i'd like tips for making sure i watch out for early signs of skin cancer.
How Do I Check for Skin Cancer Signs?
Doctor Answers 7
Check your moles!
Most of my patients will identify a suspicious mole well before I do. That’s because moles that turn atypical (called “dysplastic” moles) do so very prominently. Unlike some emerging cancers in your body that can grow undetected for years, skin cancer is usually immediately recognizable. Atypical moles do not “hide” well at all and you are the first line of defense to catch an emerging skin cancer before it gets serious and even potentially life-threatening. Because the skin is so immediately accessible and no x-rays or MRIs are needed to see it, its infinitely easier to catch a skin cancer before is gets out of hand.
What to look for? Well, the classic teaching is based off of the acronym. A.B.C.D. We’ll begin our discussion there, but I have a couple additional points to make to make sure you’re an at-home expert. A-Asymmetry. The first thing to look for is a mole that looks different on one side verses another.
Notice here that this mole is light brown on one-side, but deep brown on the other. That does not bode well for the behavior of this mole. B-Border: moles that have jagged or irregular edges require further examination.
Notice that this mole has very indistinct margins. It would be difficult to trace them out with a ball-point pen. C-Color: moles that have 3 or more colors are begging for attention.
This mole has nearly 4 colors and is highly atypical. D-Diameter: moles that are larger than 6mm classically should be watched closely. Let’s amend this one to expanding Diameter, that is, if you notice a mole is growing rapidly it should be tested. But if it’s been 10mm since you were in gradeschool, the likelihood of this mole being atypical is very unlikely.
More generally, dermatologist’s follow the “ugly duckling” rule. Finding moles on your body that look different from the others are the same moles we as dermatologists will notice. Let’s say all of your moles are 2-toned with borders that are a bit smudged, but one has 2 colors and perfectly symmetric. Even though its symmetry is reassuring, it’s different from all the other moles your body has made. That’s the mole that is more likely to be atypical under the microscope. Finally, any mole that is symptomatic, whether itching or painful or tingly or burning – any symptom at all, is one that requires a skin biopsy from your dermatologist.
So what happens should you locate an atypical mole on your own body? Well, atypical moles are believed to be pre-cancerous, but just how pre-cancerous we’re not entirely sure. Some of these atypical moles may become cancerous in 500 years (long after you’re gone), but others may do so over several years. Currently, the standard of care is to sample these moles to assess just how atypical the cells are. A skin biopsy can be performed with any board-certified dermatologists and takes less than 5 minutes. It’s almost painless because of a local anesthetic that’s used to numb the area and leaves a tiny scar. If a mole is examined under the microscope and found to contain rapidly-dividing cells or cells that contain irregular DNA patterns, then a complete removal is recommended. If the microscopic atypia is unimpressive then no additional removal is required.
Exciting new technology will soon allow dermatologists to look at the cells that make up your mole in real time without a biopsy. A process known as confocal microscopy allows your doctor to place a hand-held computer flush against your skin to determine a mole’s behavior without a biopsy. The technology is not quite perfected yet, so for now we still need to take a small piece of skin in order to give you an accurate diagnosis regarding that pesky looking, asymmetric, tri-colored, irregularly bordered, itch mole you’ve been trying to ignore.
Looking for Skin Cancer
When you check your skin, be on the lookout for any change in the size, shape, symmetry, or color of a mole, as well as the development of new moles or discolorations. Although these changes don't always mean cancer, it's a good idea to have them checked out by a dermatologist. If you're fair-skinned with light-colored hair and eyes, or if you have a family or personal history of skin cancer, it's advisable to have an annual full body check from a dermatologist. Moles that cause physical symptoms, such as itching or bleeding, should also be evaluated by a doctor. Best of luck and don’t forget your best defense is an offense, never forget your sunblock!
Biopsy essential for Melanoma diagnosis
Absolute definitive diagnosis requires a biopsy. However, there are other reasons to perform the biopsy. The depth of penetration as measured on the biopsy will define the treatment and provide information about the prognosis.
However, a simple clinical diagnosis is often made using the acronym: ABCD
A = Asymmetry: if you divide the lesion in half is one side markedly different from the other?
B = Border; are the borders markedy irregular and ill defined with "bleeding" into the surrounding normal skin?
C = Color: does the lesion seem to be made up of differently colored portions (black, blue, brown, grey, red,etc)?
D = Diameter: is the lesion more than 6mm (1/4") in diameter?
A dermatologist may use more complex criteria based on a process called dermoscopy, which uses light and magnification to evaluate features that are not visible to the naked eye, such as blood vessels and pigment granules.
