1 Congenital Melanocytic Naevi Written by Dr Veronica Kinsler, Great Ormond Street Hospital for Children, London in association with Caring Matters Now Support Group
2 Congenital Melanocytic Naevi
3 What is a CMN? A Congenital Melanocytic Naevus (or CMN) is a type of birthmark. It is also a mole. Congenital = present at birth. Melanocytic = to do with melanocytes. Melanocytes are cells in everyone s skin and hair that produce the pigment melanin. This is what gives us our hair and skin colour. The cells in a CMN look most like melanocytes and they produce pigment, so they are called melanocytic. Naevus = birthmark (the plural is naevi). Though CMN means birthmark or mole at birth, in fact, not all of them are present at birth. Around 1% of CMN appear after birth, usually in the first year of life. They look exactly the same as the ones present at birth, but are called CMN tardive, which means late. How often do CMN occur? Single small CMN are found in 1% of all newborn babies. Large or very numerous CMN however are rare, occurring in around 1 in 20,000 births. The frequency seems to be similar around the world and amongst different populations. What does a CMN look like? Almost every CMN looks different to the next one. Site: CMN can be on any part of the skin, including palms, soles and scalp, but also sometimes inside the mouth. Colour: the colour is usually some sort of shade of brown to black, but sometimes they can be more reddish. It is often very mixed inside the CMN, with smaller areas of different colour on a background colour. CMN at birth are often black, or even dark purple/red.
4 Hairiness: CMN usually have hair growing out of them, although this is often not visible at birth and can remain unnoticeable throughout life. The hair colour can be darker than the child s head hair, or the same, or very occasionally lighter. If a CMN is on the scalp there is usually more luxuriant hair growth over the lesion and the hair grows faster than on the rest of the scalp. Occasionally, CMN are completely hairless, even ones that occur in the scalp, or can have patchy hair loss or hairs without pigment (like grey hair). Spontaneous lightening of CMN In most children the CMN will lighten to some degree in the first few years of life. This is still being studied but it appears to happen more in children with light or red hair and pale skin than in those with darker hair and skin colour. In some children the lightening is very dramatic and in very rare cases the CMN can disappear or stop producing pigment. Texture: the texture of large CMN tends to be different from that of normal skin, being softer, looser and more wrinkled. The CMN can be nearly flat or can be very folded or lumpy. Large CMN with different colours within it. There are some open areas which can sometimes happen at birth but then heal. Flat texture on the back. Particularly dramatic lightening in a CMN.
5 Problems with CMN Fragility: many CMN are more fragile than normal skin. They can therefore tear more easily if they are knocked or scraped. However, they do not bleed any more than normal skin, and they tend to heal well with minimal scarring. Hardness: very rarely, a CMN may be really quite hard from the beginning, or may become harder over a period of time. This hardness is usually due to fibrosis, a kind of scarring process, the exact cause of which is unknown. This process is generally accompanied by loss of hair and often also by decreasing pigmentation. Lumpiness in a CMN on the hand. Dryness: some CMN are drier than the surrounding skin, need to be washed without soap, and moisturised regularly (your doctor can advise you on this). Occasionally, CMN are very itchy which can be due to dryness, or eczema in the CMN, or sometimes for no apparent reason. This itchiness can usually be treated using creams and ointments. Underlying decrease in fat: this is usually only seen with larger CMN. For some reason, the presence of the CMN interferes with the layer of fat that is normally present between the skin and underlying muscle and bone. This can result in the CMN appearing to be depressed below the general skin surface, the limb, buttock or side of the face appearing obviously thinner than normal. The thinner area functions just as normal for example, a thinner leg will be perfectly strong, as the thinness is only due to less fat and not less muscle. The right thigh is noticeably thinner than the left, due to less fat under the CMN in that area.
