Finding Melanoma. Is not easy!

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1

2 Finding Melanoma Is not easy!

3 Finding Melanoma Victoria mean depth at diagnosis is 1.5 mm.

4 Melanoma 1.5mm Has Stage 1B Mortality 10%

5 Melanoma Spotting a killer!

6

7 Spotting a killer

8

9 Visual Clues

10 What are those visual clues?

11 As easy as ABCDE

12 But is it?

13 A B C D E asymmetry border colour variation diameter more the 5mm evolving changing

14 A B C D E Finds lots of Melanoma by MD,s. Enables patients to find lots of Melanoma.

15 ABCDE 30 years use. Fails to diagnosis many types of melanoma. Mortality still remains at 15-20%.

16 Finding melanoma Early detection has not translated into reduced deaths. Aggressive melanomas not found early enough.

17 B

18

19

20

21

22

23 The ABCDE System places two much importance on moles, their detection, follow up and removal.

24 ABCD

25 Answer none A B C D blue nevus angiokeratoma blue nevus junctional nevus

26 Are there other clues we should use?

27 Big picture clues!

28 Small picture clues!

29 Big picture clues!

30 Known Risk Group Multiple Nevi. Red hair / freckles. Tanning bed user. Family History Melanoma. Previous systemic malignancy / Immune supp. Older men.

31 One of the myths out there is patients with multiple moles are at greatest melanoma risk.

32 Facts from 1469 patients Over 50% 30.9% 30% 15% 13% have no risk factors. have used tanning beds. have red hair and freckles. have multiple nevi. have a family history.

33 Tanning Bed use % have use beds. 62.9% in females <35 years. (89)

34 Risks groups 30% Red Hair and freckles.

35 Risk groups Patient with red hair and freckles do not seem to know that they are at risk (91 of 106 did not know). Our public education has not targeted this group so far.

36 We have Mole patrols what about Freckle Fridays or Red Hair Mondays!

37 Who finds melanoma? Doctors. Nurses. Families. Patients.

38 Who finds melanoma? Doctors 15% Nurses 15% Families 20% Patients 50% (49.9%)

39 A lot of fuss is made about Atypical Mole Syndrome.

40 AMS It represents < 1% of the pop. From it 10% of our melanomas arise 1% of our melanoma deaths.

41 AMS To detect one melanoma in this group costs 150 times what it costs to detect melanoma in the whole remaining population.

42 Why? Office visits. Mela Find. Confocal microscopy. Biopsies.

43 AMS Is this money well spent when we have not seen a reduction in mortality rates?

44 Small picture clues!

45 Colours of lesions.

46 How many colours expected. Nevi 2 colours. Nevi 3 colours. Nevi 3+ colours.

47 How many colours expected. Nevi 2 colours 60%. Nevi 3 colours 30%. Nevi 3+ colours 10%.

48 Colours Brown. Shades of grey. Red. White. Blue. Black.

49 Where do Melanomas arise? New lesions. Existing lesions. Unknown.

50 Melanomas appear 1448 New lesions 32.5%. Existing lesions 45.2%. Unknown 16.6%.

51 Most important sign!

52 First is Change

53 Second is Change

54 Third is Change

55 Change. Month to month to month. Average melanoma develops over 6-8 months. Rate of growth slow 0.12mm/month. rapid 0.49mm/month.

56 What is to be done! How do we improve detection?

57 We have something else. BLINK.

58 BLINK. Helps us decide which pigmented lesions to biopsy.

59 B. BLINK. Not obviously Benign

60 L. BLINK. Lesion Lonely Ugly duckling sign

61

62

63 I. BLINK. Irregular Outline and Colour

64 N. BLINK. Nervous

65 K. BLINK. Known features of melanoma on Dermoscopy

66 Remember. Be curious. Be suspicious. Listen to the patient. Melanomas can be bland.

67 Things are not always as appear.

68 Remember. B L I N K.

69 Melanoma Care Victoria

70 Melanoma Care Victoria

71 Melanoma Care Victoria Know Melanoma No Melanoma

72 Thank you

73

74

75

76 HOW DO YOU SPOT A KILLER? Visual clues Dermoscopic clues Histologic findings Experience Gerstalt Luck

77 I SPY WITH MY LITTLE EYE IS PARAMOUNT

78 WHO FINDS MELANOMA A. The Doctor. B The Patient. C The family. D Other health care workers.

79 WHO FINDS MELANOMA? A. The Patient 50% B. The family 25% C. The Doctor 25% D. Other health professionals 25%

80 WE HAVE A PROBLEM! WE MISS MANY CASES, USING PRESENT CRITERIA.

81 A.B.C.D.E.

82 ABCDE Almost 30 years ago introduced. JAAD April 2015 reevaluation by Dr Hansen Tsao Fails to diagnose Nodular melanoma Amelanotic melanomas Desmoplastic melanomas Mucosal melanomas Lentigo maligna / melanomas

83

84 See spot See spot change See a dermatologist

85 Spot the Killer

86 A B C D

87 Answer B Note asymmetry

88

89 A B C D

90 Answer C Note borders irregular

91 Answer C Note borders irregular

92 A B C D

93 A B C D

94 Answer A Note colour variations, browns, shades of grey, red, white, blue and black or mixtures of these colours.

95 Answer A Note colour variations, browns, shades of grey, red, white, blue and black or mixtures of these colours.

96 Answer none A blue nevus B angiokeratoma C blue nevus D junctional nevus

97 Answer none A blue nevus B angiokeratoma C blue nevus D junctional nevus

98 ABCD

99 Answer B Note asymmetry

100 ABCD

101 Answer all Amelanotic melanoma very difficult to diagnose Victoria Melanoma data bank 85 of 1162 case 7.3%

102 ABCD

103 Answer none A blue nevus B angiokeratoma C blue nevus D junctional nevus

104 ABCD

105 Answer all Amelanotic melanoma very difficult to diagnose Victoria Melanoma data bank 85 of 1162 case 7.3%

106 ABCD

107 Answer all Amelanotic melanoma very difficult to diagnose Victoria Melanoma data bank 85 of 1162 case 7.3%

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