1. MELANOMA Stephen G. Mallette, D.O. Athens, Alabama

2. MELANOMA A melanoma is a tumor produced by the malignant transformation of melanocytes The melanocytes are derived from the neural crest Cells derived in the neural crest migrate to the skin, G. I. tract and brain

3. MELANOMA TYPES Superficial spreading- constitutes 70% of melanoma Nodular- 15-30% of melanoma Lentigo maligna- 4-10% of melanoma Acral lentiginous- 2-8% of melanoma

6. FINDING MELANOMA Looking for the ABCDs which are asymmetry,irregular border, color changes, increase in diameter and evolving Family history Patient history—have they seen a change? Universal consideration and appearance

7. WHO GETS MELANOMA 75% of melanoma occurs after the age of 45 It is the third most common cancer in women ages 20- 39 It is the second most common cancer in men ages 20 to 39 Caucasian patients are 20 times more likely to develop melanoma than African americans. This translates to a 1 in 40 lifetime risk for Caucasians, 1 in 1000 for African Americans and 1 in 200 for Hispanics.

8. BIOPSY OF A POTENTIAL MELANOMA Punch biopsy Shave biopsy Saucer biopsy Excisional biopsy, minimal margin Excisicional biopsy,.5 to 1cm margin Which is the correct choice?

9. BIOPSY CHOICE Studies show that excision < shave < punch Shave biopsy is accurate 97% of cases when less than 2mm thick Ng: Arch Dermatol 2010 March and Zaser: J Am Coll Surg 2011 Apr Biopsy type is often chosen based on size of lesion, degree of suspicion and location

10. MELANOMA FREQUENCY Makes up 1% of skin cancers but causes a majority of skin cancer deaths About 76,380 new melanomas will be diagnosed in 2016 and 10,130 people are expected to die of melanoma About 5.4 million BCC and SCC are diagnosed each year in around 3.3 million people. Around 2000 deaths each year

11. BIOPSY This blade can adjust depth of biopsy for saucerization vs shave

12. TUMOR MARGINS

13. SENTINEL NODE BIOPSY In stage I, sentinel node biopsy is recommended if tumor depth is greater than 1mm Sentinel node biopsy is recommended for both Stage II and III Stage IV is metastatic disease

14. MEDICAL THERAPY FOR MELANOMA