6 Congenital Melanocytic Naevi
7 The size and growth of CMN CMN almost always grow in proportion to the child. In other words, they will usually continue to cover the same area of skin as at birth. (The exceptions to this are tardive CMN, as these appear after birth and can therefore appear to grow, or occasionally where part of a CMN is very pale, it can darken up in the first few months and appear to grow). The size that a CMN will end up can therefore be estimated from the size at birth by looking at its size and where it is. The total number of naevi can increase after birth, although this does not always happen. It is more likely to happen in children with very large and multiple CMN, and new naevi are always relatively small. Multiple CMN lesions of different sizes, colours and textures. CMN classification CMN are classified according to the size they will be in adulthood (known as projected adult size ). This is a difficult definition to understand because different parts of the body grow at different rates, but it is used to give doctors a way of comparing different CMN. We no longer define CMN as small/medium/large/giant, but by the size in adulthood of the largest one and the total number of naevi. Usually, but not always, these two measures go together in other words very large CMN are usually accompanied by lots of other naevi. These other naevi used to be called satellites, but now we consider them to be smaller CMN. The classifications we use at the moment are projected adult size of <10cm, 10-20cm, 20-40cm, 40-60cm and >60cm. The total number of other naevi is classified as 0, 1-10, 10-20, 20-50, , , and >400. Where the numbers are small we tend to count them, but for large numbers we estimate.
8 Congenital Melanocytic Naevi
9 What causes CMN? For most cases of large and multiple CMN, we have recently discovered the cause - a mutation in a gene called NRAS. A mutation means that there has been a spelling mistake or other change in a gene and a gene is just one of the instructions in our body. Mutations happen all the time when babies are being formed and during our lifetimes, but many of them are completely unimportant. If, however, a mutation happens in an important gene then it can have a big effect. NRAS is a very important gene, and the mutation in CMN is in a very important place in NRAS. The mutation is not inherited from either of the parents, but happens only to the baby during development. If the mutation happens very early in the baby s development then it probably results in a very early miscarriage. If it happens a bit later then the baby can survive, but will have CMN and may have the characteristic facial features and/or brain problems. In the minority of cases where NRAS mutations are not the cause, there will be another gene which is the cause. These are being investigated at the moment.
10 Congenital Melanocytic Naevi
11 Family history of CMN and the red hair gene We know that the NRAS mutation is not inherited and not passed on. It is therefore extremely rare to have more than one child with a large CMN, and extremely rare for an individual with CMN to pass it on to their children. However, we have previously found that some families seem to have more CMN than we would expect, and this is probably caused by other genes which are passed down which make it more likely for CMN to occur. One of these genes is the gene responsible for red hair and freckles (known as MC1R), which we have found occurs more commonly in families with CMN than in families without CMN. CMN syndrome Our recent research has led to the proposal of the term CMN syndrome. A syndrome is a collection of findings in one individual that can potentially be explained by the same genetic change. We think the term CMN syndrome is useful to alert healthcare professionals to aspects other than the skin. Apart from the neurological association the new association is as follows: Characteristic facial features Our research has found that most children with CMN have a similar looking face. This is a normal face, and in fact usually a very attractive face, but it is similar to other children with CMN. This is likely to be caused by the same mutation that causes the skin changes and the brain changes (when there are any).
