We are in the month of May so there’s still time for a plug for Skin Cancer Awareness Month.
Skin cancer is common.
More than 5 million cases of skin cancer are diagnosed in the U.S. every year.
As a dermatologist, I diagnose many of these skin cancers in my clinic every week. Today, I’m going to highlight a few statements that I have heard from various patients who were ultimately diagnosed with melanoma.
“This mole was changing but I wasn’t too worried because it wasn’t painful or causing any symptoms.”
A changing mole is a reason to see your dermatologist. About 50% of melanomas (a potentially deadly form of skin cancer) arise de novo — meaning not from an existing growth. That leaves the other ~50% of melanomas having arisen from pre-existing moles. If a mole is changing, please please bring it to the attention of your dermatologist. When you call the office, be clear that you have a changing mole. If you can’t get into see your dermatologist, see your primary care physician. These days, many insurance plans may require you to see your primary care physician first in order to get a referral (hopefully expedited) to your dermatologist. Melanoma is most often neither itchy nor painful. I often counsel my patients that it’s not your job to play doctor; let us evaluate your growth for you.
“I have a flaky spot on my face. I pick off or scrub off the flake and my skin seems to go back to normal but the flaking keeps coming back.”
This is often the history I get for a potentially pre-cancerous spot called an actinic keratosis. Left alone, it can progress to a type of skin cancer called a squamous cell carcinoma. If you have these spots, see your dermatologist! It’s a good marker of prior sun exposure that you’ve had. You are also more at risk for developing skin cancer. Actinic keratoses are easy for your dermatologist to treat.
“I had this growth I was concerned about for some time but I really don’t want a scar from any procedures so I didn’t come in until now. My [family member, spouse] finally made me come in.”
Yes, taking a skin biopsy can leave a scar. Yes, taking out a skin cancer can leave a scar. And yes, taking a skin cancer out can also save your life. Especially if you get it out early.
Find a dermatologist who you can communicate with so you can have a discussion about what your growth might be and what the steps for diagnosing and treating the growth are. We are not looking to biopsy and cut things out willy-nilly.
For more resources about skin cancer:
An exciting talk from this year’s American Academy of Dermatology Meeting (AAD 2013) in Miami was the annual Marion B. Sulzberger Memorial Award and Lectureship given by Dr. Hensin Tsao. Dr. Tsao talked about “Melanoma and Its Metaphors,” drawing parallels between the machinery behind melanoma to the machinery behind cars. While problems can arise with cars, so can the biological machinery that drives cells to go out of control and develop into melanoma. Dr. Tsao discussed tumor suppressor and proto-oncogenes. Likening them to faulty brake systems, Dr. Tsao discussed how tumor suppressor genes are like the brakes in cells, and when messed up, the cell keeps going, dividing out of control. On the other hand, if the accelerator of the car gets stuck in the down position, the car keeps going as well. Proto-oncogenes, or oncogenes, are accelerators of melanoma.
In the realm of melanoma therapy, we’ve made some great strides in directed therapy. Among these are the drugs that target a very specific mutation that 60% of melanomas have (the V600E mutation). These are drugs like vemurafenib and dabrafenib. Although some of the tumors then find ways around these drugs when given alone, researchers and physicians have then added an additional drug, tramatenib (a MEK inhibitor) to the cocktail. Two hits against the melanoma! And there’s even more exciting stuff to come.
In short, in these past few years, we have seen major advances in melanoma therapy and I hope that with the direction we’re going, we’ll be able to put a permanent halt to melanoma!
It’s a good idea to look over your skin about once a month. This allows you to get to know your skin and what your skin looks at baseline. Anything new or changing on top of your first exam would be of concern. Secondly, anything that looks suspicious, especially via the ABCDE criteria for melanoma, would be of concern as well.
Having a full-length mirror and handheld mirror can be helpful tools. First, look over the front of your body: your face, neck, chest, arms, belly, thighs and legs — including under the undergarment areas. Examining the back side of your body can be a little more difficult. Using a hand held mirror along with the full-length mirror can allow you to visualize the back of the neck, the back, buttocks, and back of the thighs and legs. Also look at the hands including the palms, and soles. Check behind the ears and through the scalp as well. If you don’t have a hand held mirror or find that you still don’t have good visualization of certain areas of your body, you might to have someone examine your skin for you (e.g. a partner or spouse). Your barber/hairdresser can also help you look through your scalp. If any of the spots on your skin are concerning to you, you should let your dermatologist know even before your regularly scheduled skin examination.
The American Academy of Dermatology (AAD) has a good webpage diagramming the steps to the self-skin exam.
B: Border irregularity
C: Color change or different colors
D: Diameter greater than 5 mm (the size of a pencil eraser)
E: Evolution. Watch for any change.
If you have any doubts at all, have your doctor check your skin!