Bryan C. Schultz, M.D. - Affiliates in Diseases and Surgery of the Skin, S.C.    
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MOLES, MELANOMA, AND HOW TO EXAMINE YOUR SKIN FOR THEM

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Moles (Nevi) And Skin Cancer

Moles (usually tan and brown spots) are growths consisting of pigment cells called melanocytes. In certain circumstances these melanocytes could develop into malignant melanoma - a skin cancer that is usually fatal if diagnosed too late, but as high as 95% curable if caught early and removed.

We will examine any specific moles or your entire skin surface for suspicious moles if you wish. Simply let our assistant know you want this done before you see the doctor. A good cancer prevention program for all patients is monthly self-examination (see table) and yearly or semi-annual checkups by a dermatologist, depending upon the patient's specific history.

1. Moles You Are Born With
Moles you are bom with (congenital nevi) may need to be removed. Only 1 in 100 - 200 people are born with a mole. A parent is usually the only one that can give this information, but the doctor can frequently suspect certain moles as congenital by their appearance and size: usually greater than 6 mm. There is probably a greater risk of melanoma in these moles. Since this is relatively new data from Harvard Medical School and published in a dermatology specialty journal, nondermatologists may be unaware of this data. We have seen these previously normal moles change to melanoma at every age from infancy to old age. As always, any mole should be evaluated before making specific recommendations.

Dr. Schultz has been using a new advanced microscope for the skin. It magnifies surface features and reveals detail not seen with the naked eye, making evaluation more precise and the decision to biopsy or remove a mole more accurate.

2. What Other Moles Should Be Removed?
Any change in a mole may require removal because it may signify malignant change. If the mole is suddenly growing, itches, hurts, gets easily irritated, bleeds, turns color, etc., it should be evaluated promptly. Early removal of melanoma is usually lifesaving.

The doctor may also suggest moles that are darker in color, speckled in color, have any pink, red, or black in them to be removed. Any truly black color in a mole warrants immediate removal.

If a mole is in an area the patient or spouse cannot examine routinely for change, it may be better to remove it.
Also moles that develop white rings around them (halo nevi) are sometimes removed.

N.B. Although recent elevation is a concern, most early melanomas are flat, so look for other indications such as darker or irregular colors.

3. What Risks Are Involved In Removing Moles?
This is a simple, painless surgical procedure done with local anesthetic. All attempts are made to leave as little obvious scar as possible by following time-honored cosmetic surgical techniques. The scar is frequently no bigger than the mole itself.

4. Do Moles Spread or Form A Cancer Because of Removal?
Mole cells (melanocytes) are removed so that they cannot become malignant or spread. Cells that have been removed no longer have the potential of spreading or turning malignant if removed in time. The old idea of not touching a changing (or any pre-cancerous growth in the body) mole is antiquated and completely erroneous advice that cost many people their lives decades ago.

5. Can The Mole Simply Be "Burned Off"?
In many circumstances an elevated mole may be removed just beneath the surface and the base lightly burned with a cautery machine.

In many cases this is the best cosmetic option, as long as the biopsy report shows a benign mole and the patient reports any return of color to the doctor for evaluation.

In some moles (including all flat moles) there is mole beneath the surface of the skin. I may prefer to remove some of these moles below the surface and close the area with fine sutures - a painless procedure.

6. What About Hair In A Mole?
This does not necessarily indicate anything about the potential of malignancy; however, avoid pulling hairs out, since this irritation could theoretically be harmful. Cut hair close to the surface or have us remove the mole surgically.

7. Does Melanoma Run In Families?
Frequently this is the case. If any relative has had melanoma have your dermatologist check your moles at least once a year and check them monthly yourself. A condition where many irregularly shaped and colored moles are present on the trunk has been described in family members. This inherited condition may cause multiple melanomas to develop in these patients, so early diagnosis and treatment is essential. See table on dysplastic nevi (changing moles).

