1. BIOE 301 Skin Cancer

2. US Skin Cancer: 2004 ~1,000,000 new cases of basal or squamous cell carcinoma, and 59,350 new cases of malignant melanoma in the US in 2004 –Most common cancer in US 9,800 deaths in US, 2004

3. Skin Cancer Around the World Go To…. The Cancer Atlas: UV Radiation http://www.cancer.org/downloads/AA/CancerAtlas08.pdf

4. Who gets Skin Cancer? Median age for diagnosis = 57 –Think you’re safe??? Age group < 2020-3435-4445-5455-6465-7475-8485+ % of pop. diagnos ed 0.8%9.4%15.0%19.4%17.8%17.9%14.8%5.0%

5. Who gets Skin Cancer? Median age for diagnosis = 57 –Think you’re safe??? Age group < 2020-3435-4445-5455-6465-7475-8485+ % of pop. diagnos ed 0.8%9.4%15.0%19.4%17.8%17.9%14.8%5.0% “Too Young To Get Skin Cancer? Think again. When I was only 15 melanoma changed my life forever” by Jacky SimsToo Young To Get Skin Cancer? Think again. When I was only 15 melanoma changed my life forever

6. Tune In NPR: Rising Rates of Skin Cancer in Young Adults http://www.npr.org/templates/story/story.php?storyId=4793569

8. Who is at Risk ? Although anyone can develop skin cancer, some people are at particular risk. Risk factors include: - Light skin color, hair color, or eye color. - Family history of skin cancer. - Personal history of skin cancer. - Chronic exposure to the sun. - History of sunburns early in life. - Certain types of moles or a large number of moles. - Freckles, indicate sun sensitivity and sun damage www.cdc.gov

9. Risk to Children –child's skin is thinner and more sensitive –frequent sun exposure and sunburn in childhood set the stage for high rates of melanoma later in life –Children have more time to develop diseases with long latency –Children are more exposed to the sun. Estimates suggest that up to 80 per cent of a person's lifetime exposure to UV is received before the age of 18. –Children love playing outdoors but usually are not aware of the harmful effects of UV radiation

10. UV Indicator New Global Solar UV Index For more information, visit the EPA's UV Index Web site.EPA's UV Index Web site

11. Interpret Today’s UV Index http://www.cpc.ncep.noaa.gov/products/stratosphere/uv_index/gif_files/min2brn.gif

12. Truths & Myths about Sun exposure 1.You can’t get sunburned on a cloudy day. False - Up to 80% of solar UV radiation can penetrate light cloud cover. Haze in the atmosphere can even increase UV radiation exposure. 2.UV radiation exposure is cumulative during the day True! 3. A tan protects you from the sun. False - A dark tan on white skin only offers an SPF of about 4. 4. A sun tan is Healthy. False - A tan results from your body defending itself against further damage from UV radiation. www.who.org

13. Truths & Myths of Sun Exposure Continued… 5. Sunscreens protect me so I can sunbathe much longer. Fasle - Sunscreens are not intended to increase sun exposure time but to increase protection during unavoidable exposure. 6. Sunburn is caused by UV radiation which cannot be felt. True - Most of the heating is caused by the sun’s visible and infrared radiation and not by UV radiation. 7. Water offers only minimal protection from UV radiation, and reflections from water can enhance your UV radiation exposure. True! www.who.org

14. The Skin

16. Melanocytes and Melanin Melanocytes are cells that produce Melanin, a pigment that gives skin, hair, and eyes their coloring. http://www.mayoclinic.com/health/sun-damage/HQ01462

17. Suntan A Suntan results when the skin increases production of melanin, in response to damage caused by UV light. Melanin absorbs UV light, and protects the deeper layers of skin. Everytime the skin is exposed to the sun, ones lifetime dose of UV increases. This damage accumulates, increasing ones risk for skin cancer.

18. UV Radiation (UVR) Source:http://www.durascreen-usa.com/info1.asp Sunburn Penetrating Rays

19. What About Tanning Beds? Video, CBS News: Teens Hooked On Tanning Tanning beds emit mainly UVA rays. While they do not cause sunburn, they are not safe! Research has shown that long term users have an 8 fold greater chance of developing Melanoma.

20. Sunburn UVA and UVB penetrate the skin, bombarding the genetic material inside skin cells causing damage. Cells do have repair mechanisms that can correct mutations in the DNA. When the damage is overwhelming, cells undergo apoptosis (cell suicide) causing the skin to peel. Damaged cells that are not repaired or killed may give rise to skin cancer. While dark skin may not turn red and blister, damage to the cells still occurs.

