Detecting Melanoma Incognito,&Boosting TN Graduate Medical Education
Melanoma is a type of Skin Cancer taking over 9700 American lives in 2020. That’s one person about every 55 minutes. And early detection can save most of these people’s lives.
Dermatologists like myself have long known that many American lives are saved from Melanoma by a concerned family member who inspects loved ones, detecting a changing growth or mole and getting the patient to prompt medical attention. Let look at tips on Melanoma Incognito, meaning Melanoma that might otherwise be hidden or easily missed.
By the term “Melanoma Incognito,” I mean Melanoma that’s in an area of the body generally shielded from the sun, such as hidden in the scalp or groin, or back, or melanoma that's more subtle in appearance. If you want to do a complete Skin Cancer inspection, get everyone in your family completely undressed, naked, then look over their whole bodies. If you find a suspicious lesion, get to medical attention pronto!
Years ago, we Dermatologists taught patients that certain people were at “high risk” of skin cancer: redheads, blonds, those who freckle easily, or those who love the sun or who have a history of severe sunburns. “Low risk” people were those who routinely wear sunscreen, avoid the sun and tanning salon bulbs, or who tan easily. But we now realize that really everyone’s at risk of skin cancer. In fact, African-Americans tend to have skin cancer diagnosed much later, leading to a higher fatality rate!
And don’t forget to inspect your kids. Data shows that several thousand people under the age of 20 develop Melanoma in the U.S. each year, including several hundred below the age of 12.
So what do you watch for? What features of a growth or mole cause higher concern?
Look for what we call the A, B, C, D, E warning signs:
A stands for Asymmetry: one half of the lesion does not match the other half.
B stands for Border: a jagged border, perhaps like the coast of Maine, rather than of Florida.
C stands for Color change: different hues of brown or black within the lesion, or one mole that’s a darker color than the person’s other moles.
D stands for an increasing Diameter of the lesion
E stands for Evolving: if the lesion is changing, it’s best to bring it to the attention of a Dermatologist.
The Melanoma (Skin Cancer) in the image above has different hues or Colors within it, and an irregular Border, two of the warning signs of Melanoma.
We know what action to take for suspicious moles or growths: if caught early, generally a simple removal, or “excision” of the lesion under local anesthetic is curative. If the lesion turns out to be a precancerous lesion – such as a high-risk atypical mole – or a full-fledged skin cancer, we often try to ensure that the lesion is completely out.
My own practice these last 28 years is in Cordova, TN (1-901-753-0168; wwwRheumderm.com). You can find a Dermatologist close to you by going to the American Academy of Dermatology web site, AAD.org, then simply plugging your zip code into the “Find a Dermatologist” tab.
For more helpful tips and photos of melanoma, go to the Skin Cancer Foundation website: skincancer.org.
So see spot. See spot change. See a Dermatologist!
George Woodbury Jr. M.D.
8143 Walnut Grove Road
Cordova TN 38018
President of Big River Silk Skincare Inc. (www.Bigriversilkskincare.com).
Supporting Tennessee Graduate Medical Education Funding:
Tennessee currently has about 2700 doctors who have graduated from medical school or osteopathic school who wish to pursue advanced training in particular areas of medicine. These doctors are doing what are called internships, residencies, or fellowships, and they may go into Family Practice, Pediatrics, Internal Medicine, Surgery, or even Dermatology or Rheumatology.
A large part of the funding for training these doctors of tomorrow comes from the State of Tennessee’s Medicaid budget, which is called the Tenncare Budget. But this funding had been flat since December of 1997, until January of 2019, when Governor Bill Lee proposed an $8.6 million boost in such funding, which was approved by the Tennessee Legislature in the spring of 2019. This boost will hopefully pay in upcoming years for about a 4% increase in the number of doctors pursuing internship, residency, and fellowship in Tennessee.
Stay tuned on this issue – because it would be most helpful for Governor Bill Lee to consider boosting this funding further – because the Tennessee population actually grew from about 5 million to over 6 million – meaning that funding for training of new doctors should grow to match that population growth – so the conversation with our Tennessee legislators continues.
A worrisome development on this issue was a decision made in July of 2020 by administrators at the Centers for Medicaid and Medicare Services (CMS), in Washington, D.C, that they would completely halt funding training of these Tennessee doctors effective July 1st, 2021, because they only fund 'direct patient care,' not training. But Graduate Medical Education by its very nature IS direct patient care. I am part of a team of physicians across our state articulating to CMS the essential need to preserve this funding for patients of both today and tomorrow.
So stay tuned on this issue!
George Woodbury Jr. M.D. (08/29/2019)