A Memphis Dermatologist's Take: High Risk Moles
by George Woodbury Jr. M.D. (05/23/2022)
Board-certified Dermatologists like myself continuously evaluate moles to determine whether or not they’re high risk for future development of Skin Cancer including Melanoma. Let’s take a look at key features that Dermatologists and Dermatologic Surgeons use to determine which moles promptly need to be removed for biopsy, to be tested by the Dermatopathology Lab.
The photo above shows what's called a "congenital mole," one present at birth. This one would merit close observation for color changes, in which case it would probably best be removed.
The person in the photo above would definitely benefit from regular skin cancer checks by a Board-certified Dermatologist, because he has a variety of moles with irregular colors or edges.
The mole above shows early features of Melanoma, which is a malignancy of the pigment-producing cells in the skin, the melanocytes.
The mole above has irregular shades of brown, and an irregular profile (edge), meaning that it would be best to get this lesion checked by a skincare professional: a Board-certified Dermatologist.
Well, what is a mole? A mole or nevus is a collection of pigment-producing cells in the skin: melanocytes. Melanocytes occur in the skin, protecting us from Ultraviolet Light (UV rays). The average person has between 5 and 35 moles, which generally develop between the ages of 5 and 35, though they can also be present at birth (in which case they’re called “congenital” nevi).
The lesion above has characteristic features of Melanoma: Dark color and irregular edges.
The Summer is a great time to use "Broad Spectrum Sunscreen" with an SPF of 30 or higher, and to reapply that sunscreen every 60-90 minutes when out. Why not check your family's moles, too, when you're undressed. Many spouses and partners have saved lives simply by doing a close-up inspection, and calling the alert about a changing lesion or growth.
Secondly, Nevi in and of themselves are not considered high risk. But some melanocytes after exposure to Ultraviolet Light (UV rays) from the sun or from UV rays from tanning bulbs become malignant, the first step towards a Melanoma, a big health problem in the U.S., with over 190,000 Americans being diagnosed with Melanoma this year, and over 7250 fatalities. The good news however is that if Melanoma is detected early, it is often very treatable by a minor outpatient procedure. Unfortunately, if detected late, Melanoma can compromise one’s health and well-being.
So it’s helpful to review key features of high risk lesions:
· Important tip: I’ve diagnosed a number of patients with Melanoma in the 29th years that I’ve been in practice as a Cordova Dermatologist simply by spotting one mole that is different from the person’s other moles – maybe a different hue of brown or black, or with a different shape.
The above photo shows a typical Melanoma: different Colors and Asymmetrical in profile, with irregular margins.
· High risk moles tend to exhibit one or more of the A, B, C, D, E warning signs described by Dr. Darrell Rigel of Mount Sinai University in New York City:
· A stands for Asymmetry: one half doesn’t match the other half.
· B is for Border irregularity: perhaps jagged in profile.
· C is for a Color that’s out of step with a person’s other moles, or a changing color, or maybe different hues of color, such as shades of black, gray, brown, or even red.
· D, for both Dark Mole or a a mole with an enlarging Diameter (distance across), particularly larger than the head of a number 2 pencil.
· E, for Evolving, or changing.
Freckling in an of itself is a sign of prior excessive UV rays, which are a risk factor for development of skin cancer, in an of itself.
· And what about the concept of “high risk” people for development of skin cancer? Remember that your risk of Skin Cancer is definitely higher is you have blond or red hair, or if you are Northern European-descended, or you have a history of working or playing in the sun, or a history of at least one blistering sunburn. Do remember however that many cases of Skin Cancer do arise in people with brown or black hair, or people who avoid the sun, so we’re all at risk, even darkly-pigmented African-Americans: Afro-caribbean performer Bob Marley in fact died of Melanoma in his mid-thirties.
A best first move is a consultation with a Board-certified Dermatologist for a skin cancer check, an especially high priority for people with skin lesions that could be cancerous. Check out “Understanding the Melanoma Crisis: Scarlet’s Story,’ a 2018 movie sponsored by my Dermatology practice: https://www.youtube.com/watch?v=0KSB-5pTahQ.
My own Dermatology practice is in Cordova, Tennessee, a suburb of Memphis, TN, with Rheumatology and Dermatology Associates (www.Rheumderm.com; 1-901-753-0168). Or you can find a Dermatologist closer to you by going to the American Academy of Dermatology web site, www.AAD.org. Then simply plug your zip code into the “Find a Dermatologist tab.”
Remember Benjamin Franklin’s maxim: “an ounce of prevention is worth a pound of cure.” Early detection definitely saves lives. So you really need to go on mole patrol with your family members, perhaps regularly on the first day of each month, to look for changing lesions. The rule is: “See Spot. See Spot Change. See a Dermatologist.”
George Woodbury Jr. M.D. (05/23/2022)
8143 Walnut Grove Road
Cordova TN 38018