Melanoma: Early Detection and Therapeutic Progress
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1 Melanoma: Early Detection and Therapeutic Progress David W. Ollila, MD Professor of Surgery Jesse and James Millis Professor of Surgery Thanks to my collaborators, mentors and patients May 19, 2017 Disclosures: NONE Objectives 1. Skin Cancer Awareness & Education: Importance of early detection 2. To provide an overview of therapeutic progress ( ) Silent National Epidemic The incidence per year is rising faster than any other cancer! For use for educational purposes ONLY. 1
2 Poorly Regulated Industry NC Law: Illegal for <18 year olds Societal Pressure?» Facebook responses Majority against tanning bed For use for educational purposes ONLY. 2
3 Reality TV Shows? MTV-The Jersey Shore Silent National Epidemic The incidence per year is rising faster than any other cancer! Why Stylists? Early Detection = Better Prognosis For use for educational purposes ONLY. 3
4 Objectives 1. Skin Cancer Awareness & Education: Importance of early detection 2. To provide an overview of therapeutic progress ( ) Basal Cell Carcinoma ~3.8 million cases in 2017 in US Rarely lethal Preponderance in head and neck region Squamous Cell Carcinoma ~ 1 million cases of cutaneous SCC in 2017 in US ~8800 deaths Predominantly sun exposed areas For use for educational purposes ONLY. 4
5 Melanoma ,280 estimated new cases 87,110 invasive (increasing) 59,170 in situ (increasing) 9,730 deaths (stable) Melanoma in situ Cannot spread! Skin Problem ONLY! Invasive Melanoma Can Spread to Lymph Nodes and Vital Organs For use for educational purposes ONLY. 5
6 Early Detection = Better Prognosis Early Detection = Better Prognosis Early Detection = Better Prognosis Early Detection = Better Prognosis Melanoma Survival ACS 2016 Biopsy??? For use for educational purposes ONLY. 6
7 Detection of Melanoma A Asymmetry B Border C Color D Diameter E Evolution Rigel DS, Friedman RJ, Kopf AW, Polsky D. Arch Dermatol Biopsy??? Detection of Melanoma A Asymmetry B Border C Color D Diameter E Evolution Rigel DS, Friedman RJ, Kopf AW, Polsky D. Arch Dermatol For use for educational purposes ONLY. 7
8 Computer Aided Recognition Computer Aided Recognition Class 2 Device Recall MelaFind FDA May 20, 2015 Take Home Messages Stylists can play a vital role in early detection Identify changing or suspicious lesion Now what?» Suggest evaluation by health care provider: primary care provider or dermatologist Why?» Early detection=better prognosis For use for educational purposes ONLY. 8
9 Questions?? UNC Dermatology & Skin Cancer Center NC Cancer Hospital Objectives 1. Skin Cancer Awareness & Education: Importance of early detection 2. To provide an overview of therapeutic progress ( ) Melanoma Survival ACS 2016 For use for educational purposes ONLY. 9
10 Stages IIIbc IV Metastatic Melanoma US FDA Approved Stage IV Systemic Therapy Options Dacarbazine (1970s)» Complete Response 3-5% Interleukin-2 (1998)» Complete Response 7-8% US FDA Approved Stage III Systemic Therapy Options Interferon alpha-2b (1996)» Disease-free but no overall survival advantage Checkpoint Blockade -Inhibiting the Inhibitors PD1 CTLA-4 Pardoll Nat Rev Cancer 2012 For use for educational purposes ONLY. 10
11 Differences in Checkpoint inhibitors Ribas N Engl J Med 2012 Ipilimumab Prolongs Survival 10.1 vs. 6.4 months, HR 0.66 Hodi et al NEJM 2010 PD-1 Inhibitory Antibodies (BMS936558, MK3475) Topalian N Engl J Med 2012 For use for educational purposes ONLY. 11
12 Combination Checkpoint Inhibitors Larkin J N Engl J Med Jul 2;373(1):23-34 US FDA Approved Stage IV Systemic Therapy Options Ipilimumab (2011)» 10.1 vs. 6.4 months, HR 0.66 Vemurafenib (2011)» 13.6 vs. 9.7 months, HR 0.70 Dabrafenib (2013)» PFS 5.1 vs 2.7 months HR 0.33 Trametinib (2014)» Combination for BRAF mutant US FDA Approved Stage IV Systemic Therapy Options Pembrolizumab (2014)» Response Rate 26% Nivolumab (2014)» RR 40% vs 14% p<0.001» One yr survival 72% vs 42% Combinations.. For use for educational purposes ONLY. 12
13 US FDA Approved Stage IV Systemic Therapy Options Nivolumab + Ipilimumab (2015)» Untreated Stage IV melanoma» Nivo + Ipi vs Nivo vs Ipi» RR 57% vs 43% vs 19% p<0.001» Median survival not yet published» Side Effects: colitis, diarrhea, pyrexia, pneumonitis Larkin J N Engl J Med Jul 2;373(1):23-34 Summary Stylists can make a difference Early detection = Better Prognosis has seen a dramatic improvement in therapeutic options for metastatic melanoma patients 2017 and beyond. Thank you UNC Dermatology & Skin Cancer Center NC Cancer Hospital For use for educational purposes ONLY. 13
14 The Role Of The Non Traditional Health Liaison In Early Detection Of Skin Cancer Cosmetologists, Barbers, Estheticians, Nail Care Professionals, Massage Therapists, Personal Trainers, Podiatrists AS (MOSTLY) NON TRADITIONAL HEALTH LIAISONS IN THE COMMUNITY Health Providers and Beauty/Spa Professions have a few things in common State Board Regulated Licensed Scrubs or lab coats For use for educational purposes ONLY. 14
15 We are natural helpers For use for educational purposes ONLY. 15
16 Mechanical Flower Connection Confidence Listen For use for educational purposes ONLY. 16
17 We Observe CONNECT TRUST A CONFIDENCE OBSERVE LISTEN CARE Split Picture TRUSTED PROFFESSIONALS WORKING TOGETHER FOR BETTER HEALTH For use for educational purposes ONLY. 17
18 SPREAD THE WORD, TELL YOUR SERVICE PROVIDERS TO GET EDUCATED ON HOW TO BECOME A COMMUNITY HEALTH LIASON NOUN A PERSON WHO TOUCHES MORE HEARTS THAN HAIR www. The Flow Beauty Project.com For use for educational purposes ONLY. 18
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