Most people have heard of malignant melanoma, because this type of skin cancer can be deadly. If not caught and treated before it gets advanced, the cancerous cells in melanoma can metastasize (spread to other organs), and cause death. The goal is to identify a melanoma in the early stages, when it can be more easily removed and prevent future metastasis. Deeper melanomas may warrant more extensive treatment, including lymph node examination, and we generally refer these patients to an oncologist or general or plastic surgeon. Although most melanomas occur in fair skinned individuals, they can affect patients of any skin type. Half of all melanomas occur in people under 57, including sometimes in children.
What makes a mole suspicious? This has been summarized as the “ABCDE” of melanoma.
• A = Asymmetry of outline
• B = Border irregularity
• C = Color irregularity
• D = Diameter greater than 6 mm (larger than a pencil eraser)
• E = Evolving (changing)
That is to say that most melanomas are fairly large and irregular in shape and color, while benign moles are generally small and symmetrically round or oval. A rapidly growing, itchy, bleeding or tender mole of any size should arouse suspicion but, conversely, most melanomas produce no symptoms. The average American has a one-in-50 lifetime risk of developing melanoma. Things that increase risk include:
• Two or more blistering sunburns before age 16
• Fair skin, freckles, blue eyes, and sensitivity to the sun
• Having more than 50 moles
• Having atypical moles
• Having a parent, brother, sister or child with a melanoma
• Having occasional intense sun exposure on weekends or on vacations
If you, a friend, or loved one has many moles or a spot that is irregular, a physician should be consulted. If the physician is even slightly suspicious, a biopsy can be done so the lesion can be examined under a microscope by a pathologist.
Even if you have no suspicious spots requiring a visit to the dermatologist, you should continue to examine your whole skin once a month using a hand mirror and a full-length wall mirror to better see your back. The sudden appearance of a fairly large, irregularly pigmented flat spot is the most common early sign of a melanoma and should alert you to make an appointment with your doctor. At the same time, as you look at your skin, perform a monthly breast exam if you are a woman or testicle exam if you are a man. This should take a total of five minutes a month or one hour a year—time well spent.
Basal Cell Carcinomas are the most common cancers of humankind, and make up the majority of the 1.5 million skin cancers diagnosed annually. Fortunately, they are also the most curable. They almost never spread to other parts of the body but can invade deeply and destroy or disfigure the eyes, nose, lips, ear or other body parts. They can be recognized as pearly bumps with fine blood vessels on the surface or as sores that do not heal. Less common forms of basal cell carcinoma can resemble a scar that appears for no apparent reason or even a rash that does not respond to appropriate therapy. Basal cell carcinoma also has been mistaken for a pimple that does not resolve.
Squamous Cell Carcinomas usually are rough-surfaced bumps that extend down into the skin, so if you squeeze the skin, it feels like a lump. One variety, called Keratocanthoma, looks like a volcano with a central crater and may be tender as a boil. They usually are only locally destructive, but can have some tendency to spread to local lymph glands (metastasize) especially if they are large (over an inch in diameter), left untreated, or on the lip, ear or central face. Bowen’s Disease is also called Squamous Cell Carcinoma-In-Situ, and refers to squamous cell carcinoma confined to the top layer of the skin.
Actinic Keratoses are pre-malignances (pre-cancers) recognized as rough-surfaced patches on sun-exposed skin, often better felt than seen. They are sometimes tender or sensitive and have a gritty feel, like fine sandpaper. They are usually treated with liquid nitrogen, applied by sprayer or cotton-tipped applicator, which produces a blister or scab, destroying the pre-malignant cells. They can also be treated with various prescription topical creams. A percentage of actinic keratoses develop into skin cancers (mostly squamous cell carcinomas), so it is important to have them treated.
HOW TO CHECK YOUR SPOTS:
Checking your skin means taking note of all the spots on your body, from moles to freckles to age spots. Remember, some moles are black, red, or even blue. If you see any kind of change on one of your spots, you should have a dermatologist check it out.
Download the AAD’s Body Mole Map to note the results of your self-examination.