Signs of Skin Cancer Are Too Often Ignored

From the WebMD Archives

July 18, 2000 -- Although we live in our skin 24 hours a day, experts say most of us don't pay as much attention to it as we should, particularly in noticing slight changes that could signal melanoma, a potentially deadly skin cancer.

"It seems intuitive that people would examine their skin, but there are many areas that are not easy to examine or are not routinely examined," Mary S. Brady, MD, of the Memorial Sloan-Kettering Cancer Center in New York, tells WebMD. For example, she says, how often do you really look at your back, the bottom of your feet, or the top of your head? Those are all places that get sun exposure, whether you realize it or not.

In her study of more than 450 people with newly diagnosed melanoma, published in the journal Cancer, Brady found that women were more likely than men to detect skin cancers. While more than half of the people in the study spotted their own melanomas, 16% of the cancers were detected by a doctor, and 11% were found by a spouse or significant other.

The study suggests that at least some high-risk people are getting the message about checking their own skin and getting routine skin exams from their doctors, Brady says. Those with a family history of melanoma, for instance, were nearly three times more likely than others to get diagnosed early, when melanoma is highly curable.

But Brady says plenty of other people who are at high risk of developing the cancer -- such as those with fair complexions or who spend time in the sun without protective clothing, sunscreen, and hats -- need to keep an eye out for skin changes, such as moles that have changed in color, size, or shape. Moles that were once light brown or dark brown and now look multicolored should be considered suspicious.

So what can high-risk people do?

Robert Skidmore, MD, interim chief of the division of dermatology at the University of Florida, in Gainesville, encourages them to do regular skin self-exams. Skin self-exams are important and should be done once a month, along with a breast self-exam for women and a testicular self-exam for men, Skidmore says. At the very least, he recommends a full skin check every six months.


To encourage its use, Skidmore teaches patients how to do the skin self-exam. "The first thing I tell them is to get naked," Skidmore says. "If they have someone they're close to, they can have them help out; if not, you need a mirror on a wall and a hand-held mirror so you can look at your back and your buttocks and the backs of your legs."

So what exactly should you be looking for? To help you out, the American Cancer Society offers the following 'ABCD Rule' for signs of melanoma:

  • A is for Asymmetry: One-half of a mole or birthmark does not match the other.
  • B is for Border: The edges are irregular, ragged, notched, or blurred.
  • C is for Color: The color is not the same all over, but may have differing shades of brown or black, sometimes with patches of red, white, or blue.
  • D is for Diameter: The area is larger than 6 millimeters (about the size of a pencil eraser) or is growing larger.

Skidmore tells patients to play "hide-the-mole" with a pencil eraser, and to be suspicious of any mole that isn't completely covered when you place the eraser over it.

"If the mole used to hide and doesn't hide anymore, that's a very sensitive indicator of change that should be looked at more closely," he says.

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