Skin Cancer & Prevention. Susan Keiler, MD Randolph Court Manitowoc, WI

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1 Skin Cancer & Prevention Susan Keiler, MD 1515 Randolph Court Manitowoc, WI

2 Skin Cancer Facts Most common type of cancer in the United States. A person has a 1 in 5 chance of developing skin cancer in their lifetime. Nearly 2 million new cases of skin cancer are diagnosed and treated each year. Early detection and treatment greatly increase the chances of cure with minimal risk of scarring.

3 Skin Cancer Facts Can occur at any age. Most common in individuals older than 40 years of age. Most commonly occurs on the face, especially the nose and ears. Frequently does not hurt.

4 Skin Cancer Facts Risk Factors Blistering sunburns Multiple sun burns Repeated sun or ultraviolet light exposure Family history Sun damage stays forever and adds up every year. It can take 20 or 30 years to develop a skin cancer. Starting sunscreen use at any age will reduce the chances of developing skin cancer.

5 Ultraviolet Radiation Most intense in mid-day, but occurs all day long. More intense closer to the equator (Florida/Arizona). Ultraviolet radiation from the sun or tanning beds can cause skin cancer. Causes almost everything we call aging of the skin.

6 The Ozone Layer Functions to filter/block ultraviolet radiation coming from the sun It is estimated that for every 1% decrease in the ozone layer there will be a 5-10% increase in the incidence of skin cancer

7 Signs of Sun Damage Dry Leathery Skin Brown Spots Uneven Coloration/freckles Loss of Elasticity White spots Wrinkles

8 Sun Damage Adds Up

9 3 Types of Skin Cancer

10 Skin Cancer Incidence BCC over 2,000,000 annually in the US SCC over 700,000 annually in the US Melanoma 60,000 annually in the US o Accounts for 5% of skin cancers, but 75% of skin cancer deaths o 1 person dies every hour in the U.S. from melanoma

11 Basal Cell Carcinoma The most common type of skin cancer (Accounts for 80% of skin cancers) Most commonly occurs on the face, especially the nose and ears Pearly or flesh colored bump

12 Basal Cell Carcinoma Scaly patch with slightly raised edges Often will get a small yellowish or slightly bloody crust A pimple that won t heal

13 Basal Cell Carcinoma

14 Basal Cell Carcinoma Locally very destructive Almost always bigger than it looks President Clinton had one on his back

15 Basal Cell Carcinoma

16 Basal Cell Carcinoma

17 Basal Cell Carcinoma

18 Basal Cell Carcinoma

19 Actinic Keratosis Appear as dry, scaly, red spots Most commonly on the face, ears, or hands Usually do not itch, bleed, or hurt

20 Actinic Keratosis Pre-cancerous, if left untreated, 1 in 10 will evolve into a Squamous Cell Carcinoma Easily treated with liquid nitrogen or athome prescription creams President George W. Bush had several removed from his face

21 Squamous Cell Carcinoma The 2 nd most common type of skin cancer (Accounts for 15% of skin cancers) Looks like a firm, reddish, scaly & crusted bump Often bleeds with minor trauma Often does not hurt

22 Squamous Cell Carcinoma Occurs on face, arms, legs, trunk Occurs primarily on sun damaged skin 40-60% begin as Actinic Keratoses More dangerous if on ears, lips or within scars

23 Squamous Cell Carcinoma

24 Squamous Cell Carcinoma

25 Squamous Cell Carcinoma

26 Squamous Cell Carcinoma Locally Aggressive Untreated, SCC can spread to the rest of the body (metastasize) 3000 deaths a year from skin SCC

27 Non-Melanoma Skin Cancer Sometimes what is seen at the surface is only the tip of the iceberg

28 Non-Melanoma Skin Cancer Sometimes what is seen at the surface is only the tip of the iceberg

29 Malignant Melanoma The most dangerous type of skin cancer 1 in 60 will develop one in their lifetime Rate of melanoma is increasing faster than any other cancer Senator John McCain has had multiple melanomas

30 Melanoma Number one cause of cancer death in women age % of melanomas arise from preexisting nevi (moles) 60-80% of melanomas arise from normal skin Most common places Women Legs Men Back

