Melanoma

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