OUR CHILDREN WHEN THEY WERE CUTE
OUR CHILDREN WHEN THEY WERE CUTE
THEY’RE STILL KIND OF CUTE
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
CAN’T SWIM IF YOU DON’T GET YOUR FACE WET
THE SURFER DUDE WHO HATES TO BURN!
WHO NEEDS A SURFBOARD? THE WAVES ARE GOOD ENOUGH
THE PINECREST SWIMMER
EVEN OUR DOGS SWIM
SKIN CANCER TREATMENT CENTERSEstablished 1985
BOARD CERTIFIED DERMATOLOGISTSMOH’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
SKIN CANCERA CURABLE
DISEASE
IF YOU SPOT IT
YOU CAN STOP IT
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.
SKIN CANCER INCIDENCE 20 YEARS AGO
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
PEOPLE MOST AT RISK!
ULTRAVIOLET (UV) RADIATION
HISTORY OF TANNING
SHOW ME MORE SKIN!
RECOGNIZE SKIN CANCERS
A NEW GROWTH OR ONE THAT DOES NOT HEAL
BLEEDSIS WARTYOR CRUSTYA CHANGE IN AN EXISTING GROWTHTHE A,B,C,D,E FOR MELANOMAS
IF YOU CAN SPOT IT, YOU CAN STOP IT
PRE - SKIN CANCERS
AKA
ACTINIC(CAUSED BY THE SUN)
KERATOSIS
ACTINIC KERATOSIS SCALP
SCALY DARKER IN
COLOR FEEL LIKE
SANDPAPER TENDER
ACTINIC KERATOSIS LOWER LIP
MOST OF THE TIME ARE
CRUSTY OR SCALY AND
WON’T HEAL
ACTINIC KERATOSIS LIP
CAN EVOLVE INTO
SQUAMOUS CELL
CARCINOMAVERY
DANGEROUS ON LIPS
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 FINLANDMutation of the PTCH (Tumor Suppression)
Gene allows unchecked growth of basal cells
There are other clinical subtypes of BCC: EXAMPLES OF OBVIOUS BCC’S
27
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
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
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
Pigmented BCCLooks like a Melanoma
Presents with features typical of a BCC along with globules of dark pigment
The differential diagnosis may include malignant melanoma
31
Morpheaform BCCLooks 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
BCC RIGHT UPPER LIP
ARE YOU SURE?
DOESN’T LOOK LIKE
ANYTHING. I THINK IT’S A
MOLE
BASAL CELL CARCINOMA side of nose
BCC LOOKS LIKE A MOLE
BCC LOOKS LIKE A MOLE
SQUAMOUS CELL CARCINOMA
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
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
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
SEE SPOT CHANGE SEE YOUR DERMATOLOGIST
SHOULD YOU CHECK YOUR DOG?
YES, DOGS CAN GET MELANOMA
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
Melanoma: ExamplesMust Diagnose Some of These Earlier!
44
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
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
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
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
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
A ASYMMETRY
BORDER IS IRREGULAR
COLOR VARIATION
NEW PIGMENTED LESION ON SCALPASK YOUR HAIRDRESSER TO LOOK
DEBBIE’S SELFIE
DIAMETERDON’T WAIT THIS LONG
MM VERY SMALL NEW GROWTH
EVOLVINGTHE KEY TO EARLY DETECTION
Evolving LesionDYSPLASTIC NEVUS SYNDROME
57
DYSPLASTIC NEVIREBECCAS STORY
TWO OF THESE ARE MELANOMAS
THEY ALL LOOK “UGLY”THE UGLY DUCKLING SIGNS
ONE OF THESE IS A MELANOMA
ANOTHER UGLY DUCKLINGANOTHER MELANOMA
MALIGNANT MELANOMA HAND
MALIGNANT MELANOMA FOOTHE WAS BORN WITH THIS MOLE
MELANOMA NODULARDARKENING OF PIGMENT
MELANOMA EARLY EXCISED WITHOUT “MESSING UP” HER TATOO
MELANOMA CHANGE IN BROWN SPOT ON FACE
MELANOMANOTE SUBTLE CHANGE OF COLOR
MELANOMA SUPERFICIALA SAILOR WHO HAS HAD MANY MELANOMAS
MELANOMA SCALPLENTIGO (OLD AGE SPOT) MALIGNA TYPE
MELANOMA ARMLENTIGO (OLD AGE SPOT) MALIGNA TYPE
MELANOMA AMELANOTIC NODULARIMMUNOSUPPRESSED (LYMPHOMA) PATIENT
MELANOMA AMELANOTIC
MELANOMA – AMELANOTICEVOLVING BUMP. DOESN’T LOOK LIKE ALL THE OTHERS
THIS ONE
NOT THESE
LET’S MAKE
A DEAL
SEEK SHADE
SHADE TENT
AVAILABLE AT WALMART FOR $35
HATS, SUNGLASSES, AND PROTECTIVE CLOTHING
AT LEAST WE MADE THE EFFORT TO HAVE RAQUEL WEAR THAT HAT!
SUN PROTECTIVE CLOTHING?
SUNBLOCK