Skin Cancer

Question: "I have a mole on my back that my wife says is getting bigger and darker. Should I be concerned?"

Any mole has the potential to evolve into melanoma, but most do not.  If you notice any recent changes in any of your moles in regard to color, size, shape, symmetry, or sensation, you should have it examined by a physician.  Often times, a biopsy of the lesion is indicated in order to examine the lesion under a microscope and determine the diagnosis.

According to the American Cancer Society, more than one million skin cancers are diagnosed yearly.   Here in the U.S., we have a one in five chance of developing skin cancer in our lifetime . The most common form of skin cancer is basal cell carcinoma (BCC) followed by squamous cell carcinoma (SCC) and finally melanoma. 

There are three main types of skin cancer:

1. Basal Cell Carcinoma (BCC)

This is the most common form of skin cancer. BCC can appear as a clear to pink pearly bump but can also be white, yellow, or waxy in appearance. The borders are often elevated and rolled making a crusted indentation. It can also appear as an open sore that doesn't seem to heal or  a sore that bleeds and oozes for weeks.

2. Squamous Cell Carcinoma (SCC)

This is the second most common type of skin cancer and can appear as a warty, crusty  growth or sore that doesn't seem to heal. Borders are often irregular and elevated forming a central depression that may rapidly increase in size. Sometimes, it could look simply like a pink to red scaly patch with irregular borders.

3. Melanoma

This is the third most common type of skin cancer but by far the most deadly.  This type of skin cancer is highly  metastatic  ( spreads to other organ systems).  Following the ABCDE's of melanoma when examining your skin can alert you to this type of skin cancer. 

The ABCDE's of Melanoma:

A:  Asymmetry:  a line through the middle would not create matching halves

B:  Border Irregularity:  uneven or scalloped borders

C:  Color variability:  variation in color on the same mole or progression of colors

D:  Diameter over 6mm (1/4 inch): Any mole bigger than a pencil eraser should be examined by a physician.

E:  Evolution (changing mole):  Changes in size, shape, color, elevation, bleeding, itching, crusting, or any other change of an existing mole should be examined by a physician.

BCC and SCC are especially associated with ultraviolet (UV)  radiation from the sun.  Here in Hawaii, we enjoy the outdoors. As a result, throughout the year, we tend to get more UV radiation than the rest of the country. Reducing the amount of exposure involves adopting many lifestyle changes. 

• If possible, avoid the sun between 9am and 4 pm
• Apply a daily sunscreen (SPF 15 or greater) every morning (even if you work indoors) 
• Use sun protective clothing such as long sleeve shirts, wide brim hats, and pants
• If sun exposure occurs during the hours of 9am-4pm, apply a sunscreen with an SPF 30 or greater and reapply every 2 hours during sun exposure or sooner if you have heavy perspiration or are swimming