Does This Look Funny to You?

From Cancer

“Is it me or is that mole seem growing? Do you think? I mean could it be, well you know . . . skin something?”

“You mean skin cancer?”

“Oh my god, do you THINK it IS!”

This recent, and real, discussion made me think of something I just read. When it comes to skin cancers, some government experts (more on these experts in a future post) believe the patient may be as accurate a judge of what looks worrisome on their skin, as opposed to the physician searching willy-nilly. Specifically, when it comes to doing a whole-body skin examination by a physician to detect cancers versus a patient’s own examination, the jury is out. Physicians are fairly accurate at detecting melanoma, the most aggressive form of skin cancer. But surprisingly, the evidence is less clear that this early detection prevents disfigurement or ultimately saves lives. The same studies can’t even agree how much harm results from misdiagnosis and unnecessary biopsies or treatment of benign (normal) skin lesions. We’re told to just ‘be alert’ when looking at the skin.

So do we just throw our magnifier in the air and walk away? Fortunately, those in the know suggest we look at risk factors for skin cancer. Family history of skin cancer is important. So is a personal history of excessive sun exposure and frequent sunburns. Men and women older than 65 that have fair skin (which is more easily burned) are at increased risk for melanomas (and if you think a tan from a tanning bed is safer, or somehow ‘protects’ you from developing skin cancers, guess again). Physicians also look for ‘atypical moles‘ and those of us with more than 50 moles (who’s counting?). We also learn our ABC’s. Actually, our ABCDE’s, which means Asymmetry, Border irregularity, Color variability, Diameter greater than 6 mm, Elevation above the skin and anything growing or changing like gang busters. This describes lesions that are most worrisome for cancer.

So my response to the above patient was, “Thank you for bringing it to my attention. It could just be a normal mole. Let’s be safe and send you for a biopsy. In the meantime, don’t go out in the sun without at least a number 30 or higher sunscreen, or better yet cover up.”

My advice to you? Review the pictures in the links provided, because you may find what your physician would have missed. After all, when it comes to identifying suspicious lesions, we’ve all got skin in that game.

About Steve P. Sanders

A general internist writing and sharing ideas and art.

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