12 Congenital Melanocytic Naevi
13 Complications of CMN Neurological problems Problems in the brain or spinal cord are the most common complication seen in children with CMN. The pigment cells of the skin and the brain develop from the same cells in an embryo, and as a result children with CMN can have differences in their brain or spinal cord. The most common problem is pigment-containing cells (a bit like a CMN) in the brain or spinal cord. This is called neuromelanosis, or neurocutaneous melanosis. Other much rarer problems include benign brain or spinal tumours, too much fluid in the brain, or abnormal brain structure. All of these neurological problems are more common with larger and more numerous CMN, but there is no connection with the site of the CMN. In other words having a CMN overlying the brain or spine does not increase the chance of having neurological problems. Our current recommendations are that any child born with two or more CMN should have a routine MRI scan of the brain and spine, preferably by the age of 6 months. It is not possible to say that MRI abnormalities could never occur in children with only one CMN at birth, but the risk is much less. scan is to pick up the rare cases of tumours and extra fluid on the brain that require an operation, and to allow us to monitor development more carefully in children with MRI findings. The pigment cells in the brain or spine cannot currently be treated. We also recommend that children with CMN more than 20cm projected adult size should be followed up regularly to watch their development, even if they do not have more than one CMN. In addition, any child with any type of CMN who has a problem with development or fits or limbs should have an MRI. The overall chance of finding an abnormality on MRI scan in children with large and multiple CMN is around 25%, but only around half of these children will have any actual problems. If they do have problems these can be fits (convulsions), developmental delay, or problems with their limbs. It is possible to have problems in development even when the scan is normal, but these tend to be milder. The reason for doing the
14 Malignant melanoma Melanoma is a cancer of melanocytes, the skin cells which produce pigment and which make up CMN. It used to be thought that melanoma was very common in people with CMN, but we now know that it is rare, occurring in around 1-2% of all people with CMN over their lifetime. However, the risk is higher in people with very large and numerous CMN, around 10%, and there is a peak of risk during childhood. When considering these risks, you need to bear in mind that every one of us has a risk of about 40% of developing some kind of malignant tumour at some time in our lives. Melanoma in children with CMN can occur anywhere, not just within the CMN. It can present as a lump in the CMN, in another area of skin, or in the lymph nodes (which are throughout the body). In about half the cases it occurs within the brain or spine, when it can present with persistent headaches with nausea/vomiting, or visual disturbances, balance problems or fits. Unfortunately, most often it seems to be the case that when malignant melanoma occurs in a person with a CMN, it is aggressive and difficult to treat. Our recommendations are that any rapidly changing area should be reviewed by an experienced doctor, who can decide whether a biopsy is required. Do remember however, that nodules appear in CMN quite frequently, and the great majority are completely harmless. We also recommend that children who develop new neurological problems such as recurrent headaches, visual disturbance, fits, or developmental changes should be seen urgently by a specialist doctor, such as in the Great Ormond St Hospital CMN clinic. Sun protection Children with CMN can and should enjoy a normal life. They should have good sun protection but the same as we would recommend for all children. In particular, it is important that they should not become sun burnt. As a general rule: sun avoidance, coupled with good clothing protection, are much more important than suncream. Sun avoidance: children should be kept out of direct sun as much as possible during the hottest hours of the day and in the hottest months of the year, for example, by staying in the shade. The hottest hours of the day are Since finding the NRAS gene mutation, we understand more about why melanoma happens in people with CMN. As lots of the cells in the body carry that gene mutation it makes those cells vulnerable to other mutations, which can then lead to the melanoma. This finding though will also help us to direct treatments for melanoma better.
15 10am-4pm, and the hottest months of the year are April to October. Outside these times there is usually no need for sun protection in the UK. This does not mean children should not go outside between 10am-4pm in the hot months, it just means they should stay in the shade where possible and wearing appropriate clothing. Good clothing protection: sun hats with a brim that covers ears and the back of the neck as well as the face are ideal, as are longer sleeved tops and longer shorts/skirt. Suncream is not a substitute for sun avoidance and good clothing protection. It should, however, be used as extra protection if the child has to be in direct sun during hot periods for areas that are not protected by clothes. The best sunscreens contain a reflectant barrier such as titanium dioxide; select a high protection factor (SPF), ideally 25 or more, and with high UVA protection (4 or 5 stars, usually on the back of the bottle). Sunscreen needs to be refreshed every 2 hours or so, more often when swimming or sweating. Other important points to remember UV exposure is much higher when beside water or snow, so special care should be taken when swimming outside or skiing. The sun is more harmful at higher altitudes. The sun remains almost as harmful when it is cloudy, so even if the day is cloudy the child should wear appropriate clothing such as a sunhat during the hottest times of the year. Shade provides less protection when near water or snow or when the weather is cloudy. The increased risk of skin cancer in children with CMN probably applies to their whole body, not just on their CMN.