So to answer your question, biopsy is undeniably and important part of melanoma diagnosis and mangement.
Checking for Skin Cancer Signs
I have trained, taught, and performed in-depth medical research—with a focus on skin cancer—at world-renowned institutes, such as Rockefeller University and Memorial Sloan-Kettering. My patients come to me for regular mole checks because of his comprehensive background in skin cancer research, prevention, detection and treatment.
The most common precancerous skin growths or lesions are:
Actinic (or solar) keratosis are small, scaly, crusty growths or lesions that are often pink or red in color. They’re found most often on any areas of skin that have had prolonged exposure to the sun over the years (such as the face, scalp, ears, lips, and the backs of the hands). Left untreated, these can develop into cancer.
Dysplastic nevi (pre-cancerous moles) are atypical moles that resemble melanoma (the deadliest form of skin cancer). Sometimes dysplastic nevi will develop into melanoma—which is why it’s critical to examine your skin regularly and have regular moles checks with a board-certified dermatologist (who will remove the dysplastic nevi and have it biopsied.) The earlier these are diagnosed and removed, the less chance of developing melanoma. People who have dysplastic nevi are at increased risk of developing melanoma.
There are different types of skin cancer—all of which should be examined and biopsied by our doctors:
Basal cell carcinoma is the most common type of skin cancer in the lowest layer of the skin, called the basal layer. It comes in several varieties and usually looks like raised, waxy pink bumps or a pink patch. It rarely spreads.
Squamous cell carcinoma is the type of skin cancer that affects skin cells in the middle layer of the epidermis. It usually looks like red, scaly, rough skin lesions. It may spread and is dangerous if not removed promptly.
Melanoma is the least common type of skin cancer but, left untreated, it can spread and be deadly. It occurs in the skin cells that create pigment, called melanocytes. It can develop in moles or lesions that are asymmetrical, have irregular borders, are uneven in color, are larger than a pencil eraser, and have changed over time.
Whatever precancer or skin cancer you might have, rest assured that we are one of the leading dermatology offices who can help assess, biopsy, and diagnose the cancer so you can receive the treatment you need. Remember: the earlier you find skin cancer, the easier it is to treat successfully.
Skin cancers and premalignant skin lesions appear in...
Skin cancers and premalignant skin lesions appear in more ways than one. Irregular or enlarging moles are certainly the most important skin changes to look for, as melanoma is by far the worst type of skin cancer. But basal cell carcinoma is actually the most common, most preventable, and most treatable skin cancer.
Basal cell carcinoma presents as a slowly growing, pearly papule (bump) on the skin. Over time, this type of skin lesion frequently develops a chronic central erosion (open sore) that intermittently bleeds and/or scabs over. Excess sun exposure, resulting in ultraviolet radiation damage to the skin, eventually leads to the formation of basal cell carcinomas.
A similar, but more aggressive, type of skin cancer is squamous cell carcinoma. Squamous cell carcinoma also presents as a non-healing, sometimes rapidly enlarging, skin wound, often with a 'rolled' pearly border. This type of skin cancer has a higher rate of invasive spread, or metastasis, to the lymph nodes and adjacent areas, compared with basal cell carcinoma.
Both basal and squamous cell carcinomas are treatable with destructive modalities (liquid nitrogen or CO2 laser), surgical excision, or radiation therapy. Prevention of basal and squamous cell carcinomas starts with sun precautions, including wearing SPF 30 sunscreen and avoiding prolonged sun exposure (such as tanning).
Early treatment of premalignant lesions, such as actinic keratoses, which present as persistent rough, irregular, or eroded areas of the skin, is the next step. Chemical peels and CO2 laser resurfacing are actually excellent ways both to cosmetically and functionally rejuvenate the skin. For any skin irregularity, when in doubt, have it checked out!
It is very important to go for yearly skin exams with a...
It is very important to go for yearly skin exams with a dermatologist. Checking your skin at home is simple and can be a life-saving procedure.
Using a handheld mirror you can check your back and other areas of your body for moles. I recommend checking your body monthly usually after a shower when you are completely undressed. Any change in a mole should bring you to see your dermatologist right away.
We talk about the ABC and D of moles:
- Moles that are Asymmetric
- Moles with unclear Borders
- Color changes to dark browns or black
- Increasing size to the Diameter of a pencil eraser.
Dr. Coyle Connoly demonstrates the technique for...
Dr. Coyle Connoly demonstrates the technique for conducting a full-body exam for Melanomas and other harmful skin cancers.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.