31 Lifetime Risk of Melanoma / / / /150

32 Lifetime Risk of Melanoma / / / /60

33 Malignant Melanoma ABCD s Evolving most important Bigger Changing shape Changing color New symptoms Any spot that looks different than the rest

34 Why talk about risk factors for melanoma? Knowing your risk factors can raise your awareness, leading to earlier detection Melanoma is best treated when detected early

35 Malignant Melanoma If it penetrates less than 1 mm into the skin, 5 year survival rate is > 90% If it penetrates more than 4 mm into the skin, 2 in 3 individuals will die within 5 years

36 Melanoma

37 Melanoma

38 Melanoma -1.2 cm (.28B)

39 Melanoma Risk Factors Atypical moles (dysplastic nevi) Moles with irregular borders or variation of color Dysplastic nevi, with no personal or family history of melanoma, have 7-27 times the risk of melanoma

40 Dysplastic Nevi Asymmetry Irregular Border Color

41 Melanoma and Dysplastic Nevi 1 dysplastic nevus increases risk by or more dysplastic nevi increase risk by % of melanoma arise from dysplastic nevi Melanoma Risk is strongly related to the number of dysplastic nevi

42 Melanoma Risk Factors Positive family history for melanoma 5% Applies to 1 st degree relatives Personal history melanoma 5-7% for another melanoma Latitude Hawaii vs. WI

43 Melanoma Risk Factors Immunosuppression Organ transplant patients 3x risk HIV Medications Cancer Increasing age

44 Melanoma Risk Factors Blistering sunburn as a child/teenager Inability to tan Type I skin (3x) Freckles (3x) Fair complexion red hair, blond hair (3x) Eye color blue, green (1-2x)

45 Melanoma Risk Factors UV Exposure (tanning outside or tanning bed use). Increases risk by 75%. Several blistering sunburns as a teenager more harmful than prolonged exposure in later years Intermittent high UV exposure melanoma risk factor *Basal cell and squamous cell skin cancer risk correlates more with total cumulative UV exposure

46 Prevention and Surveillance Wear Sunscreen with SPF 30 Reapply it every 2 hours Wear sun protective clothing (wide brim hats) Remember, it s the acute intermittent sun exposure that promotes melanoma Chronic sun exposure associated with SCC

47 Prevention and Surveillance Avoid mid day sun (10am- 3pm) when ultraviolet light is most intense See a physician for a skin examination Be alert to any changes in your skin Exam your significant other s skin Be proactive

48 Not everything that looks bad is bad Malignant Melanoma

49 Why we need to treat Skin Cancer early

50 Mohs Micrographic Surgery Developed in the 1930 s by Dr. Frederick Mohs at the University of Wisconsin It is performed by Mohs surgeons who are dermatologists who have take an additional year of training dedicated to learning Mohs surgery & facial reconstructive surgery. It is accredited by the American College of Mohs Micrographic Surgery & Cutaneous Oncology.

51 Mohs Micrographic Surgery It is a systematic method of removing skin cancer one layer at a time. Allows the surgeon to selectively remove the cancer while sparing the normal surrounding skin. All other forms of treatment involve removing a margin of normal skin around the cancer to increase the chances that they get it out. Thus, with Mohs surgery, the hole required to remove the cancer is smaller.

52 Mohs Micrographic Surgery Mohs surgery is the most effective method of treatment for basal and squamous cell carcinomas with cure rates of >99% versus a cure rate of about 90-95% for electrodessication & curettage or standard excision by a general dermatologist or plastic surgeon.

53 What is Mohs Surgery? A thin layer of skin (less than 1 mm) is taken around the entire cancer The layer of tissue is brought to the lab right in our office for immediate processing

54 What is Mohs Surgery? 100% of the edges are examined under the microscope The cancer can be seen and mapped

55 A Typical 3 Stage Case Pre -Op Sta g e Stage 2 4 3

56 Example of a Typical Case

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60 ?? Questions??

61 The Sun, Skin Cancer, and Mohs Micrographic Surgery Susan Keiler, MD 214 Monroe St. Sheboygan Falls, WI (920)