1. 3.4.2016 Mark Browning, M.D. IUSME

2.  Intermittent high exposure to the sun is a major risk  Other risk include a family history and an increased number of nevi  Familial atypical multiple mole syndrome (FAMM) caused by mutation of p16 gene

3.  Sun Exposure & Indoor Tanning  Many Moles, Fair Skin, & Family History  Inherited conditions, Familial Melanoma  Previous History of Skin Cancer  Race White’s 24X > Blacks  Average age is 50 …but increases with Age  Immunosuppression

4.  Malignant nevi show variance of color, irregular surface, irregular perimeter, bleeding and ulceration (very bad sign)  Trunk location is worse than extremity location

7.  Key diagnostic information:  Immunohistochemistry S-100 (+), Melan-A (+)  Depth of invasion (Breslow’s score)  Presence or absence of ulceration

9.  Intermittent high exposure to the sun is a major risk  Other risk include a family history, increased number of nevi  Malignant nevi show variance of color, irregular surface, irregular perimeter, bleeding and ulceration (very bad sign)  Breslow's’ score and presence/absence of ulceration are critical to know

10.  76,000/year 47k men & 29 k women  1% of All Cancer  10,000 Deaths per year  10 year Survival Rate is 89% for all melanomas  Survival Rate Depends on the Stage

11.  Self Examination  Front & Back With Mirror & with Arms Raised  Front & Back of Both Legs, Palms, Soles  Neck, Scalp with Hand Mirror  Back, Buttocks & Genitals with Hand Mirror  Photographs with caliber q 6 months & logged  Call Doctor for:  New Growth  Change In Mole  Sore that Doesn’t Heal

12.  Biopsy…Diagnosis…Wide Excision  Sentinel Node Biopsy for Depth > 1mm  Adjuvant Interferon for + Lymph Node or Depth > 4mm  Metastatic Disease  BRAF Inhibitors  BRAF & MEK inhibitors  KIT Inhibitors