
33. BCC RIGHT UPPER LIP
ARE YOU
SURE?
DOESN’T
LOOK LIKE
ANYTHING. I
THINK IT’S A
MOLE
38. 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
39. 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
40. 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
43. 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
45. 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
46. 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
47. 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
48. 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
49. 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
