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Know your ABCDE’s of melanoma

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Garrett, Jeryl
Wednesday, April 25, 2012
Know your ABCDE’s of melanoma 
What to look for when checking moles for signs of skin cancer
YOUR HEALTH | By Katie Murdoch, Herald writer

Knowing what to look for when checking moles for abnormalities starts with knowing the ABC’s.

Dermatologists tell their patients to look for specific signs that could indicate melanoma and use the first five letters of the alphabet as a reminder.

Moles that are asymmetrical, have scalloped or uneven borders, a mix of colors, a diameter greater than the head of a pencil eraser or one that has evolved suddenly, should not be ignored.

Being on the more preventative side of things is the better deal in the long run when patients and physicians can detect a problem early on, said Dr. Gail de Imus, a dermatologist for The Everett Clinic.

She prefers patients are informed, rather than panicked.

“It’s a nice guide but it’s not a hard and fast rule,” de Imus said of the alphabet exercise.

There is also the “ugly duckling” sign. This is a mole that stands out from the rest and ought to be examined by a doctor.

Moles follow a pattern, so the one that is a different color or size than the rest is the one to pay attention to, said Dr. John Knox, a dermatologist with Minor & James Medical, which is affiliated with Swedish/Edmonds.

Knox is critical of the diameter rule. He has removed cancerous moles that were smaller than the head of a pencil eraser. He advises patients to pay attention to patterns, colors and duration.

“Anything new and very dark is worrisome,” he said. “Look for anything different that lasts longer than one month.”

De Imus recommends patients have their skin checked by a physician, either their primary care provider or a dermatologist, once per year. A physical can teach people how to check their own skin for which signs to look out for.

“As with all cancers, prevention and early detection are key,” she said.

Knox tells patients to pay attention to their moles and watch their partner’s back -- literally.

Often it’s complacency and a false sense of security that catches people off guard, de Imus said. People with darker skin or those who live in the overcast Northwest falsely believe they don’t need to pay attention to moles or wear sunscreen. Often, appealing to young people’s vanity is a more effective deterrent to tanning booths than reminding them of the health risks.

She tells patients to stay out of tanning booths as it dramatically increases the risk of developing skin cancer and to wear sunscreen and sun-protective clothing. Scrutinize sunscreen bottles to ensure it’s “broad spectrum,” which means it protects from both UVA and UVB rays. Make sure to apply enough -- a shot glass-size amount to cover one’s entire body should suffice -- and reapply after sweating or swimming.

People who say they go tanning for the exposure to Vitamin D don’t realize they’re exposed to UVA rays and not UVB which are a source of Vitamin D.

“Tanning beds emit UVA rays, deep penetrating rays that damage cells worse than UVB rays,” de Imus said.

Damage from sunburns and tanning during one’s youth can turn into cancer down the road as it increases one’s lifetime risk of developing skin cancer, she said.

She also advises people with fair skin, freckles or lots of moles, light eyes and those who work and live in warm climates to take extra precautions in the sun as they are at a greater risk of developing skin cancer.

People with darker skin, namely African Americans, Hispanics and Asians, are at a higher risk of developing aggressive forms of skin cancer between their fingers and toes and underneath their nails. By the time people with darker pigmented skin are diagnosed with skin cancer, it’s likely in advanced stages.

“They’re more likely to have advantaged stages because they weren’t expecting it,” she said.

ABCDE signs of melanoma
Some general guidelines that can help identify problem moles:
A - Asymmetry: One half is unlike the other half
B - Border: An irregular, scalloped or poorly defined border
C - Color: Is varied from one area to another; has shades of tan, brown, or black; or is sometimes white, red or blue
D - Diameter: Melanomas usually are greater than 6mm (the size of a pencil eraser) when diagnosed, but they can be smaller.
E - Evolving: A mole or skin lesion that looks different from the rest or is changing in size, shape or color
Source: American Academy of Dermatology