Risk%Factors%for%Skin%CancerSkin%CancerqEach%Year%over%1.0%million%people%in%the%United%States%find%out%that%they%have%skin%cancerqEs timated%new%cases%and%deaths from%melanoma%in%the%United%States %in%2 01 0:New%cases:%68,130Deaths:%8,700qNon-Melanoma;%New%cases:%more%than%1,000,000Deaths:%less%than%1,0 00What%are%ri s k%factors%for%skin%cancer?qHeredity - people%with%a%family%history%of%skin%cancer%are%generally%at%a%higher%risk%of%developin g%the%disease.%People %with%fair%skin,%and%a%northern%European%heritage,%appear%to%be%most%susceptible%qEnvironment - level%of%UV%light%today%is%higher%than%it%was%50%or%100%years%ago.%Ozone%serves%as%a%filter%to%screen%out%and%red u ce %the%amount%of%UV%light%that%we%are%exposed%to.%With%less%atmospheric%ozone,%a%higher%level%of%UV%light%reaches%the%earth's%surface .%qMultiple%nevi (moles)%or%atypical%nevi.%qOccupational%exposure to%coal%tar,%pitch,%creosote,%arse n ic%compounds,%or%radium.%qElevation - UV%is%stronger%as%elevation%incre ases%(because%the%thinner%atmosphere%at%higher%altitudes%cannot%filter%UV%as%effectively%as%it%does%at%sea%level).%qLatitude - the%rays%of%the%sun%are%strongest%near%the%equator.%qCloud%cover - places%with%regular%cloud%cover%may%actually%red u ce %UV%-- resulting%in%a%50%percent%lower%level%of%UV%light.%Skin%Cancer%Risk%FactorsTanning%beds%as%bad%as%tobacco?Skin%Cancer%and%Exposure%to%SunlightUVA%with%wavelength%315-400%nm%UVB%with%wavelength%280-315 nm%UVC%with%wavelength%100-280%nmThe%Electromagnetic%SpectrumWhat%to%look%out%for...Effects%of%UV%RadiationqUVB%is%the%main%cause%of%skin%cancer%(also%1000%times%more%effective%in%causing%sunburn)%qDamages%DNAqOxidize%lipids%and%produces%harmful%free%radicals%qCauses%inflammation,%which%also%produces%free%radicals,%particularly%nitrogen%radicals.%qDisrupts%cell%communication%and%causes%expression%of%stress%response%genes.%qWeakens%the%immune%responses%of%the%skinOrigin%of%The%Three%Types%of%Skin%CancerIncidence%and%Mortality%Rates%for%Different%Types%of%Skin%CancerFrom L. J. Kleinsmith, Principles of Cancer Biology. Copyright (c) 2006 Pearson Benjamin Cummings.Non-Melanoma%canc ersqNon-Melanoma- 2%major%types;%usually%non-Invasive/no n-metastaticv(1)Basal%Cell%Carcinoma%-80%v(2)%Squamous%cell%carcinoma%-16%Basal%and%Squamous%Cell%Carcinomasq Pearl-like%greyish%nodule,%few%mm%in%size,%appears%mostly%on%th e%sun%exposed%areas%of%the%face%(including%the%lips),%scalp,%neck,%upper%area%of%the%chest%or%back,%or%on%the%back%side%of%forearms%or%hands.%q Several%nodules%may%merge%together.%A%nodule% may%ulcerate,%crust%over%or%ooze%fluid.q Appears%as%a%scaly,%reddish,%dome-shaped,%fleshy%nodule,%from%5%mm%to%few%cm%(if% l eft%untreated)%in%size,%ofte n%with%a%central%ulcer.q Mostly%appears%on%sun%exposed%areas%of%the%skin%or%lips.MelanomaqMelanomas%arise%from%melanocytes%and%are%more%dangerous;%metasta size%before%tumor%is%noticedqMelanomas%account%for%only%4%%of%skin%cancer s%but%are%responsible%for%the%majority%of%fatalitiesStages%of%MelanomaCharacteristics %of%MelanomaqMelanomas%can%develop%any where%on%your%bodyqMost%often%develop%in%areas%that%have%had%exposure%to%the%sun,%such%as%your%back,%legs,%arms%and%face.