16 Congenital Melanocytic Naevi
17 Can CMN be treated with surgery? We think that the decision to have surgery has to be made on an individual basis, and very much depends if the plastic surgeons think they can improve the appearance, or whether it would not improve. In cases of very large CMN, surgery is often not possible. In other cases the following points should be considered: 1. Many CMN will lighten spontaneously to at least some degree over a period of years. This can be monitored with repeat photographs. 2. Surgery has not been shown to reduce the risk of melanoma in the child. 3. Early surgery has not been shown to be advantageous. We do not do any routine surgery before 1 year of age. 4. The site of the CMN is very important for example, the child may get more benefit if a CMN on the face is removed, compared to one hidden in the scalp. If a CMN can be removed, for example by excision or serial excision (more than one operation but relatively straight-forward), the cosmetic benefits may easily outweigh the small risks associated with any operation. However, if a CMN is in a difficult place for removal, or if it is too large ever to be removed completely then that balance changes. It is very important in these cases to take time to decide about surgery, particularly to see if the CMN is lightening over time. 5. The size of the CMN is very important - we have found that children with larger CMN were less pleased with the cosmetic result than those with small lesions which could be completely removed. 6. The number of naevi is important, in particular if the child has a tendency to develop lots of new ones as this may reduce the benefit from removing some. 7. Whether you want your child to take part in the decision, in which case it is better to decide later. 8. What is involved in the type of surgery being offered this will depend on the individual case.
18 have exactly the same appearance and feel as the original ones. Most parents find that they do not need to shave an area more often than once every couple of weeks in order to maintain a satisfactory appearance. Laser hair removal is possible but needs to be done regularly over a relatively long period and needs a general anaesthetic in children under teenage years. Electrolysis is slow and painful and is therefore not suitable for large areas. This CMN on the back is hairy in some places and relatively hairless in others. What can we do about hairiness? Hairiness only needs to be treated if it is causing a problem (eg making an area difficult to clean) or the child or family feel it looks better without hair. An electric shaver is best, and clipping the hair short rather than completely shaving often avoids problems of itchiness with regrowth. Hair removal creams etc should not be used as they can irritate the skin. Shaving does not affect the amount or thickness of hairs that grow. Hair regrowth after shaving is generally slow and the new hairs will Psychological issues Children who grow up with a prominent CMN or many CMN may well have problems adjusting to the disfigurement that they perceive, particularly during the teenage years. This, however, is a very individual thing, and varies depending on the child s personality and on the support from family and friends. It would be ideal if we were able to offer all children at risk some degree of automatic counselling during their childhood. At GOSH we currently have a psychology service available. However, not all families want psychology input, and not all hospitals have this facility. Changing Faces is an example of a support group specialising in all types of disfigurement which has some excellent guidelines and information. Its website is
19 Support and Research Support Group Caring Matters Now is a registered charity and support group specifically for people with CMN and their families. Their aims are: To support those affected by CMN To raise awareness about CMN To raise funds for the CMN research Support is provided in many different ways. The group has a dedicated telephone line, a network of trained support contacts, hold family support days and activity weekends, use social media and manage online forums to give the opportunity to chat, share experiences and seek advice. They also have a very informative website They use these sources to spread news of the research findings and developments. Caring Matters Now also coordinates a voluntary fund-raising programme to contribute significantly to the research into CMN at Great Ormond Street Hospital in London. CMN Research Dr Kinsler is conducting