SKIN CANCER 2013 REPORT

Transcription

1 Nancy N. and J.C. Lewis Cancer & Research Pavilion SKIN CANCER 2013 REPORT SELECTED A NATIONAL CANCER INSTITUTE COMMUNITY CANCER CENTER PROGRAM.

2 2 St. Joseph s/candler Mission and Vision Mission Rooted in God s love, we treat illness and promote wellness for all people. Vision To set the standards of excellence in the delivery of healthcare throughout the regions we serve. Nancy N. and J.C. Lewis Cancer & Research Pavilion and the Oncology Service Line Mission and Vision Mission Holistic, multi-disciplinary, patient-centered cancer care provided across the disease continuum for all stages of a patient s journey. Vision To be the premier destination for comprehensive cancer care in the region while providing a superior patient experience.

3 3 A Message from the Cancer Committee Chairman The Nancy N. and J.C. Lewis Cancer & Research Pavilion (LCRP) embraces the highest standards of service, quality, and best practices in care through adherence to the Commission on Cancer and the National Cancer Institute standards and initiatives. Melanoma is the 5th most common cancer in the United States and its incidence continues to rise. Among young women ages 20 to 30, melanoma is the most common cancer. According to the American Cancer Society s Cancer Facts and Figures 2013, an estimated 2,360 new melanoma cases were diagnosed in Georgia in 2013 and an estimated 209 individuals in Georgia died of melanoma. Additionally, the lifetime risk of developing melanoma is 23 times higher among whites than among African Americans. The incidence rate of melanoma in Georgia, at 21.6 cases per 100,000 individuals, is higher than the national rate of 19.0 cases per 100,000. The LCRP is responding to this need. As a regional destination for cancer care, we ensure that all skin cancer patients have access to the most technologically advanced treatment options, nationally recognized evidence-based treatment guidelines, personalized medicine, and access to clinical trials. In addition, we offer supportive oncology services including palliative care, navigation services, nutritional services, support groups, and survivorship care. For example, the LCRP is expanding access to clinical trials for skin cancer patients. From , we enrolled a total of 10 skin cancer patients into clinical trials providing the opportunity for our patients to access the latest and most innovative oncology treatments available. To help advance melanoma cancer treatment and research the LCRP participates in fundraising events such as the annual Fishin for Jamie golf and fishing tournament. Within the LCRP service areas of Bryan, Chatham, Effingham, Screven, and Beaufort counties, melanoma incidence rates are higher than national averages. In line with these higher incidence rates along coastal Georgia and South Carolina, 83.0 % of the skin cancer cases treated at the LCRP in 2012 came from counties within the LCRP primary service area - Bryan, Chatham, Effingham, and Beaufort. To this measure, each year an in-depth cancer site specific analysis of disease and treatment through St. Joseph/ Candler is completed and reviewed by the Cancer Committee. At the LCRP we are committed to the prevention and early detection of skin cancer. The best prevention for skin cancer is to always use sunscreen and hats when spending time in the sun, avoid the sun during its strongest hours, avoid sunburns, and wear long sleeves or other protective clothing if you know that you must be in the sun. Individuals should never use tanning beds use of tanning beds is a significant risk factor to the development of skin cancer. Even individuals who take these preventive measures should be sure to regularly visits to their dermatologist for assessment. Remember the ABCDE warning signs rule to help you recognize changes in skin growths that may be melanoma: A: Asymmetric. Half of the mole does not match the other half. B: Border irregularity. Mole edges are ragged, notched, or blurred. C: Color. Mole pigmentation is not uniform, with variable degrees of tan, brown, or black. D: Diameter greater than 6 millimeters or about the size of a pencil eraser. E: Elevation above the skin surface. In coordination with local dermatologists the LCRP offers MoleSafe to conduct surveillance for melanoma survivors. In 2011 and 2012, MoleSafe identified lesions of concern needing further follow-up in 12 % of clients. This service allows local dermatologists an additional personalized surveillance tool to closely monitor changes in skin lesions for melanoma survivors.

