As a sun lover with a fair complexion and a history of blistering sunburns, I've spent much of the last decade waiting for skin cancer. So when I noticed that a fleshy pink nodule on the side of my head seemed to be growing exponentially, I headed to the dermatologist for official confirmation.
In less than five seconds, Dr. Roopal Kundu dismissed the unsightly growth. But after lightly tracing my face with her fingers, she zeroed in on a tiny red spot above my lip that I've had for, oh, about a year. "This could be precancerous," she said, lightly rubbing the tiny rough spot.It's a common mistake: I worried more about an ugly (but harmless) lesion than a potentially problematic one. And although I thought I knew the signs of melanoma, the most lethal type of skin cancer, I couldn't spot precancer — actinic or solar keratoses — or the two forms of non-melanoma skin cancer, called basal cell and squamous cell carcinomas, if they landed on my face.
Actinic (solar) keratosis and non-melanoma cancers do not lead to melanoma because they begin in different types of cells. But it's important to know the signs of all skin cancers because they all can cause health problems, including local tissue destruction. The earlier skin cancer is caught, the easier it is to treat.
Unfortunately, signs are often missed, and "we see people who have had melanoma for months," said Kundu, an assistant professor of dermatology at Northwestern University's Feinberg School of Medicine.
What to look for
Kundu teaches patients to look for two things: The ABCDEs of mole evaluations and spots called "ugly ducklings."
The ABCDEs of melanoma stand for these warning signs: asymmetry, borders (irregular or non-smooth), color (uneven variations), diameter (bigger than a pencil eraser) and evolution (changing moles).
Ugly ducklings are new growths that stand out because they don't look like anything else. "Eighty percent of melanomas are new spots," Kundu said.
Still, campaigns against skin cancer often focus on melanoma and leave out the more common skin cancers, such as basal cell and squamous cell, said Dr. D.J. Verret, a facial plastic surgeon and an assistant clinical professor at the University of Texas Southwestern Medical School.
These cancers rarely spread and are much less likely than melanomas to be fatal. But if left untreated, they can grow and cause scarring or disfigurement.
"Spots which come and go, areas which bleed, are scaly or itch can often be a small skin cancer which requires attention," Verret said.
Early on, pre-skin cancers are the size of a pinhead, sandpapery and usually found on sun-exposed areas. The lesion may be a skin-colored or reddish-brown "bump" and can grow to the size of a quarter.
Once skin cancer is caught, treatment can proceed in several ways, depending on the type of cancer, size and location. I used a common dermatologic treatment for both precancer and basal cell cancer that involved rubbing a chemotherapy cream over my lip twice a day for two weeks. With topical chemotherapy, the lesions blistered, grew inflamed and looked pretty darn ugly before healing.
Other basic treatment options include cryosurgery, or using liquid nitrogen to "freeze" the skin off, a simple surgical excision, laser treatments, and alternately scraping and burning the tumor.
If actinic keratoses is untreated it can progress to squamous cell carcinoma, which can metastasize into nearby tissues.
The key message, dermatologists say, is to be vigilant, especially if you have a fair complexion, sun exposure and a family history of melanoma. And don't assume something is harmless because it has been there for years. "Don't assume something is safe just because it has been with you for years," said Dr. Oanh Lauring, the chief of dermatology at Mercy Medical Center in Baltimore. "In fact, most skin cancers typically grow slowly over years before it is noticed," she said.
Skin cancer misconceptionsThe earlier skin cancer is caught, the easier it is to treat. But common misconceptions deter many people from getting mysterious bumps or lesions checked out. Here are six common excuses patients have for missing skin cancer, according to dermatologists.
I thought a raised lesion was more dangerous than a flat one. "Most early melanomas are flat," said Orlando dermatologist William Grisaitis. "The important thing is that that flat spot is changing and getting bigger." Many raised gray-brown spots, meanwhile, are actually seborrheic keratoses or "barnacles," which are benign and never become skin cancers.
I was waiting for it to go away.
Some people mistake a basal cell carcinoma for a pimple or razor bump. "The basal cell may last more than one month at exactly the same location," said Dr. Murad Alam, an associate professor of dermatology, otolaryngology and surgery at Northwestern University. If a lesion hasn't healed in six to eight weeks, have it checked by an expert.
It's in a spot where the sun doesn't shine. Melanoma can occur anywhere on the body, including areas that aren't exposed to the sun. In women, it often appears on the legs, neck and face. Men often get melanoma on the chest or back. "Look at your scalp, groin, soles and buttocks, said Dr. Lee Laris, a Phoenix dermatologist. "If it has skin on it, it can get skin cancer, even your lips, inside your mouth or on your eye."
My moles didn't change. An evolving mole can indicate melanoma. But "the most common type of skin cancer is basal cell carcinoma, which isn't a mole at all, but a pink pearly bump most often found on the face, ears and upper back, said dermatologist Raphael Darvish of Los Angeles. "Squamous cell carcinomas, which are less common than basal cells, can show up as crusty lesions on the skin, mostly on the face."
It didn't hurt. "When it comes up quickly and hurts, it could be a fast-growing squamous cell skin cancer. But most skin cancers have no symptoms; they feel like normal skin and are not painful," Grisaitis said.
It was tiny. "People tend to worry about spots that are large. In fact, melanomas can be a few millimeters wide," said Alam, chief of cutaneous surgery at Northwestern. "Size does not equate with dangerousness." Non-melanoma skin cancers can also be subtle, Alam said. "These most commonly occur on the face and backs of arms and may be slightly raised red areas, or crusty areas. They may not be the largest or ugliest-looking spots on the face."