Published: May 22, 2013
Updated: May 22, 2013
The reason for the sunscreen season is skin cancer prevention. And the most serious skin cancer is melanoma, which will be diagnosed in more than 70,000 people in the next year. Not every skin cancer is a melanoma, but melanomas are the skin cancers that require the most vigilance. That’s because when they are caught early, they are very treatable—but if they are caught at an advanced stage, the five-year survival rate is as low as 20 percent.
When checking for potential melanomas, the standard reminders of what to look for are the trusty ABCDs:
A—moles that are asymmetrical
B—moles with an irregular border
C—moles with uneven color
D—moles with a diameter larger than a pencil eraser
But now there’s a new addition to this alphabet: E for evolution. “That means any mole that is changing in appearance or size,” says Kelly Nelson, MD, a Duke Medicine dermatologist who specializes in melanoma. A mole that is changing could be a key to catching melanoma before it reaches an advanced stage.
There are some people who have a higher likelihood of melanomas; in fact, about half of all melanomas occur in just 1 to 5 percent of the population. These are people who have more than 100 moles on their bodies; those who have a family history of melanoma; and those who have been diagnosed with atypical moles.
All moles are new at some point, especially in young adults, so a new or an enlarged mole is not necessarily a melanoma.
“Everyone makes moles a little differently,” Nelson says, so the key is to look for changes: a new mole that doesn’t look like your other moles, or a mole that is changing in its characteristics.
And if you’ve never visited a health care provider for a skin check, you should. After this first visit, your doctor can determine how often you should come back for follow-up checks. Duke dermatologists use a few technologies to provide the best possible care and monitoring for patients who have moles and skin cancer.
When You Find a Suspicious Mole
Anytime you have concerns about your skin, it’s a good idea to check with your doctor. The wait-and-see strategy is not a winning one.
“If you do have a questionable mole, physicians can take a closer look at the area in question and put it into context with other skin findings,” Nelson says. “If a mole is deemed suspicious by a physician, most likely it will be removed and the tissue sent to pathology for further examination.”
There’s been good evidence that patients who are “aware of their skin” do better, because they are better able to recognize when something is changing and visit their doctors.
Nelson says that there isn’t a defined time for looking over your skin, but you should be familiar enough with your skin to note changes over time.
What about Children’s Skin?
“Melanoma before puberty is profoundly rare,” Nelson says. Once children cross the threshold into adulthood, if they do have a lot of moles, their primary care physicians or dermatologists can evaluate them, she says.
It is normal for children to develop moles, and usually the moles grow in size at the same rate the child grows. “Anything that is growing at a much faster pace than the child is growing should probably be evaluated,” Nelson says. Most pediatricians are good at sorting out which moles are OK and which need further evaluation.
If it is Melanoma
Nelson’s medical practice is for those who have recently received a diagnosis of melanoma or who have advanced melanoma. The Duke Cancer Center offers a multidisciplinary melanoma clinic geared to patient convenience.
The melanoma program has a dedicated melanoma navigator, an experienced nurse who talks to each new patient to sort out which specialists should be involved in the person’s care. The cancer center and the oncology hub handle scheduling to ensure patients get what they need as efficiently as possible.
Once a week, the melanoma specialist and other caregivers meet and use a team approach for each new patient to develop the best care plan for him or her.
“Some of our patients need to see their dermatologist, surgical oncologist, and medical oncologist, and we can do that in one visit in one clinic at the cancer center,” Nelson says. The patient stays in the clinic room while physicians visit, one after the other, to provide advice, exams, testing, and treatments as needed. The providers collaborate to develop customized care plans for complex cases.