The ABC’s (And D’s And E’s) Of Melanoma

A new mole or a noticeable change in an existing mole can be a possible sign of skin cancer

None of us has eyes in the back of our head. If a new mole develops on our back, neck, or scalp, we may not even be aware of it until someone close to us points it out.

“We see patients who come in and say, ‘my husband saw something on my back’ or even ‘my hairdresser saw something on my scalp.’ That’s often how it begins,” says Howard A. Zaren, MD, FACS, Medical Director for the Nancy N. and J.C. Lewis Cancer & Research Pavilion (LCRP). “You become aware of something that wasn’t there before or that doesn’t look the same. But how do you know if that’s meaningful?”

The ABCDE Rule For Moles

Light-skinned, blond, blue-eyed men and women are most at risk for developing melanoma. A smart choice for this population, and their loved ones who can see where they can’t, is to know the ABCDE rule that physicians use when checking a patient’s skin. Each letter corresponds with a concept that people should consider when investigating moles:

A for Asymmetry: Does one half of a mole or birthmark not match the other?
B for Border:  Are the edges irregular, blurred, or ragged?
C for Color: Is the color not the same all over? Does the mole include shades of brown or black, or patches of pink, red, white, or blue?
D for Diameter: Is the spot is larger than the size of a pencil eraser (6 millimeters or about ¼ inch across)?
E for Evolving: Did the mole change in size, shape, or color?

For African-Americans, melanoma will often present in the parts of their body where there is less melanin, the pigment that helps protect their skin, such as their palms or the soles of their feet.

Other warning signs for melanoma include redness or swelling beyond the border of a mole, a change in the mole’s surface such as scaliness, bleeding, or a bump, a sore that doesn’t heal, and pigment spreading from the border of a spot into the skin around it.

Basically, if you or a loved one sees new spots or growths on your skin, your primary care physician or a dermatologist needs to have a look.

Mole Mapping – An Advanced Tool For Seeing Changes

The reality in the Southern coast is that most of us will experience a large amount of exposure to the sun and its UV rays, which are a major cause of melanoma. But our region is also one of the few in the country to have mole mapping technology available to patients who are at high risk for this type of skin cancer.

Mole mapping at the LCRP is done by melanographers, nurses who are specialized in identifying and imaging moles.  The patient will receive a skin assessment and have their moles documented with digital technology.

“We use a dermoscopic camera and a digital photograph of pigmented and non-pigmented lesions on your body, from head to toe, that are bigger than 3 millimeters,” Zaren says.

The program stores the images, which can be retaken yearly and examined for changes by a physician.

“If there is a change in the mole, based on the ABCDE guidelines, or if a new pigmented lesion develops, we will suggest that the patient’s dermatologist biopsy that lesion,” Zaren says.

The treatment and survival rate of melanoma can improve if it is detected early. Mole mapping is one of the most advanced tools in making that early detection.

Prevention Starts Now

Dr. Zaren, of course, would prefer that there is no melanoma to detect. But he also sees the reality of living in this region.

“I would say avoid the sun, but we can’t,” Zaren says. But there are preventative steps we can take. Dr. Zaren urges everyone to:

  • Use sunblock with at least a 50 SPF (Reapply every 2 hours and just after swimming or sweating)
  • Limit activities in the sun to before 10 a.m. and after 4 p.m.
  • Wear a hat and sunglasses (“You can get melanoma in your eye,” Zaren says.)
  • Wear the specially-made clothes that carry an ultraviolet protection rating
  • Never use any kind of tanning bed
  • See a dermatologist routinely if you have a family history of melanoma

Dr. Zaren also hopes that parents will protect their children from sun exposure and pass these smart habits on to them.

“We’re seeing 7 percent more melanoma cases this year,” Zaren says. “How we take care of our children will change the incidence of this disease. If we protect our children now, in 30 years there will be less melanoma.”

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