Sun safety needs to start at an early age, and continue throughout life, in order to reduce the risk for skin cancer. Learn about prevention and ways to reduce your risk, screening for skin cancer and innovations in treatments.

1. Melanoma
Prevention, Detection &
Treatment
Presented by: Stephanie Badalamenti, MD, PhD, Dermatology
June 10, 2021

2. Melanoma
• Define Melanoma
• Magnitude of Problem
• Prevention
• Detection
• Diagnosis/Staging
• Treatment
2

3. What is Melanoma?
3

4. What is Melanoma?
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5. Melanoma Survival by Depth
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6. Melanoma Survival
Stage of Diagnosis Stage of Distribution 5-year Survival
Localized (primary site) 84% 99%
Regional spread (nodes) 9% 66%
Distant spread organs 4% 27%
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7. r 7
Magnitude of the Problem
Melanoma

8. Magnitude of the Problem
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9. Magnitude of the Problem
• 120,000 cases detected each year
• 8,700 deaths per year
• Most early detectable cancers: colorectal, breast, cervical and prostate have
demonstrated substantial declines over the past 3 decades; however, melanoma
mortality rates have continued to rise
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10. 10
Melanoma Risk Factors
Prevention

11. Melanoma Risk Factors
• Ultra-Violet Radiation (Tanning Salons, Sun Light)
• Personal history of Melanoma
• Family history of Melanoma
• Dysplastic nevi
• More than 50 moles
• Age/Gender
• Skin type
• Occupation
• Socioeconomic Status
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12. Energy – UV Rays
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13. Sunshine Rays
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14. Ultraviolet Light
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15. Tanning Salons
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16. Tanning Salons
In a quest to get a “sunless” tan, almost 30 million Americans visit indoor tanning salons each year. On an average day, more than
1 million Americans visit tanning salons. Of these, 70% are Caucasian girls and women between the ages of 16 and 49. More than 25%
of teen girls have used tanning salons three or more times in their lives.
"Ever-use of indoor tanning services is associated with a 20% increase in lifetime melanoma risk, and this risk doubles if use begins
before age 35 years."
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17. Percentage of U.S. High School Students Who Reported
Indoor Tanning in the Past Year
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18. Natural Sunlight
18

19. Natural Sunlight
• Five sunburns doubles your risk of melanoma
• Cumulative and intermittent sun exposure
• High altitudes increase exposure
• Reflection off sand and snow increase exposure
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20. Seek Shade
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21. Sun Protective Clothing
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22. Sunscreen
22

23. Sunscreen
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24. Sunscreen
• 1-2 ounce
• 30 minutes prior exposure
• Reapplied every 2 hours
• SPF 30- 50
• Creams
• Lotions
• Gels
• Sprays
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25. Sun Protection
• Slip
• Slap
• Slop
25

26. Do public health campaigns that are aimed at modifying sun
exposure work?
• Increased use of sun protection
• Decreased the number of sunburns
• Decreased the number of squamous cell and basal cell skin cancer
• Decreased thickness of melanoma at diagnosis
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27. 27
Early detection saves lives!!
Detection

28. Detection
• Increase the detectors
• General Public
• Spot the Spot
• ABCDEs
• High Risk Patient
• Improve the detectors
• Education
• Technology
• Dermoscopy
• Full Body Photography
• Eye on future technology
• Telemedicine-MoleSafe, iPhone Apps
• Confocal Microscopy
• Non- invasive DNA technology DermTech
28

29. 29
ABCDEs
Melanoma

30. A-Asymmetry
Benign Mole - Symmetrical
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31. Asymmetry-
These are Melanomas - Asymmetrical
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32. B -Boarder
Benign Mole – Sharp Boarder
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33. B-Border
These are Melanomas – Uneven Borders
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34. C -Color
Benign Mole – One Color
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35. C-Color
These are Melanomas – Two or More Colors
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36. D Diameter
Benign Mole – 6mm or Smaller
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37. D- Diameter
These are Melanomas – Larger than 6mm
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38. Evolving
This is Melanoma – a Mole that Changes
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39. 39
Remember:
Asymmetry
Border
Color
Diameter
Evolving
Get ready spot detectors?

40. Is this Melanoma?
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41. Is this Melanoma?
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42. Is this Melanoma?
42

43. Is this Melanoma?
43

44. Is this Melanoma?
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45. Is this Melanoma?
45

46. Is this Melanoma?
46

47. Is this Melanoma?
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48. 48
Because screening saves lives!
Screening

49. Screening High Risk Patients
• New or Changing Mole ABCDEs
• Personal History of Melanoma
• Family History of Melanoma
• History of Tanning Salon Use
• Older Light Skin Men*
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50. 50
Improving the Detectors

51. Dermoscopy
• Studies show this tool improves our
accuracy at identifying Melanomas
• This tool gives us another pattern to
correlate with the ABCDEs of
Melanoma
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52. Dermoscopy
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53. Full Body Photograph
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54. 54
Future technologies

55. Future-Confocal Microscopy
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56. Future-Telemedicine
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57. Future-Non-invasive DNA technology-DermTech
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58. 58
Diagnosis/Staging
Melanoma

59. Biopsy
59

60. Excisional Biopsy
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61. Skin Sample
61

62. Skin Tissue Processed
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63. Dermatopathologist
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64. Dermatopathologist
Essential
• Tumor thickness
• Ulceration
• Mitotic rate
• Margins
• Anatomic level
• Microsatellitosis
Optional
• Angiolymphatic invasion
• Histologic subtype
• Neurotropism
• Regression
• T stage
• Tumor infiltrating lymphocytes and
vertical growth phase
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65. Melanoma Staging
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66. Sentinel Node Biopsy
66
Sentinel
lymph node