long-term research into CMN at Great Ormond Street Hospital. If you would like to be involved and are not attending GOSH regularly, please ask your doctor (GP, Dermatologist or Paediatrician) to refer your child for a one-off appointment in order to participate in this research. The aims of this research are to understand what causes CMN, to identify those patients at highest risk of neurological and melanoma complications, and ultimately to design better treatments for CMN. Disability Living Allowance Parents of children with extensive CMN or NCM may be eligible for Disability Allowance, but in general this is only for children with neurological problems or melanoma. If you would like further advice, contact your Citizen s Advice Bureau or the Social Services Department in any hospital your child visits. Alternatively, there is more information at
20 Caring Matters Now Support Group CMN PO Box 732 Cambridge CB1 0QF Tel: Charity Number: Research programme undertaken by Dr Veronica Kinsler Paediatric Dermatology Department Great Ormond Street Hospital London WC1N 3JH Design by CBA Design & Marketing Print by The Print Works Ltd
about Why You Should Know Melanoma Why You Should Know about Melanoma Each year, more than 3 million Americans are diagnosed with skin cancer. This is the most common form of cancer. Of these, more than
MELANOMA IN SITU What are the aims of this leaflet? This leaflet has been written to help you understand more about melanoma in situ. It will tell you what it is, what causes it, what can be done about
BOWEN S DISEASE (SQUAMOUS CELL CARCINOMA IN SITU) What are the aims of this leaflet? This leaflet has been written to help you understand more about squamous cell carcinoma in situ (Bowen s disease). It
Melissa O Neill, O MS, APRN Nurse Practitioner, Dermatology Three Types of Skin Cancer > Basal Cell Carcinoma > Squamous Cell Carcinoma > Malignant Melanoma Basal Cell Carcinoma > Most common skin cancer
Squamous Cell Carcinoma Patient Information What are the aims of this leaflet? This leaflet has been written to help you understand more about squamous cell carcinomas of the skin. It tells you what they
Skin cancer Patient information What is cancer? The human body is made up of billions of cells. In healthy people, cells grow, divide and die. New cells constantly replace old ones in an orderly way. This
Skin Grafts Skin Oncology Service Delivering the best in care UHB is a no smoking Trust To see all of our current patient information leaflets please visit www.uhb.nhs.uk/patient-information-leaflets.htm
Produced 2010 Next revision due 2012 Sun safety If you have been treated with radiotherapy or chemotherapy for Hodgkin lymphoma or non-hodgkin lymphoma you should always be careful in the sun. However,
Speakers Bureau Series EYELID SKIN CANCER By Leslie M Sims, MSPH, MD, FAAO Board Certified Ophthalmologist The Sims Center for Eyelid and Facial Aesthetics 1 Most Common Eyelid Skin Cancers: Basal Cell
GenoMEL the Melanoma Genetics Consortium GenoMEL 2011. First published 2006. Revised February 2011. This leaflet is designed to help you look after your own moles. It is hoped that it will be useful for
Basal Cell and Squamous Cell Carcinoma Dori Goldberg, MD Umass Medical School Division of Dermatology Basal and squamous cell carcinoma Definition The most common types of skin cancer Excluding melanoma,
May Is National Melanoma/Skin Cancer Detection and Prevention Month What is Melanoma? Melanoma is a type of skin cancer. It begins in the cells of the skin called melanocytes. To understand melanoma, it
Saint Louis University Cancer Center SKIN CANCER Saint Louis University Cancer Center 3655 Vista Avenue St. Louis, Missouri 63110-2539 (314) 268-7015 or (866) 977-4440 cancercenter.slu.edu www.slucare.com
Staying Safe from Skin Cancer Types of Skin Cancer Actinic Keratosis Rough, red or pink scaly patches on sun-exposed areas of the skin Basal Cell Carcinoma Raised, pink, waxy bumps that may bleed following
Oxford University Hospitals NHS Trust Department of Dermatology Looking after your skin when you are taking immunosuppressants Information for patients If you have had an organ transplant or are taking
Skin Graft Your Operation Explained Patient Information Introduction This leaflet has been written to help you understand the skin graft you are about to have. We hope it will answer some of the questions
Treating Melanoma Skin Cancer A Quick Guide Contents This is a brief summary of the information on Treating melanoma skin cancer from our website. You will find more detailed information on the website.
