1. Treatments and therapies “What do you need to know”
Melanoma
Treatments and therapies “What do you need to know”
Sandy Beam RN, OCN, CCRC Research Nurse Clinician Maryland Melanoma Center Franklin Square Medical Center Baltimore, Maryland

2. Sun damage done today may be tomorrows skin cancer.
SKIN FACTS & FUNCTIONS
Largest organ in the body
1st barrier to protect us from infection and
injury, heat and light.
* Regulates body temperature, Prevents
dehydration, and Stores water, fat and
vitamin D.
Sun damage done today may be tomorrows skin cancer.

4. Skin Cancer Facts Primary cause is ultra violet (UV) rays from:
excessive SUN exposure (UVB)
tanning bed exposure (UVA)
Over 1 MILLION new cases will be diagnosed this year.
Melanoma = 121,740
Basal cell and squamous cell OVER 1 MILLION
Can develop on any skin surface
95% are curable, with early detection and treatment
SKIN CANCER DOES NOT DISCRIMINATE!
Affects all ages, sex, ethnicities, and skin colors

5. SKIN CANCER FACTS 4 Types of skin CANCER:
Basal cell carcinoma (BCC) most common,100% from UVB-sun and UVA-tanning bed, slow growth, rarely spreads
Squamous cell carcinoma (SCC) caused by UVB and UVA damage. 1 out of 3 with disease will spread or metastasize to other areas of the body
Merkel cell most lethal and least common
MELANOMA is the 2nd most deadly skin cancer, but it is the more common killer of the skin cancers.
Can develop on any area and spread or metastasize to any area of the body: skin, lymph nodes, organs

6. Moles, freckles and spots!
Most are NOT cancer
May not look pretty
NEED to be observed for changes

7. Benign Hutchinson's Freckle has the potential to become cancer
Benign nevus

8. How do I get skin cancer? RISK FACTORS
Factors beyond our control…..
Hereditary: what our ancestors gave us
Fair or freckled skin
Light hair: blonde, red or light brown hair
Light color eyes: blue, green, or grey green
Family history of melanoma or skin cancer
Personal history of melanoma or skin cancer

9. RISK FACTORS Factors you can control may change your future
UVB rays of the sun, #1 cause of skin cancer! FACTS
1 hour of daily sun exposure and adequate diet provides all the vitamin D we need.
Tanning and burning increase production of melanin (pigmented cells of the skin) which can cause genetic damage to skin cells, may lead to skin cancer.
Environmental exposures: chemicals, radiation, burns (scald, fire, chemical)

10. BUT I GET MY VITAMIN D!!!!!!!!!!!!!!!!!!!

11. RISK FACTORS Factors you can control may change your future
UVA rays of tanning beds: FACTS
2-3 times more powerful and delivered in a shorter period of time, than natural UVA rays emitted from the sun
penetrate the skin deeper (pre-mature aging)
may damage eye sight + immune system
Tanning and burning increase production of melanin (pigmented cells of the skin) which can cause genetic damage to skin cells, may lead to skin cancer.
YOU CAN’T PROTECT THE SKIN BY DAMAGING IT!
7 out of 10 people age 16 to 30 who tan at least 10x year (not per month), will (not may) develop skin cancer

12. What do I look for! “ABCDE”
ASYMMETRY - imaginary line mid lesion, no mirror image
BORDER - edges are ragged, blurred or irregular
COLOR - changes, uneven, multiple colors can be black, brown, tan, red, pink, pearly
DIAMETER - change shape, size or gets larger than a pencil eraser (5mm)
EVOLUTION - ALERT your parents, teacher or doctor of any mole or spot that changes, grows, is new, or bleeds
GET IT CHECKED!

13. What do I look for! “ABCDE”
ASYMMETRY - imaginary line mid lesion, no mirror image
BORDER - edges are ragged, blurred or irregular
COLOR - changes, uneven, multiple colors can be black, brown, tan, red, pink, pearly
DIAMETER - change shape, size or gets larger than a pencil eraser (5mm)
EVOLUTION - ALERT your parents, teacher or doctor of any mole or spot that changes, grows, is new, or bleeds
GET IT CHECKED!