67. Sentinel Lymph Node Biopsy: Lymphoscintigraphy
67
Sentinel lymph node
Injection of radiotracer around melanoma

68. 68
Treatment
Surgical
Medical

69. Surgical Treatment –
NCCN-Recommended Surgical Margins for Melanoma
Tumor Thickness Recommended Margin
In situ 0.5 cm
< 1.0 mm 1.0 cm
1.01 – 2 mm 1—2 cm
2.01 – 4 mm 2.0 cm
> 4 mm 2.0 cm
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70. Surgical Treatment
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71. Surgical Treatment
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72. Surgical Treatment
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73. Surgical Treatment
What about patients who have Melanoma in their sentinel lymph nodes?
Until 2017: Completion lymph-node dissection was standard for all patients.
MSLT-II Clinical Trial
• -provided prognostic information
• -did not increase melanoma-specific survival
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74. Medical Treatment
• Radiation therapy
• Chemotherapy
• Biologic therapy
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75. Treatment of Advanced Melanoma
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76. Immune checkpoints and their inhibitors in advanced
melanoma.
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77. Dysregulation of the MAPK signaling pathway in melanoma
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79. Decreasing the Mortality Rate of Melanoma
Prevention
Treatment
Detection
79

80. 80
• Prevention
• Detection
• Well informed patients
• Well trained dermatologists
• Diagnosis
• Dermatopathologist
• Treatment
• Integrated team dermatologists,
oncologic surgeons, oncologists
Summit Health

81. Learn more about Summit Health’s
Dermatology Team at
summithealth.com
Thank You!

82. References
Jenkins, R. W. & Fisher D. E. ( 2021) Treatment of Advanced Melanoma in 2020 and Beyond. Journal Investigative
Dermatology 141, 23-31
Welch, H. G., Mazer, B.L., and Adamson A. A.(2021) The Rapid Rise in Cutaneous Melanoma Diagnoses. New
England Journal of Medicine. 384(1): 72-79.
Qian, Y., Johannet, P., Sawyers, A., Yu., Osman, I., and Zhong, J.(2020) The Ongoing Racial Disparities in Melanoma: An
analysis of the Surveillance, Epidemiology, and End Results (SEER) database (1975-2016). Journal of the American
Academy of Dermatology .08.097
Paulson, K.G., Gupta, D., Kim, T. S., Veatch, J. R., Byrd, D. R., ... Gardner, J.M. (2020)Age-Specific Incidence of Melanoma
in the United States, Journal of American Medical Association Dermatology. 156(1): 57-64.
Leonardi, G.C., Candido, S., Falzone,L., Spandidos, D.A., ….Libra, M.(2020) Cutaneous
Melanoma and the Immunotherapy Revolution. International Journal of Oncology 57: 609-618
Trucco, L.D., Mundra, P.A., Hogan, K. et al.(2019) Ultraviolet radiation–induced DNA damage is prognostic for outcome in
melanoma. Nature Medicine 25, 221–224
Kann, L., Mc Manus, T., Harris, W. A.,Shanklin, S. L., Flint, K. H.,...Ethier, K. A. (2108) Youth Risk Behavior Surveillance-
United States, 2017. Morbidity and Mortality Weekly Report .67(8) 1-114.
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83. References
Faries, M. B, Thompson, J.F., Cochran, R. H, Andtback, N., Mozzillo, J.S., ...Elashoff, R. M (2017) Completion Dissection
or Observation for sentinel-Node Metastasis in Melanoma. New England Journal of Medicine 376; (23) :2211-2222.
Gershenwald, J. E., Scolyer, R. A., Hess, K. R, Sondak, V. K, Long, G. V.,...Thompson, J.F. (2017) Melanoma Staging:
Evidence-Based Changes in the American Joint Committee on Cancer Eighth Edition Cancer Staging Manual. Cancer
Journal Clinics 67(6):472-492.
Trip, M.K., Watson, M., Balk, S. J., Swetter, S. M.,... Gershenwald, J.E. (2016) State of the Science of
Prevention and Screening to Reduce Melanoma Incidence and Mortality: The Time is Now. Cancer Journal Clinics.
66(6):460-480.
Boniol M, Autier P, Boyle P, Gandini S.(2012) Cutaneous melanoma attributable to sunbed use: systematic review and meta-
analysis. British Medical Journal.345:e4757.
Riegel, D.S., Russak, J., & Friedman. R. (2010) The Evolution of Melanoma Diagnosis: 25 Years Beyond the ABCD's. CA
a Cancer Journal For Clinicians. 60(5): 301-16
Abbasi NR, Shaw HM, Rigel DS, Friedman R. J., McCarthy W. H., ...Polsky. D. (2004) Early diagnosis of cutaneous
melanoma: revisiting the ABCD criteria. Journal of American Medical Association 292:2771–2776.
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84. How to find out if your dermatologist did a dermatology
residency
FAAD Fellow of the American Academy of Dermatology
https://find-a-derm.aad.org/
Routine dermatologist-performed full-body skin examination and early melanoma detection.
Kantor J, Kantor DE.Arch Dermatol. 2009 Aug;145(8):873-6. doi: 10.1001/archdermatol.2009.137.PMID: 19687416
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85. Questions?
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