MelanomaPrevention, Detection, Treatment
Stephanie Badalamenti MD-PhD
Dermatologist SMG
West Orange , NJ
May 1, 2013
Melanoma
• Define Melanoma• Magnitude of Problem• Prevention• Detection • Diagnosis/Staging• Treatment
What is Melanoma
What is Melanoma
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%
What is Melanoma
Melanoma
• Define Melanoma• Magnitude of Problem• Prevention• Detection • Diagnosis• Treatment
Magnitude of Problem
Melanoma
• 120,000 detected each year• 8,700 death per year
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
Melanoma
• Define Melanoma• Magnitude of Problem• Prevention• Detection • Diagnosis/Staging• Treatment
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
Energy
Sunshine Rays
Ultraviolet light
Modifiable Risk FactorsSunshine/ Ultraviolet Radiation
• Tanning Salons
• Sunshine
Tanning Salon
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
Natural Sunlight
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
Minimize Sunlight
• Avoid Sun 10-4 pm Slip• Sun Protective Clothing Slap• Sunscreen Slop
Seek Shade
Seek Shade
Sun Protective Clothing
Sunscreen
Sunscreen
Sunscreen
• 1-2 ounce• 30 minutes prior exposure• Reapplied every 2 hours• SPF 30- 50
sunscreens
• Creams• Sprays
Sun protection
• Slip• Slap• Slop
Does modifying sun exposure work?
Increases use of sun protection Decrease sunburns Decrease thickness of melanoma
Melanoma
• Define Melanoma• Magnitude of Problem• Prevention• Detection • Diagnosis/Staging• Treatment
Detection• Increase the detectors
General Public• Spot the Spot• ABCDE’s• High Risk Patient
• Improve the detectors Technology
• Dermoscopy• Full Body Photography
Melanoma ABCDE’s
Asymmetry
Benign Mole — Symmetrical
Melanoma Asymmetrical
Melanoma — Asymmetrical
Border
Benign Mole — Even Edges
Melanoma — Uneven Edges
Melanoma — Uneven Edges
Color
Benign Mole — One Shade
Melanoma — Two or More Shades
Melanoma — Two or More Shades
Diameter
Benign Mole — 6mm or Smaller
Melanoma — Larger than 6mm
Melanoma — Larger than 6mm
Evolving
Melanoma — a Mole that Changes
Screening High Risk Patients
• New or Changing Mole ABCDE’s• History of Melanoma• Family history Melanoma• Tanning salon users• Older men• All new patients
Screening
• American Caner Society Every 3 years between 20-40 years Every year over 40 year
Improving the Detectors
• Dermatologist are the best at finding melanoma
Dermoscopy
Dermoscopy
Full Body Photograph
Melanoma
• Define Melanoma• Magnitude of Problem• Prevention• Detection • Diagnosis/Staging• Treatment
Biopsy
Excisonal Biopsy
Skin sample
Skin tissue processed
Dermatopathologist
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
Staging
Sentinal node biopsy
Melanoma
• Define Melanoma• Magnitude of Problem• Prevention• Detection • Diagnosis/Staging• Treatment
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%
Surgical Treatment
Summit Medical Group• Prevention• Detection
Well informed patients Well trained dermatologist
• Diagnosis Dermatopathologist
• Treatment Integrated team dermatologists, surgeons, oncologists
Surgical Treatment
Surgical Treatment
Surgical Treatment
Surgical treatment
• If melanoma is found in the sentinal lymph node the lymph nodes in that section may be removed
Medical Treatment
• Radiation Therapy• Chemotherapy• Biologic therapy
Ipilimumab/ Yervoy Vemurafenib/ Zelboraf
• 5% vs 48%
11 Possible Medications
Melanoma
• Define Melanoma• Magnitude of Problem• Prevention• Detection • Diagnosis/Staging• Treatment
SMG Dermatology
• Monib Zirvi MD-PhD• Hari Nadiminti MD• Sam Kim MD• Gabe Gruber MD• Emily Altman MD • Naheed Abbasi MD MPH
Melanoscan
Dermoscopy Advances
Confocal Microscopy
Confocal Microscopy
Recommended
