MOLES, MELANOMA and SKIN CANCER Mary C. Martini, MD, FAAD Associate Professor Dermatology Director, Melanoma and Pigmented Lesion Clinic Northwestern 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

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 monostand balanced 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 Nevi reticulated pattern

Dysplastic Nevi

Asymmetric pigment pattern Irregular depigmentation Irregular edge Dysplastic Nevi

Melanoma

Changes in Overall Cancer Mortality ( ) Prostrate -5% Breast -15% Colorectal -25% MELANOMA +28%

Melanoma

Tumor Thickness- Breslow level Level 5yr survival <0.75mm 97.9% mm 91.7% mm 72.8% >4mm 57.5% Barnhill et al,Cancer 1996

Incidence of melanoma in 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

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

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