4 4 With a total of 160 cases (95 analytic and 65 non-analytic), skin cancer was the fifth most commonly treated cancer sites at the LCRP in 2012, representing a 57 % increase in the number of cases from 2011 (57 analytic ad 45 non-analytic) % of the individuals treated for skin cancer at the LCRP in were age 70 or older. A significant proportion 38.2 % - were ages and 17.1 % were individuals ages Corresponding to higher rates of skin cancer among men than women in Georgia and nationally, from the LCRP treated 104 men and 48 women for skin cancer. With the continual development of the LCRP Pigmented Nevus Center, the LCRP multi-disciplinary treatment team is increasingly treating rarer forms of aggressive skin cancer such as merkel cell carcinoma, skin appendageal tumors, and sebaceous carcinoma. Individuals faced with a diagnosis of skin cancer can be confident that, by picking the Lewis Cancer and Research Pavilion for their treatment and survivorship surveillance, they will receive holistic, multi-disciplinary, patient-centered care at a regional destination for comprehensive cancer care. H.A. Zaren, MD, FACS Medical Director, LCRP Cancer Committee Chairman Primary Investigator, NCCCP Professor of Surgery at Georgia Regents University and Distinguished Cancer Scientist

5 5 Community Need Melanoma is the 5 th most common cancer in the United States and its incidence continues to rise. 1 The risk of developing melanoma increases with age 2, however melanoma is the most common cancer in women between 20 and 30 years of age. 3 The lifetime risk of developing melanoma is 23 times higher among whites than among African Americans. 4 An estimated 76,690 individuals in the United States were diagnosed with melanoma in ,360 of these individuals were from Georgia of these individuals were from Chatham County. 6 An estimated 9,480 individuals in the United States died of melanoma in of these individuals were from Georgia. 8 of these individuals were from Chatham County.7 Melanoma Incidence in LCRP Primary, Secondary, and Tertiary Service Areas 2012, State Cancer Profiles Incidence Rate per 100,000 individuals Data limited if fewer than 16 cases were reported JENKINS JOHNSON SCREVEN EMANUEL 21.5 MONTGOMERY EVANS TOOMBS 11.9 TATTNALL WHEELER TREUTLEN JEFF DAVIS COFFEE 14.0 ATKINSON APPLING BACON WARE 13.6 CANDLER BULLOCH 18.0 PIERCE WAYNE 12.4 BRANTLEY BRYAN 30.4 LIBERTY LONG 9.4 EFFINGHAM 25.8 McINTOSH GLYNN 17.8 JASPER 13.9 CHATHAM 20.9 BEAUFORT 44.3 LCRP Analytic Skin Cancer Cases by Service Area , LCRP Cancer Registry Data Outside Service Area Tertiary Secondary Primary 90% 87% CLINCH CHARLTON CAMDEN % 6% 7% 4% 2% % 2012

6 6 Throughout this report, statistics referring to national data are reported for melanoma rather than for all skin cancers while data from the LCRP cancer registry includes all skin cancers treated at the LCRP. Melanoma is the only skin cancer with reporting requirements to cancer registries, thus national data is not available for other skin cancers. In actuality, melanoma makes up less than 5 % of all skin cancer cases, however, almost all deaths from skin cancer come from melanoma. 8 Melanoma Death and Incidence Rates per 100, , State Cancer Profiles DEATH RATE ANNUAL INCIDENCE Georgia United States Five counties in the LCRP service area (Bryan, Chatham, Effingham, Screven, and Beaufort, South Carolina) have melanoma incidence rates higher than national averages. JENKINS JOHNSON SCREVEN EMANUEL JASPER TREUTLEN CANDLER BULLOCH EFFINGHAM MONTGOMERY WHEELER TOOMBS EVANS BRYAN TATTNALL CHATHAM COFFEE JEFF DAVIS ATKINSON APPLING BACON WARE PIERCE WAYNE BRANTLEY LIBERTY LONG McINTOSH GLYNN BEAUFORT CLINCH CHARLTON CAMDEN

