Melanoma is one of the few cancers that is externally visible, and therefore is usually diagnosed quite early. If you have a mole that you are concerned about, go see your physician or dermatologist to get it assessed professionally.
Self-exams are one of the most effective ways to detect melanoma. Continue reading to learn more about what you should be looking for!
Early detection and skin self-exams
As melanoma rapidly emerges as a public health issue, early detection becomes key to its prevention, as skin cancers found and removed early are almost always curable. The Skin Cancer Foundation recommends that everyone practice monthly head-to-toe skin self-exams to detect any blemishes that may be precancerous or cancerous [11].
Skin Cancer Foundation – Step by step self-examination
Skin Cancer Foundation – Do you know your ABCDEs?
Routine is important! A 2011 study by S. A. Oliveria et al. found that melanoma survivors who performed regular, frequent skin self-exams (SSE) felt more confident they were performing SSEs effectively. One survivor said, ‘I trust myself to catch it (melanoma) better than anybody, because I’m looking for changes’ [12].
A thorough SSE entails looking at all parts of the skin: including the scalp, finger and toes spaces, and around and in-between the anal and genital region [13]. In their study on thorough SSEs, Weinstock et al. found that people rarely or never inspected the backs of the thighs, upper back and shoulders, and mid and lower back 30—43% of the time [14].
Scheduling a full-body skin exam with a competent dermatologist, one who is familiar with skin cancers, will provide assurance that existing spots, freckles or moles are normal and, if not, the dermatologist can treat them. This provides a starting point for patients, so they may then continue to self-monitor and report any changes to their dermatologist.
The ABCDEs of melanoma
The ABCD acronym, introduced in 1985 and expanded to ABCDE in 2004 [15], is an exam tool used by health care professionals and the general public to evaluate potential melanocytic lesions and detect melanoma earlier. Melanoma often manifests as some or all of the ABCDE features:
Asymmetry — A benign mole is not asymmetrical. If you draw a line through the middle, the two sides will match, meaning it is symmetrical. If you draw a line through this mole, the two halves will not match, meaning it is asymmetrical, a warning sign for melanoma.
Border irregularity — A benign mole has smooth, even borders, unlike melanomas. The borders of an early melanoma tend to be uneven. The edges may be scalloped or notched.
Color variability—Most benign moles are all one color— often a single shade of brown. Having a variety of colors is another warning signal. A number of different shades of brown, tan or black could appear. A melanoma may also become red, white or blue.
Diameter greater than 6 mm—Benign moles usually have a smaller diameter than malignant ones. Melanomas usually are larger in diameter than the eraser on your pencil tip (¼ inch or 6mm), but they may sometimes be smaller when first detected.
Evolution or change— Common, benign moles look the same over time. Be on the alert when a mole starts to evolve or change in any way. When a mole is evolving, see a doctor. Any change — in size, shape, color, elevation, or another trait, or any new symptom such as bleeding, itching or crusting — points to danger.
[16] Taken from the Skin Cancer Foundation
Firm- Firm, tender or sore moles aren’t normal and should be checked.[17]
The Ugly Duckling sign
Given that research shows that 53% of melanomas are discovered by patients and a further 17% by their family members [18], the ‘ugly duckling’ sign is a newer, useful detection tool for both the general public and clinicians, as the ABCDE method has limitations; for example, dermatologists diagnosing potential skin cancers face the challenge of distinguishing melanoma from other atypical nevi, which can display some or all of the ABCDE criteria. In addition, relying solely on the ABCDE approach
may result in overlooking melanomas smaller than 6 mm in diameter or lack the ABCDE criteria.
In 1998, Grob et al. introduced the ugly duckling concept: the observation that nevi on an individual tend to resemble one another, and that melanoma often deviates from this nevus pattern. This clinical realization pointed to the importance of not just evaluating the morphology of the nevi in question, but also comparing it to that of surrounding nevi, looking for anomalies in the background of similar moles [19].
