Barbara J. Fox, MD, FAAD

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Take Note of Your Skin Spots

Published on CityLivingSeattle.com on July 18, 2016


As Seattleites take to Matthews or Alki beach, the mountains or the happy hour patio tables, it’s a critical time to remind everyone about sun protection and the risk of skin cancer.

 

Here in the Pacific Northwest, even on cloudy, rainy or drizzly summer days, 80 percent of the sun’s harmful ultraviolet rays will still reach your skin. Precaution is critical to your health. According to the National Oceanic and Atmospheric Administration, Seattle has clear skies just 28 percent of the time in the winter months, the lowest rate of any city in the U.S. Yet Washington state ranks eighth when it comes to the incidence of melanoma, higher than any of the southern states or Hawaii.

 

Start Being Sun Smart

If you are going to be outside for more than a few minutes:

Always wear a sunscreen with a Sun Protection Factor (SPF) of at least 30 on all exposed skin.

Cover all the skin you can.

Avoid the sun between 11 a.m. and 3 p.m., when it is most intense.

Seek the shade when possible.

Spot Check

You should examine your skin regularly, at least every three months — every square inch! But how can you tell if a spot is suspicious? What to look for depends on the type of skin cancer. Below are the three most common types:

 

1. Basal cell carcinoma is by far the most common skin cancer, and, fortunately, it is highly curable if  it’s caught early. These cancers usually show as an enlarged pink,  fragile bump that may eventually get a scab or ulcer in the center. They tend to grow very slowly, and most have been present for well over a year before a patient comes in to have them checked.

2. Squamous cell carcinoma is the second most common skin cancer, and these spots are also very treatable when discovered early. However, a small percentage (2 to 5 percent) of incidences may see the cancer spread to other parts of the body, with potentially life threatening implications. These tumors are usually hard, dry, scaly bumps that can grow quickly in just a few months.

3. Melanoma is the least common skin cancer; however, it is potentially the most lethal, and early detection is key to survival.

The American Academy of Dermatology and the Skin Cancer Foundation discuss the “ABCDEs” of melanoma:

 

A stands for “asymmetry.” If a mole is not round or oval and even in shape, it is suspicious.

 

B stands for “border.” If the edges are blurry, are irregular or have protruding, fingerlike extensions, it is a concern.

 

C stands for “color.” A normal growth will have the same color evenly distributed, but a worrisome lesion has different shades of brown, black, gray, blue, red or white scattered in it.

 

D is for “diameter.” After about age 21, it is not common to get new moles, and existing moles generally do not grow in diameter. So if you have a new one that is getting larger or an older mole that starts getting larger in diameter, it needs to be checked.

 

E is for “evolving.” If you can see monthly changes in a mole such as size, shape or color, get it evaluated.

 

Because there are many common growths that occur on the skin and it can be difficult to know which lesions may be suspicious, I always recommend seeing your physician. However, here are some of the more commonly acquired benign (noncancerous) growths:

1.  Seborrheic keratoses: light to dark brown, “wart-like,” stuck-on growths that gradually increase in size. These are very common and tend to run in families. Some people get many of these as they age, and they can occur anywhere on the skin surface, unrelated to sun exposure.

2.  Lentigines:  commonly referred to as “liver spots” or “age spots.” These are light brown, smooth, large, freckle-like growths that appear in sun-exposed areas like the face, neck and hands.

3.  Actinic keratoses:  pink, rough, sandpaper-like, slightly tender patches that occur most often on sun-exposed areas like the balding scalp, temples, ears, hands and forearms. These can eventually become a squamous cell carcinoma if not diagnosed and treated.

Be proactive about your skin health and watch for new or enlarging pigmented (brown) spots, especially if they are irregular in shape or color. Any new pink or red bumps that persist and enlarge over several months are of concern, especially if they are crusty or bleed or scab easily.

 

Dermatologists recommend that most individuals over 50 years old or those with increased risks for skin cancer have an annual, full-skin exam. Above all, remember the best rule of thumb: “When in doubt, check it out!”

Dr. Fox is a dermatologist at PacMed's First Hill and Northgate clinics