where is the danger · 2015-07-22 · cutaneous oncology health quest •surgical oncology...
TRANSCRIPT
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Skin Cancer
What you absolutely need to know if you work outside
James R. Nitzkorski, MD, FACSSurgical Oncologist
Director, Cutaneous and Gastrointestinal OncologyAttending Surgeon, Vassar Brothers Medical Center
Poughkeepsie, NY
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Where is the danger ?
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• 1 in 5 people will get skin cancer
• More skin cancer than– Breast cancer
– Prostate cancer
– Lung cancer
– Colon cancer
COMBINED
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Basal cell cancer
• Most common form
• Rarely fatal, rarely spread
• Highly disfiguring
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Squamous cell cancer
• 2nd most common cancer
• 200% increase last 30 years
• 2% die from disease
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Melanoma
• SERIOUS
• 1 person dies from melanoma EVERY HOUR
• Incidence is increasing
• Survival
– 98% early
– 62% lymph node spread
– 16% distant
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• Melanoma increasing ~1.8%/year
• 24% increase among women 1970-2009
• 1 indoor tanning session increases melanoma risk by 20%
-SEER Cancer Statistics Factsheets: Melanoma of the Skin. National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/statfacts/html/melan.htm-Lowe, et al. Mayo Clin Proc 2014-Boniol , et al. BMJ 2012
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Staging
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Survival at 5 years:98% early
62% lymph node spread16% distant
1. Avoid Risk2. Detect EARLY
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Avoid Risk
• Genes
– Red/blonde hair, fair skin
– tendency to burn
• Sun Exposure
• Environment
– ? Pesticide use
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Avoid Risk
• UVR= proven carcinogen
– Cigarettes
– Arsenic
– Plutonium
• More people develop skin cancer from tanning than lung cancer from cigarettes
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Avoid Risk
• Stay in the shade, especially between 10-4
• Broad spectrum sunblock
• SPF 15 daily reduced risk of melanoma by 50%
• Avoid tanning
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• Clothing– Light colored long sleeve/long pants
– Hat with 4 inch brim- better than baseball hat
• Sun Guard
• Can “wash” SPF 30 into your clothes
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Pesticide use
• Melanoma risk is high among farmers
• High arsenic levels measured in toenails associated with melanoma
• Association does not mean causation
Blair A, et al., Environ Health Perspect 1995Blair, A, et al. Occup Med 1991
Spiewak, R. Ann Egric Environ Med 2001Beane Freeman, et al. Am J Epidemiol 2004
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Pesticide use
• National Cancer Institute
• ~60,000 licensed pesticide applicatorsrecruited 1993-1997 Iowa, North Carolina
• Use of 50 pesticides
• Additonal Information:– Crops/livestock used, protective equipment, application methods
used, nonfarm exposure- alcohol/smoking, etc, cooking practices, vitamin use, sun exposure, hair color ……
Dennis, et al. Environ Health Perspec 2010
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10 year follow-up
• 271 cases of melanoma
• Dose – response data analysis
– Total years mixing/applying, days per year of use
– Cumulative exposure estimate
Dennis, et al. Environ Health Perspec 2010
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Results
• Red Hair – Strongest association melanoma
• Tended to be a little older and heavier
• Strongest association:
– Maneb/mancozeb (dithiocarbamate fungicide)
– Parathion (ethyl/methyl insecticide)
• Also associated:
– Benomyl
– Lead arsenate
Dennis, et al. Environ Health Perspec 2010
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Bottom Line
• Farmers are at high risk for skin cancer
• Squamous and basal cell cancer need excision but are typically easy to treat and not life threatening
• Melanoma is deadly, especially when not caught early
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Early Detection
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For the cure:
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Skin Cancer???
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Early Detection
• Regular skin checks
• Dermatologist every year
• Report abnormality ASAP
• Melanoma prevention easy as ABC
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Melanoma ABCDE
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Treatment
• Wide Excision
• Sentinel lymph node biopsy
• Lymph node removal
• Advanced therapy
– Isolated limb infusion
– Removal metastatic melanoma
– Chemotherapy
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Isolated Limb infusion
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Chemotherapy
• 1970s– 1 drug– Extremely toxic
• 1990s– 1 drug– Toxic, very marginal improvement
• 2011– Rebirth chemotherapy– 1st new drug in 13 years
• 7 new drugs in 3 years
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Advanced Melanoma
• Vemurafenib BRAF inhibitor
PET – widespread disease
Repeat PET 2 weeks after therapy
Future:New drugs as adjuvant therapyCombination regimens
Bollag, et al. Nature 2010
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Cutaneous Oncology Health Quest
• Surgical Oncology
• Plastic Surgery
• Medical Oncology
• Radiation Oncology
• Nurse Navigation
• Radiology
• Perfusionists
• Pharmacists
• Case Management
• Thoracic Oncology
• Dermatology
• Survivorship Planning
• Nuclear Medicine
• Lymphedema Support
• Anesthesiology
• Administrators
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Questions?