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Melanoma

Melanoma. Due to its preventable nature and its increasing incidence, the U.S. Surgeon General has labeled melanoma a “public health crisis” 1 - U.S. Surgeon General’s Office. Skin cancer - most commonly diagnosed cancer in the U.S. 2

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Melanoma

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  1. Melanoma

  2. Due to its preventable nature and its increasing incidence, the U.S. Surgeon General has labeled melanoma a “public health crisis” 1 - U.S. Surgeon General’s Office Skin cancer - most commonly diagnosed cancer in the U.S.2 Melanoma- mostskin-cancer related deaths: one person every hour dies from melanoma in the United States.2,3. Men have worse outcomes. 67%of deaths occur in men. 2 Introduction

  3. Anatomy

  4. Melanoma: cancer of Melanocytes1,2 pigment producing cells in basal epidermis Anatomy

  5. Risk Factors

  6. Blue or Green Eyes Light Colored Skin Immunocompromised Risk Factors

  7. Dysplastic Nevi Risk Factors Blistering Sunburns

  8. Higher Elevation Closer to Equator Risk Factors

  9. Upper Back Freckles • Family • History • of Melanoma • 3+ • years of outdoor occupation • as teen • 6 High Risk Factors That Independently Increase Melanoma • Blond or Red Hair • Actinic Keratosis • 3+ Blistering Sunburns under • Age • 20 Risk Factors

  10. Indoor Tanning Tried by: 35% of adults 55% of college students 19% of teens The World Health Organization has labeled tanning beds as “carcinogenic” Risk Factors

  11. 2/3 of tanning bed customers are Caucasian females Melanoma is increasing at a faster rate in females 15-29 than in young men in same age bracket. Risk Factors

  12. Individuals with one or twoof the risk factors have a • 3Xrisk of developing melanoma1,2,3 • 9Xrisk of developing melanoma recurrence 1,2,3 Risk Factors - Significance

  13. Pathophysiology

  14. Progression of Melanoma1 Pathophysiology

  15. Epidemiology

  16. In the U.S, over 1 million people living with melanoma1 • 5th most common cancer in males 2 • 7th most common cancer in females 2 Epidemiology

  17. New Cases Diagnosed per year1 Deaths per year1 Epidemiology

  18. Between 1990 and 2009 1,2,3 Melanoma death rates by 10.5% in males by 9.6% in females Epidemiology

  19. In the U.S, there are nearly 10,000 melanoma deaths yearly.1 Melanoma Mortality by Sex 1,2 • 2/3 • 1/3 Females 33% Males 67% Epidemiology

  20. Female Survival Advantage

  21. Females have a 30% survival advantageover males.1 • Observed across every stage of melanoma1,2,3 Female Survival Advantage

  22. Females have a lower risk of: 1,2 • Tumor Progression • Metastasis to Lymph Nodes • Metastasis to Distant Site Female Survival Advantage

  23. Most common melanoma sites by sex1 Female Survival Advantage

  24. 2 Groups of Hypotheses1,2 Female Survival Advantage

  25. Preventive Behaviors1,2,3,4 Females are more likely to see a physician: sooner Earlier Diagnosis Earlier Stage (Better Prognosis) Female Survival Advantage-Behavioral

  26. Health Maintenance • Females more likely to:1,2,3,4 • Self-examine skin for abnormal markings • Have full body skin check by a healthcare provider • Regularly visit physician for a skin exam to monitor for recurrence Female Survival Advantage-Behavioral

  27. Skin Protection • Females are more likely to wear: 1,2,3,4 • Long sleeved shirts • Sunscreen • Sunglasses • Scarf or umbrella • Pants that reach their ankles Female Survival Advantage-Behavioral

  28. Sun Avoidance Behavior • Females are more likely to: 1,2,3,4 • Limit outdoor activity • Seek shade when outdoors Female Survival Advantage-Behavioral

  29. Males are more likely to have melanoma on the trunk, especially the back.1,2,3 Females are more likely to have melanoma on the extremities such as legs.1,2,3 More visible, may lead to earlier diagnosis Female Survival Advantage-Biological/Behavioral

  30. IMMUNE SYSTEM • Females with Melanoma: • More CD4+ T cells that are antigen specific to melanoma cells1,2 • More resistant to immunosuppression caused by UV radiation1 Female Survival Advantage-Biological

  31. ESTROGEN • Conflicting data on the role of estrogen • Estrogen receptors, not the hormone levels, are more likely to explain the survival advantage of females Female Survival Advantage-Biological

  32. ESTROGEN RECEPTORS1 • ERβ-expressed in melanoma cells • Agonists of inhibit melanoma cell proliferation • Premenopausal women have higher levels of ER β than males and postmenopausal females. Female Survival Advantage-Biological

  33. MELANOMA AND PROSTATE CANCER1,2,3 • Men with prostate cancer have increased risk for melanoma. • Mechanism still unknown • Hypothesized that androgens may be involved Female Survival Advantage-Biological

  34. Clinical Presentation

  35. Clinical Presentation

  36. Treatment

  37. Surgical Excision1,2,3 • First Line Treatment Treatment

  38. Immunotherapy1,2 • Following Surgery • Some may benefit Treatment

  39. Chemotherapy1,2 • For those unable to tolerate immunotherapy • Patients have shown poor response to treatment • No increase in survival Treatment

  40. Population Based Screening

  41. Many developed countries have adopted population based screening for skin cancer.1 Australia Germany France Population Based Screening Japan Belgium France

  42. Since then, Germany has seen a nearly 40% decrease in melanoma mortality. 1,2 Population Based Screening

  43. United States Preventive Services Task Force (USPTF) Recommendation: • “Insufficient” evidence for skin cancer screening for adults without a history of skin cancer Population Based Screening

  44. In response to the USPSTF, the American Academy of Dermatology issued its own statement: • Encouraging the public to regularly perform self skin checks • And to see a dermatologist for spots that change in appearance, itch, or bleed Population Based Screening

  45. Conclusion

  46. WE KNOW THERE IS A GENDER GAP STATSICALLY BEHAVIORALLY BIOLOGICALLY DO SOMETHING As providers, let’s about it Population-based Screening Conclusion Patient Education Follow-Up

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