Freckle, Mole, or Skin Cancer?
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Freckle, Mole, or Skin Cancer?

That spot may not look like much, but if it's new or changing or it just seems weird to you, have it checked out -- ASAP.

Melissa Flesher was thrilled to be pregnant. She and her husband, Ryan, who met as students at Kansas State, had been hoping for a baby since they got married, in 2003. "We wanted it so badly," she says. On a September morning in 2010, when she was in her seventh month, Flesher noticed something strange as she stood in the bathroom of their Topeka, Kansas, home. "I was trying to avoid stretch marks so I put lotion on my stomach and legs after each shower," she recalls. "Because I was having trouble reaching around my growing belly, I hoisted my leg up onto the bathroom counter. I just happened to look in the mirror and saw a dark spot on the back of my thigh in an area I normally wouldn't be able to see. I thought, 'Oh my God, I have a tick.'

"I freaked out and started picking at it, trying to remove it," she says. When she realized it wasn't a tick, Flesher calmed down. Still, she thought she should have a doctor look at it. "I hadn't seen a dermatologist in at least five years," she says. "I thought, 'Well, I'd better get this figured out now because I'm going to be taking care of someone else pretty soon.' So I called the doctor." That move might have saved her life.

She made an appointment with Joseph E. Gadzia, MD, medical director of dermatology at Laser Institute of Kansas, and he did a biopsy of the spot. When the pathologist's report came back, the news wasn't good. At 36 years old Flesher had a melanoma, the most dangerous and deadly kind of skin cancer. When she heard the diagnosis, she burst into tears. So did the nurse, who had a daughter Flesher's age.

Flesher knew practically nothing about skin cancer. "I was in shock," she says. "We had no family history of melanoma." She has fair skin, though, and as a child she loved the sun. "When I was growing up, I knew I didn't tan well like my friends did, but that didn't stop me from trying. My mother was a teacher and had summers off, so she took my sisters and me to a local pool every day. When I was old enough to drive, I'd often hang at the pool with my friends." She remembers at least one scalding sunburn that made her skin blister and peel. "My goal was to get red because I knew my skin would eventually turn a golden color. I overdid it on a regular basis."

Flesher also used tanning beds in high school and college. "Then twice -- with a guilty feeling -- before my wedding. But that was the very last time," she says. Tanning beds gave her a light golden glow, plus freckles -- never the deep, even tans that she admired on many of her friends. "But yes, it made me feel prettier and sexier," she says.

She never dreamed she would be one of the 30,000 or so women who learn they have melanoma each year, or that she was part of the fastest-growing group to get it: young women 18 to 39. She was lucky that it was caught early, says Dr. Gadzia, but even a small, thin melanoma can spread and become deadly. He wanted to do surgery right away. "The risk of waiting till after the baby was born was much greater than the risk of doing the surgery while Melissa was pregnant," he says.

The next thing Flesher knew she was hugging Ryan good-bye and remembers "lying on my side like a beached whale on the operating table." The news post-surgery was cautiously good -- her tumor was stage 1A, meaning it was no more than 1 millimeter thick. (The only better news would have been stage 0.) "If the tumor had been invasive, I might not have been able to do chemo or radiation while pregnant, so who knows what would have happened?"

Her healthy baby boy was born two months later, in November 2010. "When Tyler arrived it reminded Ryan and me that life is a gift and it motivated us to live differently," Flesher says. Today she embraces her pale skin. She avoids the sun, wears hats, and uses broad-spectrum sunscreen religiously -- and slathers it on Tyler, too.

The three-inch scar on the back of her thigh may not need any further treatment. "I just go back every six months for a checkup. That seems like a small price to pay to ease my mind." She's grateful for the role her baby played in her diagnosis. "I truly believe that if I hadn't been pregnant, I wouldn't have seen that melanoma. Tyler saved my life."

 

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 skincancer.org has excellent resources on everything from sun protection to FAQs to how to find a surgeon.

 
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