%qMelanoma%can%occur%in%areas%that%don't%receive%much%sun%exposure,%such%as%the%soles%of%your%feet,%palms%of%your%hands%and%on%fingernail%beds.Melanoma%of%the%EyeIris%MelanomaIf%untreated,%can:q Press%on%the%lens%to%cause%cataract;%andq Invade%the%angle%to%cause%glaucoma.q Most%often%present%in%adultsq Rare%- 6%cases%per%mil lion%people%per%year%in%the%United%States.q Most%often%presents%in%patients%ove r %age%45%with%an%average%age%of%presentat ion%at%55.Choroidal Melanoma%Sun%Prote ction%Factor%(SPF)%qMeasure%of%a%sunscreen's %ability%to%prevent%UVB%from%damaging%the%skinqSunscreens%should%be%applied%30mins%before%sun%exposureqRea pply%if%you%stay%out%in%the%sun%<2h,%after%you%swim%or%sweat.qA%wet%T-shirt%offers%much%less%UV%protection%than%a%dry%one.Skin%Type%Dictates%SPF%Useq Type%I (very%fair)% have%pale%skin,%burn%very%easily%and%rarely%tan.%They%generally%have%light%colored%hair%or%red%hair%and%freckles.%q Type%II (fair)%usually%burn%but%may%gradually%tan.q Type%III (light)%burn%with%long%exposure%to%the%sun%but%generally%tan%quite%easily.%Olive%skinq Type%IV (medium)%burn%with%very%lengthy%exposures%but%always%tan%easily%as%well.%They%usually%have%brown%eyes%and%dark%hair.%q Type%V (dark)%have%a%naturally%brown%skin,%with%brown%eyes%and%dark%hair.%Burn%only%with%excessive%exposure% to%theq Type%VI (dark)%black%skin%with%dark%brown%eyes%and%black%hair.%Burn%only%with%extreme%exposure%to%the%sunDistinguishing%benign%moles%from%melanoma:%The%ABCD RuleTreating%Skin%CancerqChemotherapy: %If%squamous%cell%carcinoma%spreads%beyond%the%skin%to%the%lymph%nodes%or%to%other%organs,%systemic (affects%entire%body)%chemotherapy may%be%used%to%kill%the%cancer%cells.%qRadiation%therapy:%may%be%used%to%treat%an%older%adult%who%has%a%large%tumor;%tumors%that%cover%a%large%area;%or%a%tumor%that%is%difficult%to%surgical l y%remove%because%of%location,%such%as%one%on%an%eyelid,%nose,%or%ear.%BioVex Vaccine%for%Advanced%MelanomaOncoVEXGM-CSFAmgen%buys%BioVex renames%T-Vec• T-Vec is%a%genetically%engineered%herpes%virus%(an oncolytic%herpes%virus).%• Two%genes%were%removed%– one%that%shuts%down%an%individual%cell's%defense%another%that%helps%the%virus%evade%the%immune%system%• a%gene%for%human granulocyte-macrophage%colony-stimulating%factor (GM-CSF)% was%added%• T-Vec is%delivered%locally%by%injecting%it%directly%into%melanoma%lesions.The%FDA%has%approved%the%first-in-class%oncolytic%(T-VEC)%based%on%results%from%the%phase%III%OPTiMstudy.• for%the%local%treatment%of%unresectable cutaneous,%subc utaneous ,%and%nodal%lesions%in%patients%with%melanoma%recurrent%after%initial%surgery,• OPTiM randomized%436%patients%with%unresected stage%IIIB/C%and%IV%melanoma%in%a%2:1%ratio%to%receive%intralesional T-VEC%(n%=%295) % or%subcutaneous%GM-CSF%(n%=%141).• T-VEC%was% ad ministered%initially%at%≤ % 4%mL%x106PFU/mL%for%3%weeks%followed%by%≤%4% mL% x108PFU/mL%every%2%weeks.%GM-CSF%was%administered%daily%at%125%µg/m2every%14%day s%in%a%28-day%cycle.In%regards%to%cancerous%tumors,%the%method%for%assessment%used%is%the Response%Evaluation%Criteria%In%Solid%Tumors (RECIST).%• Partial%Response%Rate (PR):%A%partial%decrease%of%at%least%30%%of%the%longest%diameter%of%targeted%cancerous%lesions;%sometimes%also%referring%to%a%30%%de