Freckle, Mole, or Skin Cancer?

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The Facts on Melanoma

Yes, You Could Be at Risk

"Melanoma can happen to anybody," says Jerry D. Brewer, MD, a dermatological surgeon at the Mayo Clinic in Rochester, Minnesota. "And it can kill you, even when you're young." Melanoma has grown a whopping 705 percent among women under 40 in the past four decades. According to the American Cancer Society, some 32,000 women were diagnosed in 2012, and more than 3,000 died from it. Indoor tanning may have played a major role. "About 70 percent of those who use tanning beds are young women," Dr. Brewer says. "Tanning beds give you nearly 10 times the dosage of UVA you would receive on a hot day in the Mediterranean, which speeds up the formation of skin cancer. That's why melanomas can start to show up in your mid-20s and 30s."

A Better Biopsy

The skill of the pathologist, the doctor who looks at your biopsy, is just as important as the skill of the surgeon who will remove the tumor, says David Kriegel, MD, director of dermatologic and Mohs surgery at Mt. Sinai School of Medicine. "There's a very specific surgical plan based on what the pathologist tells me. A couple of millimeters in the depth of the lesion, as seen under the microscope, can significantly change the surgical approach as well as the prognosis." If you have a history of skin cancer, ask about the pathologist your biopsy will be sent to. If you've been diagnosed with melanoma, consider getting a second opinion on pathology before surgery. "If you're in a small town it is very easy to send a block of tissue to a big urban center and have the tissue reviewed by someone more experienced," Dr. Kriegel says. "This could make a difference in your outcome."

Keep an Eye on Your Skin

While the main culprit is UV radiation, melanomas can also be caused by genetic factors and immune system problems. "If your mother or father had melanoma, you need to be really vigilant," says Dr. Kriegel, a member of the Ladies' Home Journal Medical Advisory Board. But whether you have known risk factors or not, you should do a skin check once a month and keep track of anything that's changing.

Melanoma can develop on a mole you already have and it can also appear where there wasn't a spot before. By now you've heard about the ABCDEs of melanoma (asymmetry, border irregularity, color variation, diameter larger than a pencil eraser, and evolving). You can find pictures on many websites. But guess what? Your spot may not look like any of those pictures and still be a melanoma, especially if it's small, in an early stage.

"I tell my patients that skin cancers don't read textbooks," says Dr. Kriegel. "Some cancers don't fit into the ABCDEs. I might see a mole that looks normal to me, but if the patient says, 'You know, I just don't like it -- I don't know why, but it just doesn't seem right to me,' I will always biopsy it. Instinct is a strange phenomenon, but it's often accurate." If you think it's just a scratched or irritated mole, you can watch it, but if it doesn't go back to what it looked like before in four to six weeks, Dr. Kriegel says, get it checked right away.

Watching for any change in your skin is key, agrees Dr. Brewer, even if it doesn't follow the ABCDE guidelines. "A melanoma might look like a normal freckle or mole while it's changing, but if you know your skin, you'll be able to tell that it's different."

He tells the story about a Mayo Clinic photographer who was recently shooting a melanoma brochure, using his wife as a model. As she was demonstrating how to examine your skin, she looked down at her side and saw a mole she hadn't noticed before. "She went in and got it looked at, and it was melanoma."

Where to Learn More

The Skin Cancer Foundation helps build awareness about prevention, detection, and treatments. Its comprehensive website at has excellent resources on everything from sun protection to FAQs to how to find a surgeon.



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