VARICOSE VEINS Information Leaflet Your Health. Our Priority. Page 2 of 7 Varicose Veins There are no accurate figures for the number of people with varicose veins. Some studies suggest that 3 in 100 people
This melanoma patient brochure is designed to help educate melanoma patients and their caregivers. It was developed under the guidance of Dr. Michael Smylie, Professor, Department of Oncology, University
What is laser tattoo removal? Laser tattoo removal is a treatment to help fade and remove unwanted tattoos. We are able to remove the following types of tattoos: Amateur tattoos - normally formed using
Laser treatment for the removal of unwanted Hair Exceptional healthcare, personally delivered Welcome to the Bristol Laser Centre We are part of the Plastic Surgery Department at North Bristol NHS Trust
What is Laser Surgery? Laser (Light Amplification by Stimulated Emission of Radiation) surgery uses a very hot, focused beam of light to remove or cauterise a skin lesion and control bleeding without affecting
Patient Information Radiation Therapy and Caring for Your Skin Comments, Feedback? Contact Patient and Professional Education 519-685-8742 Email: firstname.lastname@example.org Reviewed by the LRCP Patient Education
What is laser resurfacing? Laser resurfacing is a treatment to help reduce the appearance of raised birthmarks, moles, acne scarring and sun-damaged skin. It can also help to reduce and reshape the nose
James Whale Fund for Kidney Cancer Childhood kidney cancer factsheet Kidney cancer rarely afflicts children and about 90 paediatric cases are diagnosed in the UK each year. About 75% of childhood kidney
Slide 1 Skin Cancer American Cancer Society Reviewed February 2016 Slide 2 What we ll be talking about How common is skin cancer? What is skin cancer? The 2 main types of skin cancer Causes of skin cancer
Laser Treatment for Acne Exceptional healthcare, personally delivered Welcome to the Laser Centre of the South West We are part of the Plastic Surgery Department at North Bristol NHS Trust, and were set
ALBINISM Other Common Names Hypopigmentation Causes/Etiology Incidence Most types of albinism are inherited when a child receives the albinism gene from both parents. There is an exception with one type
Skin Cancer Risks in Transplant Recipients: Know the Facts What is skin cancer? The skin is the body s largest organ. It protects against heat, sunlight, injury and infection, controls body temperature
Endoscopic Third Ventriculostomy (ETV) Information for Patients, Parents and Carers Joanne Kehoe Neurosurgical Nurse Co-ordinator 01 892 1753 Monday to Thursday 8am and 4pm Friday 8am -12pm Main Hospital
Introduction There are more than one hundred types of cancer. All the kinds of cancer begin in our cells. Normal cells grow and multiply and then die. Cancer cells grow and multiply and keep growing and
C H A P T E R Anatomy of the Skin and a Clinical Approach to Patients with Skin Disease 1 1 This manual will begin with a brief revision of the main structures and functions of the skin. Much of this manual
Introduction This factsheet will tell you about the range of tests that can be carried out to try to find the cause of your child s hearing loss. The process to find out why a child is deaf is sometimes
Ilioinguinal dissection (removal of lymph nodes in the groin and pelvis) This sheet answers common questions about ilio-inguinal dissection. If you would like further information, or have any particular
Basal Cell Carcinoma Affecting the Eye Your Treatment Explained Patient Information Introduction This booklet is designed to give you information about having a Basal Cell Carcinoma near your eye and the
Thymus Cancer Introduction Thymus cancer is a rare cancer. It starts in the small organ that lies in the upper chest under the breastbone. The thymus makes white blood cells that protect the body against
Department of plastic surgery Groin or inguinal lymph node dissection Groin lymph node dissection The surgery you are going to have is called groin or inguinal lymph node dissection. This means removing
Surgery for breast cancer in men This information is an extract from the booklet Understanding breast cancer in men. You may find the full booklet helpful. We can send you a free copy see page 9. Contents
Wide local excision Delivering the best in care UHB is a no smoking Trust To see all of our current patient information leaflets please visit www.uhb.nhs.uk/patient-information-leaflets.htm This leaflet
Patient information from the BMJ Group Ovarian cancer Ovarian cancer is a serious disease. If it s diagnosed at an early stage, ovarian cancer can usually be cured. But even cancers that are more advanced
DISCOVERY HEALTH MATTERS Spot skin cancer, stop skin cancer Vol 14 2013 Discovery Health Matters Discovery Health Matters is a layman s guide to important, but often misunderstood topics in healthcare.
