MOLES, MELANOMA and SKIN CANCER

Mary C. Martini, MD, FAADAssociate Professor Dermatology

Director, Melanoma and Pigmented Lesion ClinicNorthwestern University

MOLES Everyone gets

moles They can get

bigger and darker due to sun burns and heavy sun exposure

Some families make “atypical” or irregular moles

MOLES

MOLES Benign or healthy

moles

Irregular moles-”dysplastic”

Melanoma

Dysplastic Nevus Multicolored Asymmetric

pigment deposition

Asymmetric contour-macular and papular

Indistinct margins

Atypical mole syndrome-(Dysplastic nevus

syndrome) >100 melanocytic

nevi 1 or more nevi

>8mm in diameter

1 or more dysplastic nevi on exam

Atypical Mole Syndrome has a 10 year risk of developing melanoma of 14%

Wang et al.JAAD 2005;50:15-20

Management of the Dysplastic Nevi Patient

Close monitoring- full body exams every 6 months

Dermoscopy of all atypical appearing nevi

Whole Body Photos Excision of any changing or

markedly atypical nevi

Body Mapping Studio

positioning stage indexed monostandbalanced cross-lighting

high resolution digital camera

body mapping software

The Body Map

At Home Exam

Dermoscopy The magnified visualization of pigmented skin

lesions beyond what would be visible by the physician

Increases diagnostic accuracy by 10-20%

Dermlite.com

Benign Nevireticulated pattern

Dysplastic Nevi

Asymmetric pigment pattern

Irregular depigmentation

Irregular edge

Dysplastic Nevi

Melanoma

Melanoma

Changes in Overall Cancer Mortality (1975-2000)

Prostrate -5% Breast -15% Colorectal -25% MELANOMA +28%

Melanoma

Melanoma

Tumor Thickness- Breslow level

Level 5yr survival

<0.75mm 97.9%

0.76-1.49mm 91.7%

1.5-3.99mm 72.8% >4mm 57.5% Barnhill et al,Cancer 1996

Incidence of melanoma 1900 - 1 in 2000 2004 - 1 in 70 Major cause is ultraviolet exposure

Tanning bed use before the age of 35 increases the risk

of skin cancer by 75%

SUN DAMAGE

PHOTOAGING Sun damage

Pollution

Heredity

LENTIGOS “Sunspots or big

freckles” Increase in size

and color with more sun exposure

Areas with these growths may be areas that develop skin cancer years later

Lentigo

Lentigo

Photodamage

Actinic Keratosis

SKIN CANCER Basal cell

carcinoma

Squamous cell skin cancer

Melanoma

Basal Cell Carcinoma Most common skin cancer Never metastasizes Sun damage is the major cause

Basal Cell Carcinoma

Basal Cell Carcinoma

Squamous Cell Carcinoma Second most common form of skin

cancer Can metastasize if neglected and

continues to grow Sun damage plays a major role

Squamous Cell Carcinoma Can occur in preexisting burn and

traumatic scars Can occur on lower lip due to

smoking or chewing tobacco in addition to actinic damage

Squamous Cell Carcinoma

Benign Lesions

Warts Caused by a virus Spread by shedding

skin Treated by “cryo”, 5FU or salicylic acid

plaster-oral/genital warts

linked to cervical and oral/throat cancer

WARTS

Angiomas

Seborrheic Keratosis

Dermatofibromas

Sebaceous Hyperplasia

SUNSCREENS Facial everyday sunscreens SPF 15-25: Eucerin

facial, Oil of Olay facial, Purpose

Chemical free- titanium dioxide and zinc oxide- Blue Lizard and Neutragena

Waterproof sunscreens SPF 35-70: Coppertone sport, Neutragena with helioplex, Blue lizard, in Canada or Europe sunscreens with Mexoryl

Reapply every 2 hours if swimming or sweating

Skin Cancer Prevention Skin protection involves use of

sunscreens including reapplication Wear sun screen containing

clothing and hats Avoid prolonged sun exposure

from 11 am to 3 pm