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

2. 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

3. MOLES

4. Benign or healthy moles Irregular moles- ”dysplastic” Melanoma

5. Dysplastic Nevus Multicolored Asymmetric pigment deposition Asymmetric contour- macular and papular Indistinct margins

6. Atypical mole syndrome- (Dysplastic nevus syndrome) >100 melanocytic nevi 1 or more nevi >8mm in diameter 1 or more dysplastic nevi on exam

7. Atypical Mole Syndrome has a 10 year risk of developing melanoma of 14% Wang et al.JAAD 2005;50:15-20

8. 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

9. Body Mapping Studio positioning stage indexed monostand balanced cross- lighting high resolution digital camera body mapping software

10. The Body Map

11. At Home Exam

12. Dermoscopy The magnified visualization of pigmented skin lesions beyond what would be visible by the physician Increases diagnostic accuracy by 10-20% Dermlite.com

13. Benign Nevi reticulated pattern

14. Dysplastic Nevi

15. Asymmetric pigment pattern Irregular depigmentation Irregular edge Dysplastic Nevi

16. Melanoma

19. Changes in Overall Cancer Mortality (1975-2000) Prostrate -5% Breast -15% Colorectal -25% MELANOMA +28%

20. Melanoma

22. 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

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

25. Tanning bed use before the age of 35 increases the risk of skin cancer by 75%

26. SUN DAMAGE

27. PHOTOAGING Sun damage Pollution Heredity

28. 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

29. Lentigo

31. Photodamage

32. Actinic Keratosis

33. SKIN CANCER Basal cell carcinoma Squamous cell skin cancer Melanoma

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

35. Basal Cell Carcinoma

37. Squamous Cell Carcinoma Second most common form of skin cancer Can metastasize if neglected and continues to grow Sun damage plays a major role

38. 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

39. Squamous Cell Carcinoma

40. Benign Lesions

41. 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

42. WARTS

43. Angiomas

44. Seborrheic Keratosis

47. Dermatofibromas

49. Sebaceous Hyperplasia

50. 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

51. 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