DELAYED DIAGNOSIS SKINCANCER Common Medical Malpratice Delayed Diagnosis Cases: Melanoma Melanoma makes up the smallest percentage of skin cancer cases, yet it s the deadliest form causing the greatest
INTRODUCTION This book has been prepared for people with bowel cancer, their families and friends. The first section is for people with bowel cancer, and is intended to help you understand what bowel cancer
X-Plain Psoriasis Reference Summary Introduction Psoriasis is a long-lasting skin disease that causes the skin to become inflamed. Patches of thick, red skin are covered with silvery scales. It affects
Radiotherapy for breast cancer This information is an extract from the booklet Understanding breast cancer. You may find the full booklet helpful. We can send you a copy free see page 6. Contents Radiotherapy
Informed Consent For Laser Hair Removal INSTRUCTIONS This informed-consent document has been prepared to help inform you about laser procedures, its risks, as well as alternative treatment(s). It is important
How to Examine Yourself After Treatment for a Melanoma Patient Information Introduction This booklet is designed to give you information about examining yourself following your treatment for a melanoma.
Looking after your wound following skin surgery Exceptional healthcare, personally delivered Introduction You have just undergone an operation, under local anaesthetic, for the removal of a skin lesion.
Breast Cancer Presentation by Dr Mafunga Breast cancer in the UK Breast cancer is the second most common cancer in women. Around 1 in 9 women will develop breast cancer It most commonly affects women over
PATIENT INFORMATION Radiotherapy following Breast Conservation Surgery Liverpool & Campbelltown Cancer Therapy Centres 1. Introduction This booklet is to assist you with information related to the treatment
a program that radiates good ideas www.epa.gov/sunwise U.S. Environmental Protection Agency 1 Be 2 What do you know about the Sun? 3 Helpful and Harmful Effects of the Sun Helpful Keeps Us Warm Helps Plants
Neck Dissection Exceptional healthcare, personally delivered What is a neck dissection? The aim of a neck dissection is to remove lymph nodes (glands) from one or both sides of the neck. This is undertaken
Hip arthroscopy is a relatively new procedure which allows the surgeon to diagnose and treat hip disorders by providing a clear view of the inside of the hip with very small incisions. This is a more complicated
Brain Cancer Introduction Brain tumors are not rare. Thousands of people are diagnosed every year with tumors of the brain and the rest of the nervous system. The diagnosis and treatment of brain tumors
172 W. Carmel Drive Carmel, IN 46032 Tel: (317)575-2737 INDY LASER CLIENT INFORMATION Client Name Address City Zip Code Mobile Phone Home Phone Date of Birth Body Hair Color Email Address Referral Source
Profractional Laser Resurfacing. Profractional laser is a new procedure that can dramatically improve the texture of the skin with minimal downtime. It can smooth out acne scars, improve pigmentation problems
SKIN CANCER RISKS FOR TRANSPLANT RECIPIENTS Know the Facts What is skin cancer? The skin is the body s largest organ. It protects against heat, sunlight, injury and infection, controls body temperature
Nails Diseases and Problems Introduction Your toenails and fingernails protect the tissues of your toes and fingers. The health of your nails can be a clue to your overall health. There are many diseases
Chapter 1 All you need to know about hair almost Before you know about your future see your past before improving your future hair see what has been and is the state of your hair now Ravi Bhanot Typically
Breast Cancer Introduction Cancer of the breast is the most common form of cancer that affects women but is no longer the leading cause of cancer deaths. About 1 out of 8 women are diagnosed with breast
Male Breast Cancer Introduction Breast cancer is cancer that starts in the cells of the breast. Breast cancer happens mainly in women. But men can get it too. Many people do not know that men can get breast
SKIN REJUVENATION WITH FRAXEL LASER By Akhil Wadhera, M.D. Dermatology Dr. Hendler: Hello and welcome to KP Healthcast. I m your host, Dr. Peter Hendler. Today our guest is Dr. Akhil Wadhera who s been
Radiation Oncology Patient information Radiation Therapy for breast cancers Radiation Therapy for breast cancers 1 Radiation therapy for breast cancer Radiation therapy plays a vital role in treating and
Mohs Micrographic Surgery Table of Contents Skin Cancer... What is skin cancer?... How is skin cancer treated?... Is skin cancer dangerous?... What are the causes of skin cancer?... How does skin cancer
Melanoma Understanding your diagnosis Melanoma Understanding your diagnosis When you first hear that you have cancer, you may feel alone and afraid. You may be overwhelmed by the large amount of information
About Cancer Cancer is a disease where there is a disturbance in the normal pattern of cell replacement. The cells mutate and become abnormal or grow uncontrollably. Not all tumours are cancerous (i.e.
