Moles are common benign growths of the cell that makes pigment in the skin, the melanocyte. Most people have moles, and some have more then others. Moles can be flat or raised. They can vary in color from pink, to tan, brown, and sometimes black. The vast majority of moles are benign, but sometimes moles are abnormal and rarely they can be cancerous (see Skin Cancer below). Moles can change slowly over time, but when a mole is changing quickly this can be cause for concern. It’s important to have a baseline skin exam, even if you think your moles are normal. Any changing mole should be evaluated by a dermatologist.
Skin cancer refers to any cancerous growth occurring on the skin. The three most common types of skin cancer are basal cell carcinoma, squamous cell carcinoma, and melanoma.
Basal cell carcinoma in the most common type of skin cancer. It typically appears on sun exposed areas in people with fair skin and a history of extensive sun exposure. BCCs are most common in the older population but can affect younger patients as well. They initially present as non-healing red or pink bumps or scaly patches. They do not tend to be painful, but they can bleed. Slowly, over time, they enlarge and can invade deeper levels of the skin and can even invade to muscle and bone if left untreated. A tiny percentage of untreated BCCs will metastasize.
Squamous cell carcinoma is the second most common type of skin cancer. The most commonly affected sites include the scalp, ears, face, and hands. It typically affects people with fair skin and a history of extensive sun exposure. Other risk factors for SCC are older age, history of smoking, and immunosuppression. SCCs present as red or pink bumps. In contrast to BCCs they tend to be more painful and grow more quickly. When treated early, they are highly curable. If left untreated, they are more likely to spread beyond the skin.
Melanoma, also called malignant melanoma, is the most serious type of skin cancer. It is a cancer of the cell that produces pigment in the skin, the melanocyte. Melanomas can develop from existing moles or freckles, and they can develop on previously normal skin. Melanoma typically affects fair skinned people on sun exposed areas, but it can occur anywhere on the body, including on the palms and soles, and on mucous membranes. Warning signs for melanoma include the ABCDEs – asymmetry, border irregularity, color variation, diameter > 6mm, evolving size, shape, color. If caught early, melanoma is highly treatable. If left untreated, melanoma in the most likely to spread beyond the skin.
After a biopsy is done to confirm the diagnosis, a treatment plan will be discussed. There are many options for treatment of skin cancer. These options are determined based on the type of skin cancer, size, and location on the body.
Basal and squamous cell carcinomas contained in the top layer of skin (squamous cell carcinoma in situ and superficial basal cell carcinoma) can be treated with a chemotherapeutic cream or a procedure called electrodessication and curettage (“scraping and burning”).
Small BCCs and SCCs on the trunk and extremities can be treated by excision. In skin cancer excision, a standard margin of normal skin is taken around the skin cancer and the wound is closed. The skin that was removed is sent to the lab to confirm that the entire skin cancer has been removed.
BCCs and SCCs on the head, neck, and other specific areas of the body are best treated with Mohs micrographic surgery. Learn more about Mohs surgery.
Melanomas are treated with surgical excision. For early stage melanoma, this is the only treatment needed. If the melanoma has invaded deeper layers of skin, your dermatologist may refer you to a doctor who specializes in cancer treatment (an oncologist). The oncologist may recommend further workup to determine if the melanoma has spread beyond the skin.
As a general rule, any growth on your skin that is new or changing should be evaluated by your dermatologist as soon as possible. Other signs of skin cancer include a new bump or sore that does not heal, a tender bump, and anything on the skin that bleeds without being scratched or picked at.
We use the ABCDE acronym to determine if a mole is concerning.
A- Asymmetry: a mole that is different from one side to the other
B- Border: irregular edges that are uneven or notched
C- Color: difference in color throughout the mole
D- Diameter: moles that are bigger then a pencil eraser
E- Evolution: any mole changing in size, shape, or color
While there are no set recommendations on how often you need to visit the dermatologist, it’s important to get a baseline skin exam as recommended by your doctor. Your dermatologist will then make an individualized plan for how often you need to return. We do recommend regular self skin exams every 1-3 months to monitor for new or changing lesions. If you do notice a new or changing skin growth, it’s imperative to return to the dermatologist as soon as possible for evaluation.
We understand that one of the best things about living in Colorado is enjoying the outdoors! To prevent unwanted harmful effects of UV exposure we recommend:
At your full body skin check, your doctor will look over you skin from head to toe. You will be asked undress down to your underwear. It is preferable to remove your bra. Please be prepared to remove your makeup. If you have any nail concerns, take off nail polish prior to your visit. We will also look through your scalp, so please avoid tight hairstyles and excess hair product.
It is possible for people of any age and ethnicity to get skin cancer. With that being said, skin cancer is far more common as you age and in those with fair skin, red or blonde hair, and blue eyes. Unfortunately, we are seeing more and more skin cancer in younger age groups – as young as those in their 20s and 30s. Skin cancer is exceedingly rare before puberty.