MELANOMA INCIDENCE

“REPORTED MELANOMAS”

• An estimated 192,310 cases of melanoma will be diagnosed in the U.S. in 2019.

• 95,830 cases will be in situ (noninvasive), confined to the epidermis (the top layer of skin)

• 69,480 cases will be invasive, penetrating the epidermis into the skin’s second layer (the dermis).

• 7,230 people will die of melanoma in 2019.

• 4,740 will be men and 2,490 will be women.

COCO CHANEL AND THE CHIC OF TANNING

• In the 1920s, Coco Chanel caught too much sun on a Mediterranean cruise. The photographs of her disembarking in Cannes set a new precedent of beauty; her friend Prince Jean-Louis de Faucigny-Lucigne later said: "I think she may have invented sunbathing.“

• 1960s colour film and commercial air travel was now available

• 1978 Coppertone self-tan

• 1980s and 1990s and 2000s, a survey showed that 50% of Britons said the most important goal for holiday was a tan

• Malignant melanoma rates in the UK more then quadrupled in the last 30 years

DIAGNOSTIC FACTS

• Melanoma is not just skin cancer. It can develop anywhere on the body - eyes, scalp, nails, feet, mouth, etc.

• Melanoma does not discriminate by age, race or gender.

• Melanoma is the leading cause of cancer death in young women ages 25-30 and the second leading cause of cancer death in women ages 30-35.

• In ages 15-29, melanoma is the second most commonly diagnosed cancer.

• Approximately 500 American children are diagnosed with melanoma each year.

• The lifetime risk of getting melanoma is about 1 in 40 for Caucasians, 1 in 200 for Hispanics and 1 in 1,000 for African Americans.

• Ocular melanoma, or melanoma of the eye, is the most common primary eye tumor in adults with around 2,000 new cases diagnosed each year in the United States.

• Mucosal melanoma is a rare form of melanoma that develops in the sinuses, nasal passages, oral cavity, vagina, anus and other areas, making up about 1% of melanoma cases.

DIAGNOSTIC FACTS

• Indoor tanning devices are proven to cause cancer and have been classified into the highest cancer risk category by the World Health Organization's International Agency for Cancer Research (IARC).

• Exposure to tanning beds before age 30 increases a person's risk of developing melanoma by 75%.

• Young people who regularly use tanning beds are 8 times more likely to develop melanoma than people who have never used them.

• Research has found that indoor tanning does not protect against sunburn.

• Having 5 or more blistering sunburns early in life increases one's melanoma risk by 80%.

AAD STATEMENT TO USPSTF GUIDELINES

• SCHAUMBURG, Ill. (July 26, 2016) — “In its Recommendation Statement on Screening for Skin Cancer, the U.S. Preventive Services Task Force — a group that provides guidance for primary care physicians — has determined that there is not enough scientific evidence to make a recommendation about adults receiving skin cancer screenings from a doctor.

• “The American Academy of Dermatology is disappointed with this recommendation, as dermatologists know that skin cancer screenings can save lives, yet we acknowledge the need for additional research on the benefits and harms of skin cancer screening in the primary care setting.

• “It is important for the public to understand that the USPSTF is not recommending against skin cancer screenings; it means the group did not find conclusive evidence to make a recommendation one way or another. Additionally, the public should know that this recommendation does not apply to individuals with suspicious skin lesions and those with an increased skin cancer risk, and it does not address the practice of skin self-exams.

• “The AAD’s SPOTme® skin cancer screening program has been in place for 30 years. During that time, dermatologists have performed more than 2.5 million screenings and found more than 255,000 suspected NMSC lesions and 28,500 melanomas. We know that screenings, which are noninvasive, quick and painless, are the best tool possible to detect skin cancer early when it is most treatable.

• “The AAD encourages everyone to serve as their own health advocate by regularly conducting skin self-exams. Individuals who notice any unusual spots on their skin, including those that are changing, itching or bleeding, should make an appointment with a board-certified dermatologist. In addition, individuals with an increased risk of melanoma — including men older than 50; people with more than 50 moles, or large or unusual moles; individuals with fair skin; and those with a history of skin cancer — should talk to a dermatologist about how often they should receive a skin exam from a doctor.”

5 YEAR SURVIVAL RATES BASED ON MELANOMA DIAGNOSIS 2008 TO 2014

SEER stage 5-year relative survival

rate

Localized 98%

Regional 64%

Distant 23%

All SEER stages

combined

92%

WHAT'S THE BEST NEW THERAPY DERMATOLOGISTS CAN PRESCRIBE

FOR MELANOMA?

•EARLY DETECTION AND REMOVAL (Dr. Rigel, 2019 AAD)

MEDICAL LEGAL ISSUES WITH MELANOMA

• Failure to diagnose Melanoma - 13% of all malpractice claims (1995-2001)

• 86% GPs

• 67% No biopsy

FAILURE TO DIAGNOSE

• Reasons• Difficult presentation

• Clinical diagnostic skills are variable

• Failure to take biopsy (67%)

• Partial biopsy

• Less experienced histopathologists

• Critical appraisal of pathology report

• Duration of follow up

MELANOMA RISK FACTORS

• Family or personal history

• Sun exposure, blistering burns in childhood

• Tanning beds

• Greater then 50 moles

• History of atypical moles

• Fair skin, light eyes

• Genetics (BRAF, p53, CDKN2A, MC1R)

• EARLY DIAGNOSIS IS CRITICAL TO SURVIVIAL

ABCDE

• A- ASYMMETRY

• B- BORDER IRREGULARITY

• C- COLOR VARIATION

• D- DIAMETER GROWING

• E- EVOLUTION AND UGLY DUCKLING SIGN

DERMOSCOPY

BOB MARLEY SHOULDN’T HAVE DIED FROM MELANOMA

• Bob Marley should be celebrating his birthday in May, Instead, the Jamaican singer, musician and songwriter died of melanoma in 1981 when he was only 36.

• When a dark spot appeared under his toenail, Marley attributed it to a recent soccer injury. He probably never imagined it could be anything serious, but the spot turned out to be acral lentiginous melanoma that often becomes aggressive because it is detected later than other melanomas.

BIOPSY PEARL

• Punch biopsy for suspected melanoma or excisional biopsy

• Send to dermatopathologist for reading

• Shave biopsy reserved for BCC, SCC & non-atypical nevi

• If biopsy report ambiguous, re-biopsy and re-evaluate, send to a different facility

• If lesion changes clinically, re-biopsy

55 YR MMIS

75YR 0.34 MM

57 YR 0.91MM

0.28 MM

42 YR 0.65mm

62 YR 0.5MM

73 YR 0.32MM

72 YR FEMALE MMIS

42YR MALE 0.62 MM

68YR MMIS

30 YR 0.32MM

71 YR MMIS

IN SUMMARY

• BE VIGILANT

• Self and physician based skin exams DO increase survival rate

• BIOPSY APPROPRIATELY

• DIAGNOSE, REEVALUATE OR REFFER (DOCUMENT IT!)