melanoma: skin cancer prevention and more

Beware of the SunA Melanoma May Result

Mitchell Chorost, M.D.

NY Hospital Queens – Cancer Center

Case example:

• Patient comes into your office and concerned about a mole on his arm

• Noticed mole has enlarged and looks different, but not sure how long its been there

• The question we ask ourselves is: “is this lesion a benign mole or a malignant melanoma?

Diagnosis ?

Is it OK to Get a Tan or Sunburn?Everyone, regardless of skin color,

can sunburn!

A suntan or sunburn are not indicators of good health.

Tanning and sunburns are just like smoking cigarettes; just one suntan or sunburn

can increase your risk of cancer, regardless of skin color.

Primary Prevention of Skin Cancer

Avoid Exposure to Ultraviolet Radiation• Use sunscreen > SPF 15• Wear hats and other protective clothing• Schedule outdoor activities before 10am and after 4pm• Avoid all indoor tanning activity including tanning salons

Primary Prevention of Skin Cancer

Proper Use of Sunscreens

• Apply generously and evenly• Reapply every 2 hours

- if perspiring

- if swimming• Consider waterproof formulas

How Do I Protect My Skin?“Slip, Slop, Slap, & Wrap”

SLIP on a shirt

SLAP on a hat with a 2 to 3-inch brim all around to protect neck, ears, nose and scalp

SLOP on sunscreen and lip balm with an SPF of 15 or higher

WRAP on sunglasses to protect the eyes and skin around them

Secondary Prevention of Skin Cancer

Screening and Early Detection

• Inspect moles for changes• Remove suspicious moles• Remove actinic keratoses and other precancerous

lesions

Recommendations for Skin Cancer Screening

• Skin examinations by a physician, as part of every cancer-related checkup

• Monthly self-examinations are recommended for persons with:

- personal history of skin cancer

- family history of skin cancer

- precursor lesions

- sun damaged skin

Risk Factors for MelanomaRisk Factors for Melanoma

• Light pigmentationLight pigmentation• Family history of malignant melanomaFamily history of malignant melanoma• >3 sunburns during childhood>3 sunburns during childhood• >3 years outdoor occupation during childhood>3 years outdoor occupation during childhood• Immunosuppression Immunosuppression

Source: Balch, et al, 1992.Source: Balch, et al, 1992.

ABCDs

•Asymmetry

•Border

•Color

•Diameter

AAsymmetrysymmetry

One half does not match

the other half.

BBorder irregularityorder irregularity

•The edges are ragged, notched, or blurred.

CColorolor

•The pigmentation is not uniform.

•Shades of tan, brown, or black

•A mottled appearance.

DDiameteriameter

•Greater than ¼ inch. •Any sudden or continuing

increase in size is of special concern.

EEvolutivolutionon

•Changing characteristics of the mole independent of the size or color.

Work-up

• FDG-PET• sensitivity 17% in study with SLN biopsy• some use in distant disease

Additional Therapy

• Radiation• Chemotherapy • Vaccines• Immunotherapy

• Targeted therapy - help the immune system kill cancer cells• Vemurafenib (BRAF inhibition)• Ipilimumab (An antibody CTLA-4 on T cells)

A New Paradigm in Cancer TreatmentA New Paradigm in Cancer Treatment

Haber, Gray, Baselga Cell 2011

See Spot

See Spot Change

See Doctor…………….

Or, See Spot Kill!

Knowledge is Power.

And Hope.