8. Why Didn't I Know All This Before? My Doctor Usually Said Just Leave Them Alone.
Most of our knowledge on moles and melanoma is quite recent and rapidly developing. Specialty knowledge also takes significant time to disseminate. The vast majority of moles still do not need to be removed, but regularly observed.

9. Does Sunlight Affect Moles And Melanoma?
Yes. A much greater incidence of malignant change is seen with sun exposure and especially sunburn.

Dr. Schultz was a guest faculty member at a surgical meeting with Dr. Thomas Fitzpatrick, Chairman of the Department of Dermatology at Harvard Medical School. During a melanoma panel at the meeting, Dr. Fitzpatrick relayed data to the doctors present, indicating evidence that even a single acute sunburn may induce melanoma in some individuals. With this in mind, together with wrinkling skin, basal and squamous cell skin cancer, and other problems with sun exposure, it is best to use protective clothing and sunscreen lotions with an SPF (sun protection factor) of 30 or greater routinely. Ask us to recommend a good sunscreen for you.

10. Why Be Concerned About All This? Isn't Skin Cancer Easily Treatable?
Not melanoma, if caught too late. Early removal of suspicious or premalignant moles is prevention or healthcare - keeping the healthy in good health. Treatment of existing cancer that has advanced is sickness care.

11. Do Numbers of Moles Make A Difference?
Yes. Data in the Journal of the American Academy of Dermatology indicates a gradually increasing risk of developing melanoma in patients with more moles. Patients with 11 - 25 moles had a 50% greater risk than those with less than 10 moles. The relative risk was 140% higher with 51 -100 moles and 880% with more than 100 moles. Studies have shown 15-40 moles average in non-melanoma patients, but any changing or suspicious mole should be evaluated no matter how few moles are present.
Lastly, don't worry about your moles. Most will never turn malignant. Simply be aware of what we have said above, examine your skin routinely, and avoid excess sun exposure.

 

PROCEDURE FOR SELF-EXAMINATION

The best time to do this simple monthly exam is after a bath or shower. Use a full-length and a hand mirror so you can check,any moles, blemishes or birthmarks from the top of your head to your toes, noting anything new—a change in size, shape or color, or a sore that does not heal. It is best if someone else examines areas you cannot clearly see.

1. Examine your body front and back in the mirror, then right and left sides, arms raised.

2. Bend elbows and look carefully at forearms and upper underarms and palms.

3. Sit, if that is more comfortable, to look at backs of the legs, feet—spaces between toes and soles.

4. Examine back of neck and scalp with the help of a hand mirror, part hair (or use blow dryer) to lift it and give you a close look.

Dr. Schultz installed the only sunburn/ ultraviolet/ozone meter in Illinois at Loyola University Medical School where he teaches as Associate Clinical Professor of Medicine. He recently tested a portable consumer device for the accurate measurement of ultraviolet light to prevent sunburn. He developed a surgical instrument for difficult skin cancers in 1979 (published in the Journal of the American Academy of Dermatology and presented at national and international scientific meetings), and has written articles for medical journals on skin cancer. A good portion of his book OFFICE PRACTICE OF SKIN SURGERY (for physicians) is devoted to skin cancer, as is a major part of a chapter on skin biopsy he wrote for a new textbook on skin surgery. He has studied laser surgery at several institutions, including Harvard Medical School and Marshfield Clinic. Dr. Schultz is listed in Who's Who in Cancer for his work In skin cancer and prevention.

Dr. Schultz continues to operate the sunburn meter and has provided data on peak sunburn times to the news media for over a decade. Tom Skilling (WGN-TV) has used this data during the summer since 1992 - most frequently on the noon-1PM newscast and occassionally the 9-10PM news. The Tribune lists his times daily on the weather page for 7AM, 1PM & 4PM. Dr. Schultz and his scientific paper on sun intensity are responsible for the American Academy of Dermatology and the Skin Cancer Foundation extending their "intense sun" warning to 4PM starting in 1995.

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