Melanoma – Prevention, Detection and Treatment
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MelanomaPrevention, Detection, Treatment
Stephanie Badalamenti MD-PhD
Dermatologist SMG
West Orange , NJ
May 1, 2013
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Melanoma
• Define Melanoma• Magnitude of Problem• Prevention• Detection • Diagnosis/Staging• Treatment
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What is Melanoma
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What is Melanoma
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Melanoma SurvivalStage at Diagnosis Stage Distribution 5 yr survial
Localized (primary site) 84% 98.2%
Regional spread(nodes) 9% 62.4%
Distant spread organs 4% 15.1%
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What is Melanoma
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Melanoma
• Define Melanoma• Magnitude of Problem• Prevention• Detection • Diagnosis• Treatment
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Magnitude of Problem
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Melanoma
• 120,000 detected each year• 8,700 death per year
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Magnitude of Problem
• Most early detectable cancers: colorectal, breast, cervical and prostate have demonstrated substantial declines over the past 3 decades melanoma mortality rates have continued to rise
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Melanoma
• Define Melanoma• Magnitude of Problem• Prevention• Detection • Diagnosis/Staging• Treatment
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Melanoma Risk Factors
• Sun Exposure (Ultra Violet Radiation)• Family history of Melanoma• Dypslastic nevi • More than 50 moles• Age/Gender• Skin type• Occupation• Socioeconomic Status
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Energy
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Sunshine Rays
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Ultraviolet light
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Modifiable Risk FactorsSunshine/ Ultraviolet Radiation
• Tanning Salons
• Sunshine
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Tanning Salon
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Tanning Salons• 40-50% of 16-17 year old girls • 2.3 Millions adolescents yearly• More tanning salons per city then Starbuck or
McDonalds• Increase risk of Melanoma 75% • Legislation was passed NJ April 1, 2013
Banning tanning under age 17
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Natural Sunlight
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Natural Sunlight
• 5 sunburns doubles your risk of melanoma• Cumulative and intermittent sun exposure• High Altitudes increase exposure• Reflection off sand and snow increase
exposure
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Minimize Sunlight
• Avoid Sun 10-4 pm Slip• Sun Protective Clothing Slap• Sunscreen Slop
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Seek Shade
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Seek Shade
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Sun Protective Clothing
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Sunscreen
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Sunscreen
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Sunscreen
• 1-2 ounce• 30 minutes prior exposure• Reapplied every 2 hours• SPF 30- 50
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sunscreens
• Creams• Sprays
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Sun protection
• Slip• Slap• Slop
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Does modifying sun exposure work?
Increases use of sun protection Decrease sunburns Decrease thickness of melanoma
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Melanoma
• Define Melanoma• Magnitude of Problem• Prevention• Detection • Diagnosis/Staging• Treatment
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Detection• Increase the detectors
General Public• Spot the Spot• ABCDE’s• High Risk Patient
• Improve the detectors Technology
• Dermoscopy• Full Body Photography
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Melanoma ABCDE’s
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Asymmetry
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Benign Mole — Symmetrical
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Melanoma Asymmetrical
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Melanoma — Asymmetrical
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Border
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Benign Mole — Even Edges
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Melanoma — Uneven Edges
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Melanoma — Uneven Edges
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Color
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Benign Mole — One Shade
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Melanoma — Two or More Shades
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Melanoma — Two or More Shades
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Diameter
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Benign Mole — 6mm or Smaller
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Melanoma — Larger than 6mm
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Melanoma — Larger than 6mm
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Evolving
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Melanoma — a Mole that Changes
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Screening High Risk Patients
• New or Changing Mole ABCDE’s• History of Melanoma• Family history Melanoma• Tanning salon users• Older men• All new patients
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Screening
• American Caner Society Every 3 years between 20-40 years Every year over 40 year
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Improving the Detectors
• Dermatologist are the best at finding melanoma
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Dermoscopy
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Dermoscopy
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Full Body Photograph
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Melanoma
• Define Melanoma• Magnitude of Problem• Prevention• Detection • Diagnosis/Staging• Treatment
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Biopsy
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Excisonal Biopsy
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Skin sample
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Skin tissue processed
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Dermatopathologist
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Dermatopathologist
Essential• Tumor thickness• Ulceration• Mitotic rate• Margins• Anatomic Level• Microsatellitosiss
Optional• Angiolymphatic Invasion• Histologic Subtype• Neurotropism• Regression• T stage• Tumor infiltrating
lymphoctes and vertical growth phase
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Staging
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Sentinal node biopsy
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Melanoma
• Define Melanoma• Magnitude of Problem• Prevention• Detection • Diagnosis/Staging• Treatment
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Melanoma Survival
Stage at Diagnosis Stage Distribution 5 yr survial
Localized (primary site) 84% 98.2%
Regionalspread(nodes) 9% 62.4%
Distant spead 4% 15.1%
Unkown 4% 75.8%
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Surgical Treatment
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Summit Medical Group• Prevention• Detection
Well informed patients Well trained dermatologist
• Diagnosis Dermatopathologist
• Treatment Integrated team dermatologists, surgeons, oncologists
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Surgical Treatment
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Surgical Treatment
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Surgical Treatment
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Surgical treatment
• If melanoma is found in the sentinal lymph node the lymph nodes in that section may be removed
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Medical Treatment
• Radiation Therapy• Chemotherapy• Biologic therapy
Ipilimumab/ Yervoy Vemurafenib/ Zelboraf
• 5% vs 48%
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11 Possible Medications
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Melanoma
• Define Melanoma• Magnitude of Problem• Prevention• Detection • Diagnosis/Staging• Treatment
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SMG Dermatology
• Monib Zirvi MD-PhD• Hari Nadiminti MD• Sam Kim MD• Gabe Gruber MD• Emily Altman MD • Naheed Abbasi MD MPH
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Melanoscan
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Dermoscopy Advances
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Confocal Microscopy
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Confocal Microscopy