Can you mistake skin cancer for something else?

Question:  I’ve noticed a small sore like a scab on my left upper arm that will not go away. What could that be? What should I do about it?

Answer:   Your sore could be a Basal Cell Carcinoma (BCC), so don’t take it lightly.

Sometimes a BCC can resemble something else like a mole, psoriasis or eczema,  a scar or any irritation. My rule of thumb is to watch it for one month:  If it does not go away or it enlarges or changes get it check out by a dermatologist, for an accurate diagnosis. The reason is because BCC is the most common type of skin cancer we see and anyone with a history of sun exposure is at risk of developing BCCs. A BCC is medically defined as any abnormal, uncontrolled growth or lesion that occurs in the skin’s basal cells (which line the deepest layer of the epidermis, the outermost layer of skin). They can start out as a barely noticeable lesion or rough patch, and while they rarely metastasize (spread) to larger organs beyond the original tumor site, they can be highly disfiguring and destructive to surrounding skin, if allowed to grow.

Who is at risk for BCCs? Aside from extensive exposure to UV sun rays such as in workers or athletes or even those who spend a lot of leisure time outdoors, we consider those with fair skin, blond or red hair, and those with blue, green or grey eyes to be at highest risk.

BCCs have generally been seen in older people but lately it seems the patients we are treating are younger and younger. And men have historically outnumbered women, although the number of women under age 40 diagnosed with BCC has more than doubled in the last 35 years.

There are five warning signs of a basal cell carcinoma; two or more are usually present in one tumor:

  1. Any non-healing open sore that bleeds, oozes or crusts and remains open for more than 3 weeks can be a very early sign of BCC.
  2. Any reddish or irritated area on the face, chest, shoulders, arms or leg which can be patchy or crusty may itch or hurt or may not have any sensation at all.
  3. Any pink growth that is slightly elevated with a rolled border and a crusted indentation in the center. If left to grow, tiny blood vessels may develop on the surface as it enlarges.
  4. Any shiny bump or nodule, often confused with a normal mole, that is pearly or clear, pink, red, white or even tan, black, or brown, especially in dark-skinned, dark-haired people.
  5. A scar-like area that is white, yellow or waxy and often has poorly defined borders or skin that looks shiny and taut, which indicate an aggressive, invasive BCC that is larger than appears on the surface.

BCCs are easily treated when caught early and cure rates are close to 100 percent, so any lesion that has been around for one month should be checked as soon as possible and treated and monitored by a dermatologist.

Do you have a growth that worries you? What does it look like?



Today is Melanoma Monday

Take an extra moment today to check your moles because today is Melanoma Monday®.

Have your skin checked at least once per year with a dermatologist to avoid any type of skin cancer, especially if your skin has been or is overexposed to the sun or UV radiation from outdoor activities or indoor tanning. Check  for any moles with the following characteristics and remember these warning sign ABC’s in between:

Asymmetry: Half of the mole does not match the other half.

Border irregularity: The mole’s border is irregular or jagged.

Colors: The mole has a variety of colors such as shades of brown, tan, black, red or blue.

Diameter: The mole is 6 millimeters wide (about the width of a pencil eraser) or larger.

Evolution: The mole has either changed color or growth in width or height or the mole has become bloody, crusty or itchy.

If a mole anywhere on your skin or scalp displays any one or more of these warning signs have it checked and possibly biopsied by your dermatologist as soon as possible.

Check your spots!

Meet Snooki ... she has lots of spots!

As healthcare professionals, we are expected to do a thorough review of systems, assess your medication, evaluate your past medical and family history, equip you with health maintenance and, of course, conduct a physical exam. Examining the skin is the focus in dermatology, but this kind of exam should be part of any internal medicine visit.

Often people ask me, how do you do an effective skin exam and identify a mole that is suspicious?

When I examine a patient’s skin, I am very methodical, often starting at the head and working my way down a person’s body. Additionally, I am always looking out for the “ugly duckling”–the mole that stands out and looks different from the rest.

Don’t forget the ABCDE’s:

Asymmetry–is there a lack of symmetry in the color or shape of the lesion?

Border–is the edge irregular or jagged?

Color–what color is the lesion? Is it brown, black, gray, blue, red or a mixture?

Diameter–is the lesion larger than the size of a pencil eraser (> 6mm) or changing in size?

Evolving–is the lesion new, growing, spreading or changing? Can you affirm for its changelessness?

Most moles on an individual have a pattern, a “look”. The patterns or arrangement of moles on an individual’s skin are good; they serve as an example or point of reference when examining a patient’s skin. When a mole doesn’t fit the pattern, it deserves further investigation (e.g., biopsy, etc.).

When a patient says that a lesion is changing, I believe them, even if I am not alarmed by the way it looks. After all, you see your body every day. If you notice something is different, if some aspect about the mole seems to be evolving, say something. Get it checked.

And always question an inflamed lesion, with or without pigment.

My rule of thumb is one month. If something you notice does not resolve within a month, if the mole looks different and those changes last one month, get yourself to a dermatologist for a full skin check-up and have the lesion examined.

If you live in an area where access to a dermatologist is restricted, get to your primary care giver or internist, who may be able to do a biopsy or refer you to a surgeon who can.   As part of health maintenance (this goes for everyone), you should have a full skin exam by a dermatologic practitioner yearly. If you have more than 50 moles, have had skin cancer or pre-cancerous/suspicious moles or growths, have a family history of atypical moles or melanoma, you should have a skin exam performed more frequently.