NHS breast screening Helping you decide What is breast cancer? 2 What is breast screening? 3 Breast screening results 6 Making a choice the possible benefits 9 and risks of breast screening What are the
X-Plain Breast Cancer Reference Summary The risk of breast cancer among Asian Americans living in the U.S. is relatively low compared to caucasian women. However, there is concern that the risk of breast
Traditional Chinese For the Patient: Cetuximab Injection Other names: ERBITUX Cetuximab (se tux i mab) is a drug that is used to treat some types of cancer. It is a monoclonal antibody, a type of protein
Occulta Means Hidden Spina Bifida Occulta is not easily detected because skin covers the area, such as the spinal cord, spinal bone or nerve roots, which may be affected. Spina Bifida Occulta can affect
Temozolomide (oral) with concurrent radiotherapy to the brain Temozolomide (oral) with concurrent radiotherapy to the brain This leaflet is offered as a guide to you and your family. You will find it useful
Radiation Therapy for Prostate Cancer Introduction Cancer of the prostate is the most common form of cancer that affects men. About 240,000 American men are diagnosed with prostate cancer every year. Your
BRCA1 & BRCA2 GeneHealth UK BRCA1 & BRCA2 What is hereditary breast cancer? Cancer is unfortunately very common, with 1 in 3 people developing cancer at some point in their lifetime. Breast cancer occurs
Pituitary Tumor Your doctor thinks you may have a pituitary tumor. Pituitary tumors are benign (non-cancerous) overgrowth of cells that make up the pituitary gland (the master gland that regulates other
Edited Why is sun protection at school important? Dr Judith Galtry, Skin Cancer Control Advisor, Cancer Society of New Zealand Skin cancer is the most common cancer in New Zealand. We have one of the highest
Melanoma: some useful facts Delivering the best in care UHB is a no smoking Trust To see all of our current patient information leaflets please visit www.uhb.nhs.uk/patient-information-leaflets.htm Contents
Multiple Myeloma Introduction Multiple myeloma is a type of cancer that affects white blood cells. Each year, thousands of people find out that they have multiple myeloma. This reference summary will help
RESEARCH EDUCATE ADVOCATE Just Diagnosed with Melanoma Now What? INTRODUCTION If you are reading this, you have undergone a biopsy (either of a skin lesion or a lymph node) or have had other tests in which
RESULTS YOU CAN SEE AND FEEL You do a lot to look and feel great, finding the time to enjoy life to the fullest while still taking care of your body. Yet, the effects of sun, pollution, stress and fatigue
Information for patients Radiotherapy to the Breast or Chest Wall The Beatson West of Scotland Cancer Centre 1053 Great Western Road, Glasgow G12 OYN This leaflet is for patients with breast cancer who
What is Needling? Needling has been in practice since the late 1980s, but has gained in popularity in the last two years. Needling treatment is the preferred method for 100% natural scar and wrinkle reduction.
Laser Spider/Leg Vein Q & A What are spider veins? Millions of women and men are bothered by unsightly spider veins on their faces and legs. Spider veins or telangiectasias are those small red, blue and
ELECTROLYSIS- INFORMATION AND FAQ s 1. How does Electrolysis work? A very fine sterilized filament is inserted into the hair follicle, which is a natural opening in the skin. The skin is not pierced or
Skin Cancer and Outdoor Workers Guidance for safety representatives Background Skin cancer is the most common type of cancer in the UK. The main cause is excessive exposure to the sun s harmful ultra violet