Melanoma is the third commonest invasive malignancy in Australia after breast and prostate cancer. Checking your skin can help you find melanoma early when it is highly treatable. Consult your doctor if you ever think you have a concerning skin lesion. Examine your body for early signs of melanoma. Melanoma can affect you anywhere on your skin – from your scalp, hands to the bottom of your feet. Even if the area gets only a little sun, it is possible for melanoma to develop there. The highest reported rates of cutaneous melanoma in the world are in Australia and New Zealand. Melanoma can occur in adults of any age but is very rare in children.
A strong family history of melanoma with 2 or more first-degree relatives affected
White/fair skin that burns easily
How to check your own skin?
1. A full-length mirror
Looking into a full-length mirror helps check your back and sides.
2. Underarms, forearms, and palms
Bend your elbows and look carefully at your forearms, underarms, and your palms.
3. Legs, toes and soles of your feet
Look at the backs of your legs, feet, the spaces between your toes, and the soles of your feet.
4. A hand mirror can help you check your neck, scalp, back and buttocks
A small mirror can be handy to check your own back, buttocks and the back of your neck.
The ‘ABCDE’ approach to recognizing an early melanoma
Remember the ABCDE when looking at each of your skin lesions.
A – Asymmetry
Melanomas are often neither circular nor oval in shape. If you draw a line through the middle of the lesion, the two halves do not match. This irregular shape is described as asymmetry.
B – Border
Melanoma borders tend to be uneven and may have scalloped or notched edges. Sometimes the edge of a melanoma is abrupt next to normal skin. At other times, the melanoma may merge into skin. These two border features can happen in different parts of the same melanoma.
C – Colour
Multiple colours are a warning sign. While benign moles are usually a single shade of brown, a melanoma may have different shades of brown, tan or black. As it grows, the colours red, white, or even blue may also appear. The more colours in the skin lesion, the more concerning it is.
D – Diameter
It is a warning sign if a skin lesion is 6 mm in diameter or greater. Most harmless skin lesions are quite small.
E – Evolution
Has your skin lesion changed over several months? This is a concerning feature. Harmless skin lesions often remain the same year after year. Inflamed skin lesions often change over days or weeks rather than over months.
Doctors generally do not use the ABCDE system
They usually examine your skin lesions with a dermoscope. This is an instrument with magnification and a light source that reduces surface reflection. The doctor can detect the structure of the skin lesion under the surface, and use their knowledge and clinical skills to diagnose skin lesions suspicious for melanoma. The suspicious skin lesion will need removal or an excisional biopsy. Alternatively, the dermoscope may assist your doctor to determine the skin lesion is not concerning. The ABCDE system is just a guide, and it is not foolproof. A melanoma can be smaller than 5 mm in diameter. A melanoma can be circular and only have one colour.
Dysplatic Naevi or Moles
A dysplastic melanocytic nevus is a mole with some structural abnormality. These dysplastic nevi are not skin cancers but patients with multiple dysplastic naevi are at a significant risk of developing melanoma.
Dysplastic moles look like very dark or black moles. They often have a strange irregular shape, are usually smooth to touch, and may rise gently off the skin. They are seen in people of every age. Other features may be ill defined or blurred borders, Irregular margin resulting in an unusual shape, varying shades of colour (mostly pink, tan, brown, black)
Dysplastic naevus syndrome is a condition where a patient has 5 or more dysplastic melanocytic naevi. These people are at substantial risk of developing a melanoma.
Patients with Dysplastic Naevus syndrome are at high risk of melanoma and so, It is therefore essential that extreme measures are taken to avoid sun damage. Of those people with dysplastic nevi who later develop melanoma, more grow from normal looking skin than from existing Dysplastic moles. As such, simply removing lots of dysplastic moles is not the answer. These patients need regular and careful skin checks to check for any changes. During skin checks, the doctor can take photographs of moles (with or without the dermatoscope) and any suspicious dysplastic moles and can then be followed up for any changes. The close-up photographs with dermatoscopic views should be repeated from time to time, so change can be detected early and its significance determined. Follow up is the key to managing dysplastic moles. If in doubt, a suspicious or changing atypical nevus should be removed for an excision biopsy. Partial biopsy is best avoided, as the test may miss a small focus of melanoma. People diagnosed with atypical naevi should be taught how to self examine their skin for new skin lesions and for changes to existing moles that may indicate the development of melanoma. People with numerous moles should have a thorough full body skin check 6-12 monthly.
Skin cancer is the most common cancer in the world, but unlike other cancers, you can see it, so you can do something about it.
Learning about how to detect early signs of skin cancer can make a lot of difference in reducing a patient’s morbidity and mortality from the skin cancers. When caught and treated early, skin cancers are highly curable. And in the early stages of skin cancer development, you’re the one with the best chance to see changes. That’s why we recommend that you examine your skin head-to-toe every 3-4 months. It’s a simple but powerful way to look at yourself with a new focus that can save you.
