Do You Know Your ABCDEs? Get the Details on Melanoma from Our Dermatology PA

It’s Skin Cancer Awareness Month, which is the perfect time to learn more about the most common cancer in the world. Did you know being able to differentiate pre-cancerous skin issues from harmless moles and spots could save your life?

Stacey J. Spehalski, PA-C, MPH is our amazing Dermatology Physician Assistant here at Berks Plastic Surgery, and we recently sat down with her for a melanoma Q&A. Read on for key intel on the subject, as well as the best things you can do to lower your risk of developing skin cancer.

• What is melanoma?
• What causes melanoma?
• How can I prevent melanoma?
• What is the best sunscreen to use to prevent skin cancer?
• Am I at risk of developing melanoma?
• Do I have skin cancer?
• What are the signs of skin cancer?
• Does my child have skin cancer?
• When should I contact a dermatology PA for a skin cancer check?

What is melanoma?

Melanoma is the most serious form of common skin cancers and has left many families devastated with the loss of loved ones. It’s the fifth most deadly cancer in men and women in the US, and 2/3 of melanoma in the light-skinned population is due to UV radiation, whether it be exposure to natural OR artificial sources, such as tanning beds.

The truth is, I have seen melanoma in all decades of life, so don’t tune out if you think you are too young to be at risk!

Studies show that even just one-time use of a tanning bed can increase your risk of melanoma by 20%. The risk is higher still if you used indoor tanning before the age of 35.

What causes melanoma?

Melanoma has many risk factors, but it can still be unclear why some moles or lesions turn into a melanoma while others do not. Inherited or acquired gene mutations or other changes to DNA can lead to abnormal cell growth, which in turn may create the right circumstances for a cell to become cancerous.

While inherited mutations are passed down from your parents and can raise your risk of developing melanoma outside of your control, acquired gene mutations result from exposure to an outside risk factor, such as UV rays.

The exposure to harmful rays from the sun and from artificial UV rays are particularly detrimental during our younger years, as studies have found that a history of five or more severe sunburns during adolescence more than doubles the risk of developing melanoma.

If this risk of developing melanoma wasn’t enough, excessive sun exposure can also lead to premature signs of aging or exacerbate existing wrinkles. Simply put, avoiding unprotected UV exposure will help keep you and your skin happy, healthy, and youthful.

How can I prevent melanoma?

The National Council on Skin Cancer Prevention recommends avoiding burning at all costs through the use of sunscreens, protective clothing, and staying out of direct sunlight during peak hours. It is especially crucial to avoid intentional tanning, whether out in the sun or under artificial light from a tanning bed. Many countries, as well as some US states, have actually banned indoor tanning for those under the age of 18 because of its massive risks.

There is a dangerous belief among our younger population that tanning can be seen in a positive light, as it makes you look more healthy and attractive. It’s understandable—I succumbed to it earlier in life as well and am now having to be extra vigilant because of previous mistakes.

“If you’ve noticed something new on your skin or changes to existing moles, schedule a screening with your dermatology provider. I like to remind my patients that there is no such thing as a ‘wasted appointment,’ particularly if it gives you peace of mind.”

The truth is, studies show that even just one-time use of a tanning bed can increase your risk of melanoma by 20%. The risk is higher still if you used indoor tanning before the age of 35 and with frequent use (frequent meaning greater than or equal to just 10 sessions in a lifetime). Some studies have even shown that those who first used tanning beds in their teens or into their twenties have a 75% increase in melanoma risk compared to those who did not. An increase has also been found in those who begin tanning during mid-adulthood, so it is never too late to give up this dangerous and sometimes even addictive habit.

For those who simply love the look of tanned skin, I recommend self-tanning products, which have come a long way over the years and can help provide a naturally bronzed look without all the risks associated with UV tanning.

What is the best sunscreen to use to prevent skin cancer?

A quality sunscreen with a high enough SPF rating is one of our best tools for protecting our skin from harmful UV rays and lowering the risk of skin cancer. However, sunscreen is also one of the things that a lot of folks don’t get right.

Generally speaking, my recommendation is in alignment with the American Academy of Dermatology: use at least an SPF 30 and reapply frequently throughout the day. It is important to remember to apply your product before sun exposure, not once you’ve picked that cozy spot on the beach and already have a margarita in your hand.

Once you have your 30+ SPF in hand, make sure you are reapplying per the direction on the bottle (usually around every 2 – 4 hours, depending) and after you get wet or work up a sweat.

Am I at risk of developing melanoma?

While it’s impossible to fully determine your percentage of risk, there are a few key things you can look at in terms of your family history and lifestyle habits to gauge your potential risk—and how close an eye you should be keeping on your skin.

As we’ve discussed, previous tanning bed use or excessive sun exposure throughout your life are two risk factors to keep in mind. Families can be predisposed to melanoma because of genetic mutations, so if you have one or more family members with a history of melanoma or other skin cancers, you are more at risk as well. Other risks include abnormal-looking moles or more than 50 normal moles, immunosuppression, fair complexion, red or blonde hair, and light eye color.

Did you know? Skin cancer can present differently in children, sometimes exhibiting signs that are completely opposite from a cancerous lesion in adults.

If you put a mental checkmark against any of the above risk factors, it’s a good idea to schedule a routine skin cancer screening with a dermatology practice to make sure all is well. With early detection, most skin cancers are easily treatable, so staying on top of your skin health and keeping an open dialogue with your healthcare providers is key.

Do I have skin cancer?

