Talking to Your Clients About Skin Cancer Amanda Friedrichs, MD, FAAD AMTA National Conference September 14, 2017 Objectives Provide general information about skin cancer and how skin cancers commonly occur Provide information on how to recognize the different types of skin cancers Assist with developing communication methods for discussing suspicious lesions with clients and ensuring appropriate referrals Describe resources available to therapists to help educate clients about skin cancer detection and prevention 1
Which one will it be? One in five Americans will develop skin cancer in their lifetime. Only 36% of people examine their back for signs of skin cancer at least once a year 2
Who s Got Their Back? YOU DO!!! How Does the Sun Affect Your Skin? How Does UV Radiation Cause Skin Cancer? From years of accumulation a tan today, a burn tomorrow, it all adds up. Your actions today do matter for tomorrow. It is 3
Similar to Smoking A healthy lung A diseased lung Lung images courtesy of American Lung Association www.lungusa.org Unilateral photoaging following 15 years of unilateral sun exposure through window glass. UVB does not penetrate window glass and UVA is thought to have induced this elastosis, wrinkling, and dyspigmentation. Bolognia 2003, Dermatology New England Journal of Medicine 4
Is There A Safe Way to Tan? Types of Skin Cancer Substantially more than 1 million cases of skin cancer are diagnosed in the United States every year. Basal cell carcinoma Squamous cell carcinoma Melanoma Basal cell carcinoma Squamous cell carcinoma Melanoma Basal Cell Carcinoma Most common form of cancer 5
Basal Cell Carcinoma Squamous Cell Carcinoma Second most common skin cancer Related to sun exposure Pink/red flat spots with scale More than 58 million Americans Precancerous Approx 10% develop into squamous cell carcinoma Actinic Keratoses www.mayoclinic.org 6
Melanoma Deadliest form of skin cancer Melanoma One American dies from melanoma almost every hour. Most common form of cancer for young adults 25-29 years old. Second most common cancer in adolescents and young adults 15-29 years old. Who Gets Melanoma? Melanoma can strike anyone. 7
Statistics An estimated 87,110 invasive cases of melanoma and 74,680 noninvasive (in situ) will be diagnosed in the US in 2017. Up until age 49, more women develop melanoma than men (1 in 207 women vs. 1 in 294 men). By 65 rates are twice as high in men, and 80 and older is three times higher. Melanoma survival rates Early, localized disease 98% 5 year 62% when reaches local nodes Distant organs 16% ABCDEs of Melanoma Asymmetry One half does not match the other half. Border irregularity The edges are ragged, notched or blurred. Color The pigmentation is not uniform. Different shades of tan, brown or black are often present. Dashes of red, white, and blue can add to the mottled appearance. ABCDEs of Melanoma Diameter While melanomas are usually greater than 6mm in diameter when diagnosed, they can be smaller. Evolving A mole or skin lesion that looks different from the rest or is changing in size, shape or color. 8
Skin of Color SCC most common form in African-Americans Result of trauma/scarring Acral sites http://www.podiatrytoday.com/files/pt0515dermo2.png http://stanfordmedicine25.stanford.edu/the25/hand.html Skin Cancer Risk Factors Exposure to natural and artificial UV light History of blistering sunburns Light skin/freckles Blonde/red hair Immune system-suppressing diseases or treatments Having >50 moles The presence of atypical moles Family history of melanoma Personal history of skin cancer Risk Factors Increasing intermittent sun exposure in childhood and during one s lifetime is associated with an increased risk of squamous cell carcinoma, basal cell carcinoma and melanoma. Experiencing five or more blistering sunburns between ages 15 and 20 increases one s melanoma risk by 80 percent and nonmelanoma skin cancer risk by 68 percent. In 2010, new research found that daily sunscreen use cut the incidence of melanoma in half. People older than 65 may experience melanoma more frequently because of UV exposure they've received over the course of their lives. 9
Risk Factors Exposure to tanning beds increases the risk of melanoma, especially in women 45 and younger. In females 15 to 29 years old, the torso/trunk is the most common location for developing melanoma, which may be due to high-risk tanning behaviors. Higher melanoma rates among young females compared to young males may be due in part to widespread use of indoor tanning among females. Even one indoor tanning session can increase users risk of developing squamous cell carcinoma by 67 percent and basal cell carcinoma by 29 percent. Studies have found a 59 percent increase in the risk of melanoma in those who have been exposed to UV radiation from indoor tanning, and the risk increases with each use. Risk of Further Cancer Melanoma survivors have an approximately nine-fold increased risk of developing another melanoma compared to the general population. Men and women with a history of nonmelanoma skin cancer are at a higher risk of developing melanoma 10
Common Benign Lesions Seborrheic Keratoses Solar lentigines (sun spots) 11
Cherry Angiomas Skin Tags Benign or Malignant??? Refer or Not To Refer??? 12
13
14
15
16
You see it, now what??? Refer! But How.?? 17
Best Methods Comfortable Non-threatening Casual approach Further questioning How long have you had it? Has it changed in any way? Does it ever hurt or bleed? Suggest it be evaluated by a dermatologist Patient Resources For more information: (888) 462-DERM (3376) www.aad.org **Find a Dermatologist** Patient Resources Your local dermatologist www.aad.org For the Public tab Skin Cancer Education Foundation www.skincancer.org 18
Breakout Session Groups of 3 Role play Therapist finding suspicious lesion Client Observer Pay attention to words used, reaction by client, etc Rotate roles Report of Breakout Groups What worked well? Reactions from clients Suggestions for improvement? Prevent skin cancer 19
UV Protection Curve Eltamd.com Sunscreens Chemical sunscreens prevent UV rays from reaching the skin through photochemical reactions. Because of their mechanism of action, these types of sunscreens degrade with sun exposure. Physical blocking sunscreens scatter and deflect UV rays. They are inert and therefore do not degrade with sun exposure 20
Vitamin D Studies suggest link between low serum levels and increased risk of heart disease, cancers, neurologic disease and autoimmune disease Sources Fatty fish Milk Fortified foods, i.e. cereal, orange juice, yogurt Supplementation 1000-2000 IU of Vitamin D3/day Thank You! Amanda Friedrichs, MD Radiant Dermatology 1740 Mediterranean Dr, Suite 102 Sycamore, IL 60178 815.981.4990 radiantderm.com 21