The word "mole" has become one of those generic terms applied by the public to any sort of skin growth. However, a true mole refers to a pigmented growth, (i.e. brown) whether flat or raised that has its source in the pigment producing skin cells known as melanocytes. Throughout our lifetime, we will continue to develop more "moles", or nevi as they are known medically. The older you get, the more you are blessed with moles. Some of this is hereditary, much of it due to cumulative sun damage. Most moles will be healthy, however with our sun worshipping culture and the thinning of the ozone layer, more moles than ever will develop into a potentially life threatening condition known as malignant melanoma.

A terrible group of statistics; one in 75 children who were born in the year 2000 will go on to develop melanoma at some point throughout their lifetime. It is expected that melanoma develops on the skin of 32,000 Americans annually and approximately 6,800 Americans will die from melanoma every year. With that in mind, I would like to share not only the American Academy of Dermatology's ABCD's of suspicious mole changes with you, but what you can do to help protect your skin from further sun damage.

Although a melanoma can arise rapidly seemingly out of the blue, we often see moles that have been present for years gradually change their appearance. In fact, I cannot think of a single patient who has had an abnormal mole or skin cancer that didn't declare "but I have ALWAYS had that mole; it couldn't be skin cancer!" It's these longstanding growths that are changing that must be addressed early in order to prevent serious outcomes. Melanoma is 100% curable if caught in the early stages.

An annual Complete Skin Examination (CSE) for anyone who is at high risk for developing skin cancer (family history of melanoma; excessive sun exposure or serious sunburns; past personal history of dysplastic moles or other types of skin cancers) is important for early detection. Home skin checks every month in the mirror will help keep you aware of changing skin lesions. Basically, the ideal mole has very round borders and is very evenly colored. The more irregular the margins and coloration; or the larger the mole becomes, the more suspicious the lesion appears.

Read through these ABCD's and file them away; you may find them useful someday:

• Asymmetry - One half doesn't match the other half.
• Border irregularity - the edges are irregular, blurred or may have finger-like projections.
  
• Color - There are various shades of color within the same mole.
  
• Diameter - any mole greater than 6mm (the size of a pencil eraser) bears evaluation by a dermatologist.

Rapid growth of a mole, itching, bleeding, crusting, or sore formation within ANY skin lesion should be checked. The good news is that when most patients follow up on these signs, either the lesion isn't melanoma/skin cancer or they get their condition diagnosed in the early stages when it's curable.

When a mole is changing microscopically, it is termed dysplastic. There are degrees of dysplasia (ranging in severity) called mild, moderate and severe. The ultimate step in progression is called melanoma in situ, the earliest form of melanoma. From there, melanoma is categorized by how deeply it grows. These are the Clark levels I-V. The deeper the lesion extends, the worse the prognosis. Melanoma IS a serious cancer, and can be fatal. Again, it is also curable if caught early.

The ONLY definitive diagnosis of a melanoma is through an excisional biopsy so that depth can be accessed. This means the mole suspicious for MELANOMA is cut out and stitched up. Simply destroying the lesion by "burning" it off or "lasering" it off or having it shaved off is not acceptable. I cannot tell you how many patients I have had who have either insisted that a suspicious mole should just be burned off (which I refuse to do) or that their primary care physicians have done this previously. Destruction without biopsy is not smart, regardless of what your skin lesion is. You never know when a skin cancer is incidentally present, and this may hinder your diagnosis until it is too late. That isn't to say that the occasional obvious normal raised mole that is just annoying in its presence cannot be shaved off and sent to the pathologist, or that the skin tag hanging from your neckline requires stitches. Even a growth suspicious for nonmelanoma types of skin cancer such as a basal cell or squamous cell carcinoma may have a shave biopsy performed. But sending it to the pathologist is very important. Simply lasering skin lesions off is not providing you the patient the best of medical care.

PREVENTION

What about trying to prevent the development of changing moles, skin cancer or melanoma? We now know that the earlier in life that sun damage occurs, the more likely the development of the skin cancer. It is during the first 10 years of a child's life that sun damage has the most cancer causing effects. However, those multiple sunburns you've collected over the years don't help either. Sun protection is absolutely crucial in preventing the development of skin cancer including melanoma.

SUNSCREEN

The first thing you need is a good sunscreen. You need to know how to read the sunscreen label to know you have chosen wisely. There are literally hundreds of brands, each claiming to be better than the next. However, if you select a product with an SPF (Sun Protection Factor) of 30 that provides "broad spectrum" protection against both UVA and UVB wavelengths of light (it'll say so on the label), you're doing great. A minimal entry level would be an SPF 15. We know that statistically the ability to protect your skin rises tremendously between an SPF 15 and an SPF 25. From there it goes up only 0.5% to an SPF 30 for a normal sunscreen. Total Block UVA/UVB SPF 65 is an exception as it has been formulated to block out all visible wavelengths of light, not just ultraviolet light, for those with sun sensitive skin conditions such as lupus, rosacea or are prone to skin cancer.

You can also select sunscreens that are PABA free (PABA can cause allergic rashes), and oil free such as Peter Thomas Roth Ultra Lite Oil-Free Sunblock SPF 30, DERMAdoctor Body Guard Exquisitely Light SPF 30 For Face & Body or Murad Oil-Free Sunblock SPF 15 Sheer Tint.

Read the fine print on the "water-proof" bottles. They tell you to REAPPLY after water exposure and towel drying. You also need to reapply every 2-3 hours that you're outdoors as you're likely sweating it off. Sunscreen use still doesn't guarantee complete protection from the sun.

You can easily sun protect your own clothing with Sun Guard Laundry Treatment UV Protectant and make a huge difference in cutting down on your sun damage. Remember that cloth only has an SPF of 4, making it essentially worthless in protecting yourself from the sun. When mom told you years ago to throw on that white T-shirt at the pool didn't do a whole lot to protect you, especially once it gets wet. Simply throw a packet of Sun Guard Laundry Treatment UV Protectant into your washing machine along with your laundry detergent and your clothing will be safely coated with an SPF 30 for 20 more wash cycles. How easy is that for helping cut down on the risk of developing skin cancer through out your or your family's lifetime?

Tanning beds should NOT be used. They give concentrated light and can cause skin cancer. If that seems to unreal to young people, then dwell on all those wrinkles you will develop a good 10-20 years earlier than you normally would have without using a tanning bed. Hopefully tanning beds will become a thing of the past someday; much the way tobacco has been declared a carcinogen.

Other things you can do to protect yourself include avoiding direct sun exposure between the hours of 12-3, wear sunglasses treated against UV light (you can develop melanoma at the back of the eyes!) and wear a hat that has a long brim like those made by Physician Endorsed in addition to your newly sun protected clothing.

I think everyone should have a complete skin examination by a dermatologist to use as a baseline with follow-up as determined by the physician. Changing moles are the first indication of melanoma. You CAN do something when it comes to early detection and prevention!

Thank you for taking the time to read through this important information. I hope you have found this article informative.

Audrey Kunin, M.D.

(Any topic discussed in this article is not intended as medical advice. If you have a medical concern, please check with your doctor.)

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