Melanoma: What you need to know

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Melanoma What you need to know

• Carrine A. Burns, MD
• Dermatology Associates
• October 27, 2008

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Melanoma

• Becoming more common
• Incidence more than tripled from 1980-2003
• Incidence increasing fastest in men agegt55
• Incidence also rising in children
• Lifetime risk 1 in 60
• 62,480 cases in 2008
• Mortality rates stable or decreasing since 1992
• 8450 fatalities in 2008

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Melanoma What is it?

• Cancer of melanocytes
• pigment cells
• Found normally in skin
• Increased numbers in moles
• Mutation (damage to DNA) in the melanocyte leads
  to uncontrolled growth

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Melanoma

• Risk factors
• Fair skin
• Family history
• Prior sun exposure
• Blistering sunburns
• Atypical moles
• History of prior melanoma
• Tanning booths

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Tanning and Melanoma

• Strong association between tanning bed use and
  melanoma
• Across all ages, 15 higher risk of melanoma
• 1st tanning bed use at under age 35 leads to 75
  increased risk of melanoma
• Tanning also increases risk of other skin cancer

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Tanning Damage

• There is no such thing as a safe tan
• Any tan is a sign of damage to the skin
• Trying to get a base tan prior to a trip is
  unwise
• Self tanners or spray on tans are safe but do not
  provide any sun protection

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Melanoma

• Multiple subtypes
• Not all melanomas are dark
• Childhood melanoma may more often be red or pink
  (amelanotic melanoma)
• Symptoms - often late
• Itching,
• Bleeding,
• Ulceration

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Melanoma

• Needs to be caught early
• Horizontal phase (spreading out) before
  vertical growth phase (growing in)
• Months to years
• Can spread to lymph nodes and other organs
• Prognosis depends on depth of invasion
• In Situ (only in top layer of skin) - 100 cure
  rate
• gt4mm invasion into skin-lt50 5 yr survival

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How to detect early?

• Patient awareness
• Perform self skin examinations
• Physician awareness
• Full body screening of all patients at risk
• Prevention is key!!

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What to look for The ABCDE criteria
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The Ugly Duckling sign
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Melanoma mimics

• Lots of things can look like a melanoma but
  arent
• Still need to be seen and diagnosed by a physician

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Normal moles

• Nevusmole
• Develops during childhood or early adulthood
• Groups of melanocytes
• Flat at first
• Tan or brown
• Smooth borders
• Most common on trunk

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Normal moles

• With time moles change
• Lose pigment
• Tan, brown, pink, skin colored
• Become raised
• Often end up dome shaped
• Can have increased hairs

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Congenital nevus

• Birthmarks
• May be small or large
• Become raised and bumpy
• Often have increased hairs
• Need to be watched for changes
• Need to be removed if changing significantly

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Dysplastic Nevus

• Abnormal mole
• Atypical nevus
• Potential melanoma precursor
• 30 of melanomas develop from atypical moles
• Marker of increased risk
• Flat, some have raised center
• Often gt 5mm
• Irregular border, shape, or color pattern
• Biopsy of suspicious lesions and frequent skin
  exams

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Spitz Nevus

• Aka Juvenile Melanoma
• Is NOT malignant
• Uncommon
• Can be pink, red or pigmented
• Complete excision recommended
• Can be difficult to differentiate from melanoma
  clinically and histologically

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Non-Melanoma Skin Cancer

• Much more common than melanoma
• Basal cell carcinoma
• Most common form of skin cancer
• Squamous cell carcinoma
• Due to sun exposure
• Rarely life threatening
• SCC can occasionally spread to lymph nodes
  Usually just needs local treatment
• Mohs surgery, excision, scraping and burning,
  freezing

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Basal Cell carcinoma
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Squamous Cell Carcinoma
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Melanoma Treatment

• Excision
• In Situ 0.5cm margin
• Depth lt 1mm 1cm margin
• Depth gt 1mm 2cm margin
• Lymph node evaluation
• Not needed if depth lt 1mm and no other high risk
  factors
• Sentinel Lymph Node biopsy
• Uses dye and radioactivity to find lymph node
  that melanoma would most likely spread to
• gt 1mm Breslow
• Gives prognostic information
• Helps decide who needs more treatment
• No proven survival benefit
• Trials ongoing
• Therapeutic lymph node dissection
• Removes all the lymph nodes

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Melanoma Further treatments

• For patients with spread to other organs or those
  at high risk
• No proven effective chemotherapy
• Interferon alfa-2b
• FDA approved
• Evidence mixed
• Significant side effects
• Numerous ongoing trials
• Chemotherapy
• Vaccine therapy

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So what can you do???
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PREVENTION AND EARLY DETECTION!!
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Melanoma Prevention

• There is no such thing as a healthy tan
• Tanning booths cause skin cancer
• In Maine agelt18 must have written permission from
  parent/guardian to use tanning booth
• Educate parents
• Law is often ignored
• Education around time of proms and events

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Melanoma Prevention

• Sun Smart
• Avoid sun when you are able
• Especially 10am-4pm
• Wear protective clothing
• Hats, sunglasses, shirts
• Sunscreen
• DAILY!!! for face and hands (SPF15 or gt)
• SPF 30 or 45 for outdoor activities
• Reapply every 2 3 hours or after swimming or
  sweating
• Sprays are good for active people

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Melanoma Early Detection

• Self Skin examination
• At least once a month
• Use mirrors
• Have someone else check your back
• Get used to what is there, stable, and normal
• See a physician for anything new or changing
• Skin screening by physician
• Dermatologist if high risk

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