7 7 Early Detection The American Cancer Society provides the following information about skin cancer early detection in their publication, Cancer Facts & Figures 2013: Signs and symptoms: Important warning signs of melanoma include changes in size, shape, or color of a mole or other skin lesion or the appearance of a new growth on the skin. Changes that progress over a month or more should be evaluated by a doctor. Risk factors: Risk factors vary for different types of skin cancer. For melanoma, major risk factors include a personal or family history of melanoma and the presence of atypical or numerous moles (more than 50). Other risk factors for all types of skin cancer include sun sensitivity (sunburning easily, difficulty tanning, natural blond or red hair color); a history of excessive sun exposure, including sunburns; use of tanning booths; diseases that suppress the immune system; and a past history of skin cancer. Early detection: The best way to detect skin cancer early is to recognize changes in skin growths, including the appearance of new growths. The ABCD rule outlines the warning signals of the most common type of melanoma: A is for asymmetry (one half of the mole does not match the other half) B is for border irregularity (the edges are ragged, notched, or blurred) C is for color (the pigmentation is not uniform, with variable degrees of tan, brown, or black) D is for diameter greater than 6 millimeters (about the size of a pencil eraser). Other types of melanoma may not have these signs, so be alert for any new or changing skin growths. Adults should periodically examine their skin and be aware of any changes. New or unusual lesions or a progressive change in a lesion s appearance (size, shape, or color, etc.) should be evaluated promptly by a physician. 9 The LCRP encourages all individuals to make regular visits to their dermatologist for assessment.

8 8 MoleSafe: A New Form of Skin Protection The Nancy N. and J.C. Lewis Cancer & Research Pavilion (LCRP) is one of nine clinics in the United States offering MoleSafe services. The LCRP works in collaboration with local dermatologist to use MoleSafe as another surveillance tool for melanoma survivors to enhance personalized medicine and positive survival outcomes. MoleSafe uses new technology to help detect melanoma at an early, and therefore treatable, stage. MoleSafe s diagnosis can be more accurate than a regular clinical inspection. Dana Coleman, the LCRP s MoleSafe Melanographer conducts MoleSafe digital imaging, skin cancer education, and discusses risk factors and sun protection awareness with MoleSafe clients. During a MoleSafe consult, Ms. Coleman conducts a comprehensive full-body assessment of an individual s skin, taking a combination of high resolution clinical and dermoscopy images of skin and lesions. This provides an accurate record of the distribution and locations of lesions, linked with individual diagnostic images, as well as an overall skin condition the MoleSafe melanogram. This digital melanogram is then examined and diagnosed by a MoleSafe dermatologist certified in dermoscopy. Ms. Coleman explains, The overall goal is to detect abnormal melanocytic lesions early on in order to enhance and coordinate care with the patient s dermatologist. High-resolution image of mole. Dermoscopy image of the same mole. A report, which is shared with the individual and their dermatologist, includes: Comments and recommendations for the treatment or monitoring of suspicious lesions; Printouts of lesions requiring treatment; A general melanoma risk rating; and A recommended MoleSafe follow-up program. MoleSafe should be conducted annually to track changes to the skin. Melanoma is a huge problem, and it can be deadly. But if you take care of it early, when it s local, it is highly treatable. We re always looking into technologies that will continue to help us screen for melanoma, diagnose early and treat responsibly. Mole Mapping is just the beginning. Howard Zaren, M.D. Medical Director of St. Jpseph s/candler s Nancy N. and J. C. Lewis Cancer & Research Pavilion (LCRP)

