Melanoma Prevention, Screening and Diagnosis - Dr. Ana Ciurea

Melanoma Prevention, Screening and Diagnosis

Ana Ciurea, MDDepartment of Dermatology

MD Anderson Cancer Center

January 31, 2015

What is melanoma?

• Uncontrolled growth of abnormal pigment-producing cells (melanocytes)

• It occurs when unrepaired damage to the skin cells triggers genetic defects that lead to formation of malignant tumors

Did you know?

• Melanoma remains the only preventable cancer for which mortality rate has not declined

• Fastest growing malignancy in the US, incidence increasing 3%/year since 1973

• 76,100 new cases in US, app 9,000 deaths/year in US

• Lifetime risk in the U.S. in 1935 – 1/1500, 2008 –1/58

Facts

• The steepest rise in incidence rates has been in men > 50 years of age

• For any given stage and across all ages, men have poorer melanoma survival than women

• Skin cancer rates increased in US Hispanics and African-Americans

Facts

• Most melanomas occur on the skin in sun-exposed areas

• May occur on mucosal surfaces, eye, but skin is MOST frequent site of primary disease

• Can be de novo or from preexisting moles

Facts

• 99% survival rate for patients whose melanoma is detected early

• Decreases to 15% for those with advanced disease

• Cost: $3.5 billion/year in US

Facts

• About 90% of skin cancers are associated with exposure to ultraviolet radiation from the sun or indoor tanning

Risk Factors for Melanoma

• Intense, intermittent sun exposure (blistering sunburns) especially during childhood

• Exposure to ultraviolet radiation from sun and tanning beds

• Fair complexion

• Increased number of moles (>50) or irregular moles

Risk Factors for Melanoma

• Personal history of melanomas (5 – 6 times risk)

• Heavy hand of heredity

• Immunosuppression (organ transplant recipients, HIV infections)

• African Americans, Hispanics can get skin cancer!

The Tale of Tanning

• The cumulative damage caused by UV radiation can lead to premature skin aging (wrinkles, lax skin, brown spots, and more), and skin cancer

• Indoor ultraviolet (UV) tanners are 85% more likely to develop melanoma than those who have never tanned indoors

• Average tanning beds emitted 4 x more the UVA radiation, and 2 x the UVB radiation of the midday summer sun in Washington, DC

The Tale of Tanning

• Tanning beds are linked to 400,000 cases of skin cancer per year in the US

• FDA increased regulatory control over UV lamps for tanning beds

• Reclassified as moderate-to-high risk devices

Melanoma in Ethnic Minorities The Risk is Real

• Skin cancer rates, in particular melanoma among Hispanics and African-Americans are skyrocketing

• Too little use of sun safety techniques may have contributed to the rapid rise in incidence

• Misconception that people with darker skin are not at risk for skin cancer

• Detection often delayed; advanced stage at the time of diagnosis and greater mortality

Melanoma Prevention

Melanoma Prevention

Sun exposure is the most preventable risk factor for all skin cancers including melanoma

Your Smartest Move: Melanoma Prevention

• Seek the shade when appropriate (10 am – 4 pm)

• Cover up with clothing including a broad-brimmed hat and UV-blocking sun glasses

• Avoid tanning and UV tanning beds – if you want to look tan consider using self-tanning products but continue to use sunscreen

Your Smartest Move: Melanoma Prevention

• Generously apply a broad spectrum UVA/UVB with sun protection factor (SPF) of 30 to all exposed skin

• For extended outdoor activity use water-resistant, even on cloudy days

• Use extra caution near water, snow and sand

• Apply sunscreen 30 minutes before going outside

• Reapply every 2 hours or after swimming or excessive sweating

• Keep newborns out of the sun – sunscreens should be used on babies over the age of six months

Your Smartest Move: Melanoma Prevention

Sunscreens

• Water resistant

• Reapply water-resistant sunscreen (40 min vs 80 min)

• Select a product that protect your lips

• Examine your skin head-to-toe every month

• Sun hazards in your car – watch out for skin cancers on the left side of the body

• See you doctor every year for a professional skin exam

• Children in melanoma families should be checked by a physician from age 10 on

Your Smartest Move: Melanoma Prevention

FAQs

Sunscreens

• Yes, sunscreens are safe to use !

