1. OUR CHILDREN WHEN THEY WERE CUTE

2. THEY’RE STILL KIND OF CUTE

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

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

5. THE SURFER DUDE WHO
HATES TO BURN!

6. WHO NEEDS A SURFBOARD?
THE WAVES ARE GOOD ENOUGH

7. THE PINECREST SWIMMER

8. EVEN OUR DOGS SWIM

9. SKIN CANCER TREATMENT CENTERS
Established 1985
BOARD CERTIFIED DERMATOLOGISTS
MOH’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

10. SKIN CANCER
A CURABLE
DISEASE

11. IF YOU SPOT IT

12. YOU CAN STOP IT

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.

14. SKIN CANCER INCIDENCE
20 YEARS AGO

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

16. PEOPLE MOST AT RISK!

17. ULTRAVIOLET (UV)
RADIATION

18. HISTORY OF TANNING

19. SHOW ME MORE SKIN!

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

21. IF YOU CAN SPOT IT, YOU CAN
STOP IT

22. PRE - SKIN CANCERS
AKA
ACTINIC
(CAUSED BY THE SUN)
KERATOSIS

23. ACTINIC KERATOSIS SCALP
 SCALY
 DARKER IN
COLOR
 FEEL LIKE
SANDPAPER
 TENDER

24. ACTINIC KERATOSIS LOWER LIP
MOST OF THE
TIME ARE
CRUSTY OR
SCALY AND
WON’T HEAL

25. ACTINIC KERATOSIS LIP
CAN EVOLVE
INTO
SQUAMOUS
CELL
CARCINOMA
VERY
DANGEROUS
ON LIPS

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

34. BASAL CELL CARCINOMA
side of nose

35. BCC LOOKS LIKE A MOLE

36. BCC LOOKS LIKE A MOLE

37. SQUAMOUS CELL CARCINOMA

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

41. SEE SPOT CHANGE
SEE YOUR DERMATOLOGIST
SHOULD
YOU CHECK
YOUR DOG?

42. YES, DOGS CAN GET MELANOMA

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

44. Melanoma: Examples
Must Diagnose Some of These Earlier!
44

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

50. A ASYMMETRY

51. BORDER IS IRREGULAR

52. COLOR VARIATION

53. NEW PIGMENTED LESION ON SCALP
ASK YOUR HAIRDRESSER TO
LOOK
DEBBIE’S SELFIE

54. DIAMETER
DON’T WAIT THIS LONG

55. MM VERY SMALL NEW GROWTH

56. EVOLVING
THE KEY TO EARLY DETECTION

57. Evolving Lesion
DYSPLASTIC NEVUS SYNDROME
57

58. DYSPLASTIC NEVI
REBECCAS STORY
TWO OF THESE ARE MELANOMAS

59. THEY ALL LOOK “UGLY”
THE UGLY DUCKLING SIGNS
ONE OF THESE IS A MELANOMA

60. ANOTHER UGLY DUCKLING
ANOTHER MELANOMA

61. MALIGNANT MELANOMA HAND

62. MALIGNANT MELANOMA FOOT
HE WAS BORN WITH THIS MOLE

63. MELANOMA NODULAR
DARKENING OF PIGMENT

64. MELANOMA EARLY
EXCISED WITHOUT “MESSING UP” HER TATOO

65. MELANOMA
CHANGE IN BROWN SPOT ON FACE

66. MELANOMA
NOTE SUBTLE CHANGE OF COLOR

67. MELANOMA SUPERFICIAL
A SAILOR WHO HAS HAD MANY MELANOMAS

68. MELANOMA SCALP
LENTIGO (OLD AGE SPOT) MALIGNA TYPE

69. MELANOMA ARM
LENTIGO (OLD AGE SPOT) MALIGNA TYPE

70. MELANOMA AMELANOTIC NODULAR
IMMUNOSUPPRESSED (LYMPHOMA) PATIENT

71. MELANOMA AMELANOTIC

72. MELANOMA – AMELANOTIC
EVOLVING BUMP. DOESN’T LOOK LIKE ALL THE OTHERS
THIS
ONE
NOT
THESE
LET’S
MAKE
A DEAL

73. SEEK SHADE

74. SHADE TENT
AVAILABLE AT WALMART FOR $35

75. HATS, SUNGLASSES, AND
PROTECTIVE CLOTHING

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

77. SUN PROTECTIVE CLOTHING?

78. SUNBLOCK