9 Capturing an in-depth image in the dermoscopy mode. 9 f y a o a at an early, and therefore M a in le Recording the images and data for dermatologist diagnosis. w Recording the the images and data data for for dermatologist diagnosis. f m of any new moles or lesions. Mole The process begins with a comprehensive Capturing an in-depth image the dermoscopy an in-depth full-modebody checkup to assess image your MoleSafe skin, Screening using digital Outcomes imaging and dermoscopy scans to produce a digital MoleSafe Screening Outcomes , LCRP Data melanogram. This melanogram is then examined reducing unnecessary excision by you have a lesion removed. and diagnosed by a MoleSafe dermatologist. Number of MoleSafe Patients Number of Lesions of Concern Identified 4 10 Regular follow-up examinations refer to your stored melanogram and allow comparisons of the scans over time, detecting any problems at an early stage. In 2011, MoleSafe screening identified lesions of concern that required further monitoring and diagnostic evaluation by the patient s dermatologist in 12.1% of individuals screened. In 2012, this remained fairly similar with 12.8 % of the 78 individuals screened being identified with a lesion of concern. This collaboration between the LCRP multi-disciplinary treatment and survivorship team with local dermatologists allowed these individuals to access further diagnostic testing, and treatment when appropriate, in a timely manner. MoleSafe s diagnosis can be more accurate than a regular clinical inspection. This means there s less guesswork over time. We will detect important sub-surface features and changes in existing moles as well as the appearance of any new moles or lesions. MoleSafe s accuracy can help in reducing unnecessary MMS0010 MoleSafe GP Brochure.indd 2

10 10 Lewis Cancer & Research Pavilion Response LCRP Skin Cancer Cases , LCRP Cancer Registry Data Analytic Non-analytic Analytic cases: refers to patients who are either initially diagnosed at the LCRP or newly diagnosed elsewhere and are referred to LCRP for all or part of their initial treatment or decision not to treat Non-Analytic cases: refers to patients who are diagnosed and treated elsewhere, or diagnosed and treated prior to referral to the LCRP. The LCRP is a regional destination for cancer care. In 2011, skin cancer was the sixth most commonly treated cancer site at the LCRP. From 2011 to 2012, skin cancer cases treated at the LCRP increased 57% to 160 new cases skin cancer cases have likewise continued to grow exponentially as the LCRP s skin cancer expertise is recognized regionally. In addition, the LCRP ensures all skin cancer patients have access to the most technologically advanced treatment options that are supported by nationally recognized evidencebased treatment guidelines through personalized medicine and access to clinical trials.

11 11 LCRP Analytic Skin Cancer Cases by Histology 2012, LCRP Cancer Registry Data HISTOLOGY NUMBER OF CASES PERCENT Malignant melanoma % Superficial spreading melanoma % Melanoma in situ 8 8.4% Nodular melanoma 6 6.3% Merkel cell carcinoma 6 6.3% Hutchinson s melanotic freckle NOS 5 5.3% Malignant melanoma in Hutchinson s melanotic freckle 2 2.1% Dermatofibrosarcoma 1 1.1% Desmoplastic melanoma malignant 1 1.1% Mycosis fungoides 1 1.1% Superficial spreading melanoma in situ 1 1.1% Spindle cell melanoma 1 1.1% TOTAL % With the continual development of the LCRP Pigmented Nevus Center, the LCRP multi-disciplinary treatment team is increasingly treating rarer forms of aggressive skin cancer such as merkel cell carcinoma, skin appendageal tumors, and sebaceous carcinoma. Number of Patients by Age Range at Time of Skin Cancer Diagnosis (Analytic Cases) , LCRP Cancer Registry Data < % of the individuals treated for skin cancer at the LCRP in were age 70 or older. A significant proportion % - of individuals treated were ages and 17.1% were individual ages