21. Histology of Skin Cancer

24. Types of Skin Cancer: Basal Cell Carcinoma, Squamous Cell Carcinoma, and Melanoma

25. Basal Cell Carcinoma Most common type of skin cancer. Slow-growing cancer that rarely metastasizes and is almost never fatal. Growths begin in the the basal layer and are made of basal cells. Basal cells continually divide to replenish the 2 square meters of surface skin that is continually weathering away. Basal Layer

26. Basal Cell Carcinoma Usually develop on sun-exposed areas like the head and neck. Sometimes appear as a red patch of skin or a pearly, translucent bump. They can also be an irritable open sore that doesn't heal, or a scar-like lesion.

27. Squamous Cell Carcinoma –2 nd most common form of skin cancer. –The most common type of skin cancer in people with darker skin –These cancers develop in higher levels of the epidermis, where cells grow tough to protect the body.

28. Squamous Cell Carcinoma –May occur on all parts of the body, including mucus membranes, but most common on sun exposed parts of the body (face, neck, hands, shoulder, arms). –Can appear as a scaly red patch that sometimes scabs or bleeds; an open sore that refuses to heal; or a raised, wart-like growth.

29. Melanoma Melanoma is the most severe skin cancer. While less common, it occurs at a much younger age (between 20 and 45 years). It is a malignant tumor that originates in the melanocytes. Every blistering sunburn before the age of 18 increases one’s chance of developing melanoma.

30. Diagnosis: The ABC’s of Melanoma Assymmetry When half of the mole does not match the other half. Border When the border of the mole is ragged or irregular Color When the color of the mole varies throughout Diameter If the mole’s diameter is larger than a pencil eraser

31. Progression and 10yr. Survival Rate in Melanoma.

32. How Successfully Can We Treat Skin Cancer?

33. Non-Melanoma Treatment and Cure Rate Type of CancerTreatmentCure Rate Basal Cell Carcinoma Moh’s micrographic surgery 99% Squamous Cell Carcinoma Simple Excision95-99%

34. Mohs Procedure http://www.mohscollege.org/mohssurgery.mpg

35. Melanoma Treatment Options Type of treatment depends on stage of cancer… Surgical Excision (always done) via Moh’s or other method Depending on Severity of Cancer –Removal of Regional Lymph Nodes –Chemotherapy –Radiation

36. Stage I Stage II Stage III Stage IV Melanoma Survival

37. Should We Screen?

38. Conflicting Recommendations..

39. Opinion of the National Cancer Institute Non-Melanoma and Melanoma Skin Cancer -Inadequate evidence to determine whether visual examination of skin in asymptomatic individuals would lead to a reduction in mortailty. -Fair evidence that it would have negative and potentially harmful consequences (unnecessary surgery).

40. Clinical Trials

41. Screening Technology: Dermoscopy Simple combination of light source and magnification allows for increased- diagnostic accuracy More Advanced Versions have come available –SolarScan: Records Images, computer analyzes and compares mole shape and color to known clinical diagnostic criteria. Above: SolarScan Above: Basic Dermatoscope http://www.dermoscopy.org/atlas/base.htm

42. Screening Technology Melafind MelaFind –Currently in phase III clinical trials in the United States –Produces 10 wavelengths to penetrate the skin at varying depths and collect images. –Looks for disorder among the skin cells: a characteristic of cancer

43. References http://www.southeastmissourihospital.com/health/adult/women/skincaus.htm http://www.ehponline.org/members/2003/111-14/innovations.html http://www.smu.org.au/what-is-melanoma-/what-causes-melanoma-.html http://www.cancer.org/docroot/AA/content/AA_2_5_9x_Cancer_Atla s.asphttp://www.cancer.org/docroot/AA/content/AA_2_5_9x_Cancer_Atla s.asp http://www.ehponline.org/members/2003/111-14/EHP111pa770PDF.PDF http://www.aafp.org/afp/20000715/357.html http://www.clevelandclinicmeded.com/diseasemanagement/dermatology/melanoma/t able1melanoma.htmhttp://www.clevelandclinicmeded.com/diseasemanagement/dermatology/melanoma/t able1melanoma.htm Project SAFETY Teacher’s Guide. University of Texas MD Anderson Cancer Center. Ordering information available online at: http://www.mdanderson.org/departments/projectsafety/