The risk of skin cancers depends on a number of factors including inheritance, Fitzpatrick skin type, history of unprotected sun exposure in the first 20 years of life, your occupation and hobbies.
Early skin cancer detection
Elderly patients: Some elderly patients who spent their childhood and earning age outdoors when there was no awareness of sun damage, usually get a lot of skin cancers and it is advised to have their skin checked professionally every 3-4 monthly and self checkup every month.
Past history: Patients with a past history of melanoma or dysplastic nevus syndrome are recommended to have a professional skin checkup every 6 months and self checkup every 1-2 months.
General people: For the rest of the patients, it’s okay to have a skin checkup once a year or once every 2 years provided they do their own checkup every 3-4 months.
The common types of skin cancers include Basal Cell Carcinoma (BCC), Squamous Cell Carcinoma (SCC) and Melanoma.
It’s also important to remember that technology can be a powerful aid when checking your skin. If you can have a loved one take photos of suspicious spots, it can help your physician track any changes when you head in for your skin exam.
If you see something NEW, CHANGING or UNUSUAL, get it checked with a skin cancer doctor right away. It could be skin cancer. Regarding the changing skin lesions, if you see a change appearing overnight or in the last couple of days, it is usually inflammatory and should subside within a week. In case the changes continue over 2-3 weeks, it’s better to consult a skin cancer doctor.
A growth that increases in size and appears pearly, transparent, tan, brown, black, or multicoloured.
A mole, birthmark or brown spot that increases in size, thickness, changes colour or texture, or is bigger than a pencil eraser.
A spot or sore that continues to itch, hurt, crust, scab or bleed.
An open sore that does not heal within three weeks.
Look for anything new, changing or unusual on both sun-exposed and sun-protected areas of the body. Melanomas commonly appear on the legs of women, and the number one place they develop on men is the trunk. Keep in mind, though, that melanomas can arise anywhere on the skin, even in areas where the sun doesn’t shine.
Look for ABCDE signs of melanoma – ABCDE stands for asymmetry, border, colour, diameter and evolving. These are the characteristics of skin damage that doctors look for when diagnosing and classifying melanomas.
A is for Asymmetry. Most melanomas are asymmetrical. If you draw a line through the middle of the lesion, the two halves don’t match, so it looks different from a round to oval and symmetrical common mole.
B is for Border. Melanoma borders tend to be uneven and may have scalloped or notched edges, while common moles tend to have smoother, more even borders.
C is for Colour. Multiple colours are a warning sign. While benign moles are usually a single shade of brown, a melanoma may have different shades of brown, tan or black. As it grows, the colours red, white or blue may also appear.
D is for Diameter or Dark. While it’s ideal to detect a melanoma when it is small, it’s a warning sign if a lesion is the size of a pencil eraser (about 6 mm, or ¼ inch in diameter) or larger. Rare, there are amelanotic melanomas which are skin coloured or very light or colorless.
E is for Evolving. Any change in size, shape, colour or elevation of a spot on your skin, or any new symptom in it, such as bleeding, itching or crusting, may be a warning sign of melanoma.
Steps to examine yourself in front of a mirror.
Examine your face Especially your nose, lips, mouth and ears — front and back.
Inspect your scalp Thoroughly inspect your scalp, using a blow-dryer and mirror to expose each section to view. Get a friend or family member to help, if you can.
Check your upper limbs Palms and backs, between the fingers and under the fingernails. Continue up the wrists to examine both the front and back of your forearms. Check the elbows and scan all sides of your upper arms.
Inspect your torso Next, focus on the neck, chest and torso. Lift the breasts to view the undersides
Scan your back With your back to the full-length mirror, use the hand mirror to inspect the back of your neck, shoulders, upper back. Scan your lower back, buttocks and backs of both legs
Inspect your legs Sit down; prop each leg in turn on the other stool or chair. Use the hand mirror to examine the genitals. Check the front and sides of both legs, thigh to shin. Then, finish with ankles and feet, including soles, toes and nails.
Basal Cell Carcinoma or BCC
BCC or Basal Cell Carcinoma is the most common form of skin cancer. BCC almost always never spreads beyond the original tumour site, and the cure rate after a surgical excision is above 95 percent in most body areas.
So, is this form of cancer even something to worry about?
Even though BCCs are locally invasive and don’t spread to lymph nodes or blood stream usually, there can be some aggressive forms of BCCs which rarely can metastasise. In addition, BCCs in areas like lips, ears, nose and eyelids can create a lot of tissue destruction if not removed early. As they are very slow growing, patients take them very casually sometimes and by the time they start to bleed and ulcerate, they can be hard to remove and usually need a skin graft or a skin flap repair in the areas of nose, ears and eyelids. BCCs over the lower part of the nose or in the ears can go deeper into the cartilage if left unattended, making surgery difficult. Once you’ve been diagnosed with a BCC, it’s very likely that you will develop more over the years, leading to continuous treatment and possibly even disfiguration.