12 Number of Patients by Stage and Sex at Time of Diagnosis (Analytic Cases) , LCRP Cancer Registry Data 2012 Male 2012 Female Stage 0 Stage I 6 5 Stage II 3 2 Stage III 4 1 Stage IV 4 Stage UNK 0 N/A 1 Significantly more men than women are treated at the LCRP for skin cancer. From , the LCRP treated 104 men and 48 women. This corresponds to higher rates of skin cancer among men in Georgia and nationally. In Georgia, men have a melanoma incidence rate of 28.9 per 100,000 while the incidence rate for women is 16.7 per 100, This means that it is more likely for men in Georgia to be diagnosed with skin cancer than women. Analytic Skin Cancer Cases by County of Residence at Time of Diagnosis 2012, LCRP Cancer Registry Data DIAGNOSIS COUNTY NUMBER OF CASES PERCENT Chatham 54 57% Beaufort, SC 10 11% Bryan 9 9% Effingham 6 6% Bulloch 5 5% Liberty 4 4% Candler 1 1% Houston 1 1% Jasper, SC 1 1% Glynn 1 1% McIntosh 1 1% Jeff Davis 1 1% Hampton 1 1% TOTAL % The LCRP is responding to high skin cancer rates in Chatham, Beaufort, Bryan, and Effingham Counties. 83% of the skin cancer cases treated at the LCRP in 2012 came from these four counties.

13 13 Fishin for Jamie: Raising Funds for Melanoma Treatment and Research The 2013 annual summer Fishin for Jamie golf and fishing tournament raised $15,000 for melanoma treatment and research at the Lewis Cancer & Research Pavilion (LCRP). Members of Fishin for Jamie, Inc. presented the check to Howard A. Zaren, Medical Director for the LCRP, and the staff in late November. Dr. Zaren thanked the event organizers for their hard work and commented, Not only does Fishin for Jamie allow us to honor a Savannahian who died of melanoma, but it helps to raise awareness for the high risk of melanoma in this region. Fishin for Jamie began in 2005 as a fishing tournament to raise funds for Jamie Fulcher, a young father battling melanoma. Fulcher often had to travel outside Savannah for treatment because at that time there were no local melanoma trials open for his stage of cancer. The funds raised from the original event helped pay for Mr. Fulcher s travel and other extra expenses. Before his death, Mr. Fulcher requested that the fishing tournament continue. Mr. Fulcher s wife, family, and friends started the non-profit organization that brings the tournament back each year. In 2012, a golf tournament was added to the fundraiser, making 2013 the second annual golf tournament. Teams of four, including LCRP staff and physicians, played nine holes at Wilmington Island Golf Club. This tournament, along with the growth of the fishing event, helped make this year s donation the largest in the fundraiser s history. Every dime raised from this event goes directly to melanoma treatment and research. Thanks to the growing number of melanoma and other clinical trials offered at the LCRP, individuals like Mr. Fulcher no longer have to travel outside of Savannah to receive care. To learn more, like the Fishin for Jamie Facebook page.

14 14 Footnotes 1 Dunki-Jacobs E, Callendar G, McMasters K. Current Management of Melanoma, In Brief. Curr Probl Surg. 2013; 50: Siegel R, Ma J, Zou Z, et al. Cancer Statistics, CA Cancer J Clin. 2014;64: Dunki-Jacobs E, Callendar G, McMasters K. Current Management of Melanoma, In Brief. Curr Probl Surg. 2013; 50: American Cancer Society. Cancer Facts & Figures Atlanta: American Cancer Society; American Cancer Society. Cancer Facts & Figures Atlanta: American Cancer Society; State Cancer Profiles, State Cancer Profiles, American Cancer Society. Cancer Facts & Figures Atlanta: American Cancer Society; American Cancer Society. Cancer Facts & Figures Atlanta: American Cancer Society; State Cancer Profiles, 2013.

15 SELECTED A NATIONAL CANCER INSTITUTE COMMUNITY CANCER CENTER PROGRAM.