Ultimately, the best way to determine if you have a cancerous lesion or melanoma is to have a medical screening by an experienced dermatologist PA. If you’ve noticed something new on your skin or changes to existing moles, contact us to schedule a screening. I like to remind my patients that there is no such thing as a ‘wasted appointment,’ particularly if it gives you peace of mind.

At-home skin cancer checks are incredibly important, but sometimes your dermatology provider can catch things that you have missed. While other skin cancers, such as squamous cell carcinoma, are related to cumulative or long-term chronic sun exposure, most melanomas result from intense, intermittent sun exposure—think a summer trip to the beach or days spent fishing at the lake. For this reason, many melanomas can be found in areas you don’t think of as frequently being exposed to the sun, such as the back in men and women, and especially the lower legs in women.

Melanoma can be found practically anywhere—including your palms, bottom of your feet, and under your nails—which is one of the reasons it is important to see us at BPS’ Dermatology Department for regular full body skin exams if you aren’t already doing so.

What are the signs of skin cancer?

Routinely performing an at-home skin cancer exam is one of the best ways to catch any potential issues early, particularly in conjunction with a yearly full-body scan performed by a dermatology provider.

Thankfully, there is a familiar pneumonic device that can help you know what to look for as you’re examining yourself: the ABCDEs of melanoma. While it is not substitute for a medical exam and is not all-inclusive, it can help you detect any possibly concerning spots on your own body.

If you have one or more of the following letters, it’s important to have your mole checked by a professional:

• A: Asymmetry. Most melanomas are asymmetrical, meaning the two sides of the lesion do not match. This should look noticeably different than non-cancerous moles, which typically present in a round or oval symmetrical appearance.
• B: Border Irregularities. Look at the edges of the mole or lesion. If they are uneven or have scalloped or notched edges, it is worth getting it checked out. Most common moles have smooth, even borders.
• C: Color Variation. A mole with multiple colors is concerning. Melanomas commonly have differing shades of brown, tan, or black and can even develop red, white, or blue areas as it grows. Benign moles are typically a single shade of brown.
• D: Diameter (or Dark). Detecting melanomas when they’re small is ideal, so paying attention to the size of your moles is crucial. If a mole is larger than 6mm, or about the size of a pencil eraser, that may indicate a problem. For darkness, compare the shade of the lesion of concern with other moles on your body. No matter the size, if it is darker that the others, it’s time to get it checked out. In rare cases, amelanotic melanomas are colorless, so note any noticeably lighter or colorless lesions as well.
• E: Evolution. Arguably the most important criteria of the ABCDEs, noting any changes in moles or lesions on your body can help you detect skin cancer early on. Any change in the shape, size, color, or elevation of spots on your skin can be a warning sign.

Keep in mind, this pneumonic was created for adults only—and for the most common form of melanomas—as children and certain subtypes do not generally present in the same way.

Since the E is typically the most important of all of the letters, I want to share other ways you may notice an “evolution” or change in your moles. Obviously changes in size, shape, and color are important, but changes in symptoms can be important as well.

• Is the mole inflamed?
• Have you noticed any crusting or bleeding of the mole?
• Have you noticed a change in sensation? (i.e does the mole itch or feel tender to touch?)

Did you know that some melanomas are not dark and actually have no pigment at all? These are then typically found by medical providers much later and can have a worse prognosis. These are called amelanotic melanomas. Nodular melanomas, the second most common form of melanoma, sometimes appear pink or have an even color and symmetrical borders—and they do not obey the ABCDE criteria.

Therefore, an EFG (surprise!) was developed to help detect these dangerous lesions.

• E for Elevation: the mole/lesion is raised
• F for Firm: the mole/lesion is hard when you touch it
• G for Growth: the mole/lesion has grown continuously for one month or more

Another way to find these sneaky melanomas is with the “ugly duckling” sign. This is essentially when one of the moles on your body does not look like the rest. For instance, your moles are all tan or brown and one appears much darker, almost black in color.

Does my child have skin cancer?

As I mentioned, the original ABCDEs of melanoma do not apply to children. For the kiddos, there is yet another completely different set of ABCDs, as well as CUP! Since children are still developing new moles, the ever-important “E” is not as helpful with them.

New moles can be, and usually are, completely normal in children. But here are some tips that we use as clinicians:

ABCDs of skin cancer for kids

• A for Amelanotic: mole or lesion has no color
• B for Bleeding/Bump: mole or lesion exhibits weird symptoms, such as bleeding or bumpiness
• C for Color: mole or lesion is uniform in color
• D for De Novo: new mole of any diameter

CUP! Skin cancer check for kids

• C for Colored: is the mole/lesion pink or red? Changing in color?
• U for Ulcerated: is the mole/lesion upward thickening?.
• P for Pyogenic Granuloma: lesions that present as pyogenic granulomas typically present as a shiny red lump with an uneven surface.

When should I contact a dermatology PA for a skin cancer check?

I’ve shared a lot of information that may be a bit confusing or overwhelming. It’s okay if you don’t feel confident doing at-home skin cancer checks—that’s why I’m here! If you have any concerns at all, please do not hesitate to reach out to me for a spot check. All in all, it is better to be safe than sorry.

Early detection of skin cancer provides the best prognosis for treatment. I recommend everyone schedule a routine skin cancer screening. For those with higher risk factors, biannual or yearly screenings are a great way to stay on top of your skin health.

If you have any questions at all or would like to schedule an appointment at our dermatology office, please call us at 484-755-5796. I look forward to meeting with you!