Squamous Cell Carcinoma or SCC
SCC or Squamous Cell Carcinomas are the second commonest type of skin cancers. They can be quite aggressive at times. While the majority of SCCs can be successfully treated, if left to grow, this common skin cancer can become very invasive, can penetrate deeper layers of skin and spread to surrounding lymph nodes and to other parts of the body.
The pre-cancerous lesions for SCCs (Actinic Keratosis or Bowen’s disease) can grow over a few years before they turn into invasive Squamous cell carcinoma.
Actinic keratosis is the most common precancerous lesion that forms on skin damaged by chronic exposure to ultraviolet rays from the sun and/or indoor tanning. Actinic keratosis results from long-term exposure to ultraviolet radiation. Actinic keratosis often appears as small dry, scaly or crusty patches of skin. They may be red, light or dark tan, white, pink, flesh-toned or a combination of colours and are sometimes raised. Because of their rough texture, actinic keratoses are often easier to feel than see. The lesions frequently arise on sun-exposed areas of the face, lips, ears, scalp, shoulders, neck and the back of the hands and forearms.
Actinic keratosis that turns cancerous almost always turns into Squamous Cell Carcinoma, the second most common type of skin cancer. Untreated SCCs can become invasive, and even life-threatening.
Catching and treating the actinic keratosis before it becomes an SCC can make a huge difference in your treatment experience. You want to get them early, before they go invasive, mostly to prevent possible invasion into the skin and internal organs. This is especially important in the head and neck region, as those cancers can be more aggressive in these areas. You’re also going to get less scarring than if you waited to remove a growth until it was cancerous.
Only about 10 percent of actinic keratoses will eventually become cancerous, but the majority of SCCs do begin as actinic keratosis. Unfortunately, there’s no way to tell which actinic keratosis will become dangerous, so monitoring and treating any that crop up is the only way to be sure.
What do actinic keratosis look like?
They vary widely. They could be thick, red, scaly patches or they could be red bumps with a tan crust or could present with a raised little horn-shaped part, called a cutaneous horn. Pay attention to anything that keeps coming back or doesn’t heal, just as you would while examining your skin for signs of fully formed skin cancers. I tell my patients that if they have any concerning areas like that, to call the clinic and we will see them as soon as possible. That way we can treat them early and prevent formation of squamous cell carcinoma
Actinic keratosis can be treated easily with simple procedures like cryotherapy or with some cancer burning creams, laser ablation or with curettage and desiccation.
Actinic keratosis on lips is called Actinic Cheilitis. You might think you have severely chapped lips, but that could be a warning sign of actinic cheilitis. This precancerous condition typically appears on the lower lip as scaly patches or roughness. Left untreated, it can evolve into a Squamous Cell Carcinoma of the Lip which can be very aggressive.
The SCCs can also present as a wart-like growth or a cutaneous horn. You might think you’ve developed a wart, but these funnel-shaped growths that look like a tiny horn on the skin may have a SCC in the base.
A superficial form of SCC is called Bowen’s disease or Squamous Cell Carcinoma – in – situ. You might think you have a patch of dry skin. But if the patch doesn’t heal, looks scaly, red or crusty and starts spreading outward, it could be a superficial type of SCC called SCC in situ. At this stage, it is not dangerous and the treatment is easy, but if left untreated, it can progress and turn into an invasive SCC which will need a full excision and will leave a much bigger scar.
It can be difficult to comprehend just how big a difference early detection makes with melanoma, the most dangerous form of skin cancer. Treating a Melanoma early rather than after it is allowed to progress could be lifesaving.
To fully comprehend the significance of timing, it can be helpful to understand exactly what happens to a melanoma when it advances to a later stage, and what it means when a melanoma spreads beyond the original tumour site.
Every melanoma has the potential to become deadly, but the difference between a melanoma-in-situ and one that has begun to metastasise cannot be overstated. There is a drastic change in the survival rate for the various stages of melanoma, highlighting the importance of detecting and treating melanomas before they have a chance to progress. It’s impossible to predict exactly how fast a melanoma will move from stage to stage, so you should be taking action as soon as possible.
There are different types of melanoma
Superficial spreading melanoma This is the most common type of melanoma making up about 50% of all melanomas diagnosed. This melanoma usually appears as a dark spot with irregular borders that spreads across the skin.
Nodular melanoma Nodular is one of the most rapidly growing types of melanoma. It appears as a raised lump or ‘nodule’ and can be brown, black, pink or red in colouring, or have no colour at all. About 15% of all melanomas are nodular.
Lentigo maligna melanoma Lentigo maligna melanomas begin as large freckles. They are commonly found in older people, often in areas that have received a lot of sun exposure such as the face, head, neck and upper body. This type of melanoma makes up 10% of all melanomas.
Acral lentiginous melanoma Acral is a rare type of melanoma that tends to grow on the palms of hands, soles of the feet or under the nails. It accounts for about 3% of all melanomas.
Other, less common types of melanoma include desmoplastic and naevoid melanoma. Mucosal melanomas can be found in tissues in the respiratory, digestive, and reproductive tracts. Uveal (ocular) melanomas develop in the eye.