One of the biggest threats posed by cancer is the ability of a tumor to hide deep within an organ. Sadly, many of these internal cancers produce symptoms only after the disease has become advanced. Sophisticated imaging technology, such as mammograms and computed tomography (CT) scans, and invasive diagnostic tests, such as colonoscopy, are often the best hope for diagnosing these hidden tumors when they are still small and highly curable.
By comparison, spotting a possible skin cancer is relatively straightforward -- if you know what to look for.
Basal cell carcinoma
A basal cell skin cancer generally appears as a "little pearly bump that will bleed, scab up, heal, bleed, scab up, and heal," explains skin cancer specialist Brett Coldiron, M.D. "If you have a spot on your face that bleeds, and it's not a pimple and doesn't go away in a week, you need to have it looked at by a dermatologist." He adds, "Sometimes, a basal cell carcinoma spreads across the surface of the skin and appears as a smooth, flat, pearly plaque."
Squamous cell carcinoma
This form of skin cancer is usually much more noticeable. Squamous cell cancers appear as red nodules that may or may not bleed. "They grow faster than basal cell carcinomas, and they're generally a very red, hard bump," says Coldiron. "They're hard to ignore."
Other forms of non-melanoma skin cancer (NMSC) look like a scar, says Coldiron. "You shouldn't have a big scar that grows."
Cancer lookout
According to a study reported in the Journal of the American Medical Association, patients with a history of non-melanoma skin cancer are at increased risk of dying from melanoma, non-Hodgkin's lymphoma, leukemia, or cancer of the salivary gland, prostate, testis, urinary bladder, or breast. "Although the biological mechanisms are unknown," wrote the Emory University School of Medicine researchers, "a history of NMSC should increase the (doctor's) alertness for certain (non-skin) cancers as well as melanoma."
Melanoma
According to the American Academy of Dermatology (AAD), melanoma generally begins as a mottled, light brown to black flat blemish with irregular borders. The blemish is usually at least one-quarter inch across. It may turn shades of red, blue or white, crust on the surface and bleed, AAD literature states. Melanomas most frequently appear on the upper back, torso, lower legs, arms, head and neck.
While melanoma is more common in Caucasions with fair skin, a certain type of melanoma is seen in African Americans and people with dark skin. This type of melanoma is most often seen on the soles of feet, palms of the hands, and under the nails.
A changing mole, a new mole, or a mole that is different or "ugly" or begins to grow, requires prompt medical attention, according to the AAD.
To remember the warning signs of a melanoma, use the Academy's ABCD rule:
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A: Asymmetry -- one half is unlike the other half.
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B: Border irregular -- scalloped or poorly circumscribed border.
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C: Color varied from one area to another; shades of tan and brown; black; sometimes white, red or blue.
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D: Diameter larger than the diameter of a pencil eraser.
Don't use pain as an indicator
If you have a suspicious skin growth of any kind, don't wait until it hurts before consulting a doctor. "Skin cancers won't hurt or sting until they invade the nerve," Coldiron says. "They kind of dissolve everything in their path."
Skin self-exams
Just as women are urged to perform a periodic breast self-exam, everyone should examine his or her skin from time to time. How often depends on your risk factors. If you or a blood relative has a history of skin cancer, or if you fall into another high-risk group, Coldiron, a skin cancer specialist, suggests that you examine your skin once a month. If you are not in a high-risk group, once every six months is probably sufficient. Examining your skin daily is counterproductive because you probably won't notice any subtle changes.
During your skin self-exam, the AAD advises you to:
1) Examine your body front and back in the mirror, then right and left sides with arms raised.
2) Bend your elbows and look carefully at your forearms, upper underarms and palms.
3) Look at the backs of your legs and feet, the spaces between your toes and the soles of your feet.
4) Examine the back of your neck and scalp with a hand mirror. Part your hair for a closer look.
5) Finally, check your back and buttocks with a hand mirror.
According to Coldiron, doing a proper skin self-exam is more difficult than it seems. You need a full-length mirror, a hand-held mirror and a good light source. If you don't own a full-length mirror, use a three-way mirror in a private, well-lit dressing room at a clothing store. Or ask your spouse to examine your back and buttocks for you.
Any suspicious growth should be biopsied, which involves removing all or some of the suspect tissue and examining it under a microscope. Patients are given a local anesthetic during this simple office procedure.
Which doctor to consult
Family physicians are trained to look for melanoma. If melanoma is suspected, your doctor will refer you to a dermatologist. Dermatologists are the physicians who diagnose and treat most of the non-melanoma skin cancer (NMSC) cases in the United States. Other types of doctors, including internists, plastic surgeons and general surgeons, also may have special training in the diagnosis and treatment of NMSC.
People with melanoma are often treated by a team of specialists that may include a dermatologist, surgeon, medical oncologist, and a plastic surgeon.
This article was reviewed and updated June 2007.
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