Creighton University School of Medicine

Department of Pathology
GRAND ROUNDS
“Melanocyte, Mole, Melanoma: Back to the basics ”
by Deba Sarma, MD
Tuesday, July 22, 2008
12:00 – 1:00 p.m.
Morrison Seminar Room

Dr. Sarma has listed no financial interest/arrangement that would be considered a conflict of interest.

Objectives: At the end of the presentation the participant should be able to:
1. Explore the relationship between melanocytes, moles and melanoma.
2. Summarize the risk factors for melanoma.
3. Review the preventive measures against melanoma .

The Creighton University School of Medicine designates this educational activity for a maximum of
1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the
extent of their participation in this activity.

The Creighton University School of Medicine is accredited by the Accreditation Council for
Continuing Medical Education to provide continuing medical education for physicians.
News Headline

Melanoma cases surge among young

women

The incidence of the deadly skin cancer increased by 50%

between 1980 and 2004, a study finds. Use of tanning salons is
cited as one possible reason.
Los Angeles Times. July 11, 2008
On the campaign trail, few mentions of McCain’s bout
with melanoma
The N Y Times March 9, 2008
Melanocytes
Mole
Melanoma

Deba P Sarma, MD
CUMC Pathology
Melanocytes
Melanocyte
 Nevus = Mole

 Spot, ‘Beauty mark’

Life of a nevus
Congenital nevus
 Common nevi

•Junctional
•Compound
•Dermal
Dysplastic nevus
Dysplastic nevus
 Melanoma
 Types
Melanoma in situ
Melanoma (Invasive melanoma)
 Melanoma

 Lentigo maligna melanoma

 Superficial spreading melanoma
 Nodular melanoma
 Acral lentiginous melanoma
 Desmoplastic melanoma
Lentigo maligna melanoma
Superficial spreading melanoma
Nodular melanoma
Acral lentiginous melanoma
 Estd new cancer cases, USA, 2008
American Cancer Society

Male: Female:
1. Prostate (25%) 1. Breast (31%)
2. Lung (15%) 2. Lung (14%)
3. Colorectum (10%) 3. Colorectum (10%)
4. Bladder (7%) 4. Uterus (5%)
5. NH Lymphoma (5%) 5. NH Lymphoma (4%)
6. Melanoma (5%) 6. Thyroid (4%)
7. Kidney (4%) 7. Melanoma (4%)
 Estd new melanoma cases, 2008
American Cancer Society, 2008

 USA : total 116,500

( In situ 54,000 Invasive 62,500 )
 NEBRASKA: 380 ( Invasive melanoma)

Estd deaths from melanoma, 2008

 USA 8500
 NEBRASKA 50
 Risk factors

 Uncontrollable:
Skin type (race)
History of melanoma
Moles and atypical moles
Age: 70 +
Gender: M > F

 Controllable:
UV radiation ( sunlight, tanning booths and lamps)
 Skin types

I II III

IV V VI
 History of melanoma

 First-degree relatives: Father, mother, brother, sister,

child

 Personal history of melanoma

 Melanoma pt.: Family history in 10%.

 Common acquired nevi,
atypical nevi

 Normal nevi Abnormal nevi

 Age: 2-30 New mole after 30
 Number: 20-30 Number: >50
Atypical mole: >5
Familial dysplastic mole syndrome
Sun
 Protection from UVA UVB

 Seek shade, avoid outdoors: 10am to 4pm

 Protective clothing
 Wraparound sunglasses, broad-brimmed hats
 Sunscreen, broad spectrum, at least 15 SPF
 No tanning booth or sun lamp
 Melanoma Prevention

Moles: Professional screening

Self-examination
New mole after 30
Changing mole
Danger signs
ABCD
 CML Melanoma
12 months: 3/1/07-3/1/08

 Total cases: 56 Male: 36 Female: 20

 Age: 27-95

 Male: <50: 11 >50: 29

 Female: <50: 7 >50: 13

Melanoma sites
 Sites

 Head & neck: 20 ( Male 18, Female 2)

 Upper limb: 4 ( Male 2, Female 2)
 Lower limb: 12 ( Male 2, Female 10)
 Trunk: 20 ( Male 14, Female 6)
 Types

 Melanoma in-situ: 20
Lentigo maligna 8, Pagetoid 12
 Superficial spreading melanoma: 23
 Lentigo maligna melanoma: 4
 Nodular melanoma: 5
 Desmoplastic melanoma: 2
 Recurrent melanoma: 2
 Five-year survival rate

 Overall 90%
 Localized 99%
 With regional spread 45%

 Good news: 80% localized at diagnosis

 Editorials 1985-2008

 Ackerman AB. No one should die of malignant

melanoma. J Am Acad Dermatol. 1985 Jan; 12: 115-6.

 Kittler H. Early recognition at last. Arch Dermatol.

2008 April;144: 533-4.