• No published studies show that sunscreen is toxic to humans or hazardous to human health including hormonal problems or increased risk of skin cancer

• Nanoparticles used in sunscreens prevent active ingredients from leaving a white residue on the skin; not absorbed through the skin

Vitamin D Supplementation

• Vitamin D should be obtained from diet and supplements that includes foods naturally rich in vitamin D, foods/beverages fortified with vitamin D, and/or vitamin D supplements

• Vitamin D should not be obtained from unprotected exposure to ultraviolet (UV) radiation

• A blood test that measures one's vitamin D level is widely available

Melanoma Screening

Presentation of Melanoma –Your Skin Tells the Story

• Moles, brown spots and growths on the skin are usually harmless, BUT NOT ALWAYS

• Usually brown-black or multicolored plaques

• Raised patches or nodules with irregular outlines

• May crust or bleed

Many Faces of Melanoma

• Four Basic Types

• Three of them begin in situ — meaning they occupy only the top layers of the skin and become invasive in time

• The fourth is invasive from the start

• Invasive melanomas are more serious, as they have penetrated deeper into the skin and may have spread to other areas of the body

1. Superficial Spreading Melanoma

• The most common type – 70%

• It grows along the top layer of the skin for a fairly long time before penetrating more deeply

• First sign is the appearance of a flat or slightly raised discolored patch of various colors that has irregular borders and is somewhat asymmetrical in form

1. Superficial Spreading Melanoma

• Trunk of ♂, legs of ♀

• It can occur in a previously benign mole

1. Superficial Spreading Melanoma

2. Nodular Melanoma

• Usually invasive at the time of diagnosis

• It is recognized when it becomes a bump

• The most frequent locations are the trunk, legs, and arms, mainly of elderly people, as well as the scalp in men

• The most aggressive of the melanomas

2. Nodular Melanoma

• 2nd most common type

• Uniform dark blue-black, blue-red nodule

• 5% lack pigment (amelanoticmelanomas

3. Lentigo Maligna

• Melanoma in-situ of sun-damaged skin

• Appears similar to the superficial spreading type

• Flat or elevated tan, brown, black, blue-gray

• Often large • Occurs on sun-exposed

surfaces

3. Lentigo Maligna

• Lentigo maligna is the most common form of melanoma in Hawaii

• When this cancer becomes invasive, it is referred to as lentigo maligna melanoma

4. Acral lentiginous melanoma

• Spreads superficially before penetrating more deeply

• Can often advance more quickly than superficial spreading melanoma and lentigomaligna

• The most common melanoma in African-Americans and Asians, and the least common among Caucasians

4. Acral Lentiginous Melanoma

Black or brown discoloration under the nails or on the soles of the feet or palms of the hands

4. Acral Lentiginous

Nail unit melanoma melanoma is considered a variant of acral lentiginous

Melanoma in Children

• Usually presents as a raised, light-colored or very dark lesion

• Often times bleeds

• Uniform color

Primary Malignant Melanomas in Children

Ceballos PI et al. N Engl J Med 1995;332:656-662.

The Melanoma Alphabet: ABCDE signs

• The first five letters are a guide to warning signs of melanoma

• A – asymmetry

• B – border irregularity

• C – color variation

• D – diameter

• E – evolving or changing

ABCDE Signs – Caution!

• Children may not present with conventional ABCDE criteria

• Nodular melanoma do not conform to the ABCDE!

A - Asymmetry

Benign

• The two sides match

Malignant

• Two halves do not match

B - Border

Benign

• Smooth, even borders

Malignant

• Uneven, scalloped or notched edges

C - Color

Benign

• Often one color

Malignant

• Variety of colors

D - Diameter

Benign Malignant

• Larger than a pencil eraser, sometimes smaller

E - Evolving

Benign

• Common moles look the same over time

Malignant

• Any change in size, shape, color, elevation or symptom

The “Ugly Duckling Concept”

ABCDEF of Nail Melanomas

• A - age (20-90 years of age)

• B – brown, black, breadth (> 3mm)

• C – change (recent or rapid increase in size)

• D – digit involved ( thumb haluxindex finger

• E – extenstion of the black or brown pigment lateral to the nail

• F – family history of melanoma

Nail Unit Melanoma

Melanoma Diagnosis

Melanoma Diagnosis

• First step: skin exam

• Skin biopsy to confirm any irregularities

• Once a skin cancer is diagnosed, additional tests may be initiated to evaluate for spread

Conclusions

• Year-round sun protection (sun passes through the clouds!)

• Regular self-skin examinations

• Avoid tanning beds (base tans are bad for you)

• Annual visits to dermatologists regardless of the skin tone

Go with your own glow!

“ A healthy glow does not mean a tan … it is your skin tone, glowing”

Sarah Brown

THANK YOU!