Three different clinical scenarios are shown where outlier lesions (“ugly ducklings”) should prompt suspicion. Squares A, B, and C each represent a body area such as the back. In A, the patient has one dominant mole pattern with slight variation in size. The outlier lesion is clearly darker and larger than all other moles. In B, the patient has two predominant nevus patterns, one with larger nevi and one with small, darker nevi. The outlier lesion is small but lacks pigmentation. In C, the patient shows only one lesion on the back. If this lesion is changing, symptomatic, or deemed atypical, it should be removed.
[20] Taken from the Skin Cancer Foundation
What to expect from your dermatologist
In the same 2011 study by S. A. Oliveria et al., melanoma survivors expressed how imperative it was to find an ‘highly competent’ dermatologist with whom they felt comfortable—as several survivors had been to multiple dermatologists before they were diagnosed with melanoma [21].
A dermatologist should not immediately dismiss a patient’s concerns, particularly if the patient has noticed any significant changes on their skin. Furthermore, anxiety arising in patients at the prospect of being seen naked or having negative outcomes highlights the need to have a good rapport with your dermatologist [22].
Mayo Clinic—Preparing for your appointment
Skin Cancer Foundation—Making the most of your visit to the dermatologist
[11]”Skin Cancer Foundation.” Early Detection and Self-Exams. Skin Cancer Foundation, 2015. Web. 14 May 2015.
[12] Oliveria, Susan A., Elyse Shuk, Jennifer L. Hay, Maureen Heneghan, Jacqueline M. Goulart, Katherine Panageas, Alan C. Geller, and Allan C. Halpern. “Melanoma Survivors: Health Behaviors, Surveillance, Psychosocial Factors, and Family Concerns.” Psycho-Oncology 22 (2013): 106-16. Wiley Online Library. University of Victoria, 6 Oct. 2011. Web. 14 May 2015.
[13] Hamidi, Reyhaneh, BA, David Peng, MD, MPH, and Myles Cockburn, PhD. “Efficacy of Skin Self-examination for the Early Detection of Melanoma.” International Journal of Dermatology 49 (2010): 126-34. Wiley Online Library. Web. 14 May 2015.
[14] ibid.
[15] Scope, Alon, MD, and Ashfaq A. Marghoob, MD. “The Ugly Duckling Sign.” The Ugly Duckling Sign. Skin Cancer Foundation, 2015. Web. 14 May 2015.
[16] “Do you know your ABCDE’s,” Skin Cancer Foundation “https://www.skincancer.org/skin-cancer-information/melanoma/melanoma-warning-signs-and-images/do-you-know-your-abcdes”
[17]MetaOptima Team. “Not All Melanomas Come From Moles”. MoleScope, 2017. https://molescope.com/blog/not-all-melanomas-come-moles
[19]”Malignant Melanoma.” Malignant Melanoma. Canadian Dermatology Association, 2015. Web. 25 May 2015.
[20] Scope, Alon, MD, and Ashfaq A. Marghoob, MD. “The Ugly Duckling Sign.” The Ugly Duckling Sign. Skin Cancer Foundation, 2015. Web. 14 May 2015.
[21] Scope, Alon, MD, and Ashfaq A. Marghoob, MD. Three Examples of an Ugly Duckling. Digital image. The Ugly Duckling Sign. Skin Cancer Foundation, 2015. Web. 25 May 2015.
[22] Oliveria, Susan A., Elyse Shuk, Jennifer L. Hay, Maureen Heneghan, Jacqueline M. Goulart, Katherine Panageas, Alan C. Geller, and Allan C. Halpern. “Melanoma Survivors: Health Behaviors, Surveillance, Psychosocial Factors, and Family Concerns.” Psycho-Oncology 22 (2013): 106-16. Wiley Online Library. University of Victoria, 6 Oct. 2011. Web. 14 May 2015.