14. What do I look for! “ABCDE”
ASYMMETRY - imaginary line mid lesion, no mirror image
BORDER - edges are ragged, blurred or irregular
COLOR - changes, uneven, multiple colors can be black, brown, tan, red, pink, pearly
DIAMETER - change shape, size or gets larger than a pencil eraser (5mm)
EVOLUTION - ALERT your parents, teacher or doctor of any mole or spot that changes, grows, is new, or bleeds
GET IT CHECKED!

15. What do I look for! “ABCDE”
ASYMMETRY – imaginary line mid lesion, no mirror image
BORDER - edges are ragged, blurred or irregular
COLOR - changes, uneven, multiple colors can be black, brown, tan, red, pink, pearly
DIAMETER – change shape, size or gets larger than a pencil eraser (5mm)
EVOLUTION - ALERT your parents, teacher or doctor of any mole or spot that changes, grows, is new, or bleeds
GET IT CHECKED!

16. Where can melanoma appear ?
Any skin surface in an old mole/lesion/spot or as a new spot or thing that just appeared, often on sun exposed areas
Nail beds and cuticles
Palm of hands and soles of feet, usually in dark skin people
Mucous membranes of the oral, anal or vaginal canal
Ocular or Uveal (retina of the eye)
** Unknown primary: not sure where it originated?
MELANOMA can spread or metastasize to any area of the body, such as the lung, liver, ovaries, colon, rectum, nasal passages and brain.

17. Amelanotic (no pigment) nodular melanoma
Satellite melanoma tumors

18. Mucosa melanoma tumor (inner lip)
Cutaneous melanoma of eye lid

19. Subungal melanoma of nail bed
Acral melanoma (nail bed)

20. Cutaneous (skin) melanoma of plantar aspect of foot

21. Melanoma Detection + Treatment
95% CURE with early detection and treatment! Ignore “it” and it will……
grow
ulcerate
smell
spread to lymph nodes, lungs,
liver, etc…

22. Melanoma in a lymph node
Fungating melanoma mass

23. Treatment options Metastatic melanoma :
1st FDA approved treatment is high dose IL-2 (Proleukin) which is considered as 1st line treatment.
Other options include:
Yervoy (Anti-CTLA-4)
Vemufenib (BRAF inhibitor)
Clinical trial
Adjuvant therapy is appropriate for melanoma that has been surgically removed:
Standard of care is close follow-up.
Other options include:
Interferon
Clinical trial

24. Treatment options Purpose of cancer treatment
Administration of high-dose IL-2 requires careful attention to the many physiologic changes occurring in patients during treatment
Treatment algorithms are useful tools in managing these patients but cannot replace the careful judgment and individualized decision making that is needed
The health care team should be familiar with the scope of possible side effects that may be encountered, because they must be prepared for the common as well as unusual events that occur when treating patients with high-dose IL-2
Purpose of cancer treatment
Palliative care
Reducing the severity of disease symptoms
Prevent and relieve suffering and to improve quality of life
Curative care
Treatment and therapies provided with an intent to improve symptoms and cure the patient's medical problem

25. Treatment options WHY CONSIDER PROLEUKIN?
Proleukin may induce a durable, complete response1,2
Overall response rates (complete responses + partial responses) of 15% to 16% have been obtained with Proleukin therapy3
Proleukin is the ONLY approved therapy that has shown a complete and durable response in metastatic renal cell carcinoma or metastatic melanma.
Median response duration for patients with a CR (7% metastatic renal cell carcinoma & 6% metastatic melanoma) is still not reached3:
At 80+ months for metastatic renal cell carcinoma
At 59+ months for metastatic melanoma

26. How can I reduce my risks of developing melanoma?
REDUCE risk factors you can control!
STAY OUT of the sun at peak times10am - 4pm
AVOID- Do not use tanning beds
Wear clothes to protect your skin: wide brim hat, cotton pants + shirt, sunglasses
Apply Sun block protection: SPF30 or higher
Apply minutes before you go in the sun! Beaches OR Ski slopes.
Re-apply a least every 2 hours OR after swimming, exercising OR heavy sweating.
Perform routine self skin exams
Education gives YOU the power to prevent skin cancer!

28. “UVSP” UltraViolet Ray Skin protection
EDUCATION is the key!
Reduce risk factors
Avoid excessive sun
Avoid tanning beds
Apply sun block
Self skin exams
ABCDE’s
“Slip” on a shirt “Slap” on a hat “Slop” on sunblock

29. You said to wear a HAT