Spot the difference: Early warning signs of sun damage
Yes, you need to look for changes in your moles but change is also about noticing when new spots pop up and whether that spot is a mole or not. Dermatologist Dr Karen Ordemann answers some frequently-asked questions.
According to Dr Ordemann, a mole in itself is not necessarily a problem: “We look for changes,” she says, explaining that patients are asked to look for what she refers to as the ‘ugly duckling’ sign – a mole that looks different.
A study published in the Acta Dermato Venereologica journal in February 2018 shows that roughly 25% of melanomas start in a previously normal mole but new darker spots are also worrisome. According to the same study, 75% of melanomas start this way. “When you’re over 40, if you see new spots, they’re likely to be seborrhoeic keratoses or age warts, but it can be difficult to tell the difference,” says Dr Ordemann, who emphasises that if you see a spot, specifically a darker spot, that looks different from the rest, you must get it checked.
“Melanomas are deadly and our aim is to find them in situ, which means as soon as they start,” says Dr Ordemann. If you remove a melanoma of one millimetre in depth, which is a relatively early melanoma, you have a higher than 90% survival rate, according to the National Comprehensive Cancer Network Guidelines on melanoma published in July 2018.
“If we see patients once a year, in most cases any problematic moles will be less than a millimetre, which is why we usually stick to the recommendation of an annual checkup. If the mole reaches two millimetres, the survival rate goes down dramatically. So you really want to get it very, very early,” she adds.
“If you’re worried about a mole, we want to see you. People always say, ‘Oh I’m so sorry, I came for nothing.’ It’s not for nothing; it’s what we do.”
What’s the point of mole-mapping?
Dr Ordemann: We take enlarged, close-up pictures of the patient’s moles, then the next time we see them, we take another picture. The software we use compares the two pictures of the same mole so we can clearly see if there are changes. In at-risk patients, we may also take pictures of areas of skin so we can see if a spot is new.
Are there other signs of skin damage that need attention, besides changes in moles or new moles?
Dr Ordemann: There are other types of skin cancer. Basal cell carcinomas are the most common. They can start as a little bump that scabs over and bleeds from time to time, often in sun-exposed areas. They’re not usually an issue – you just remove them – but when they’re on the face, nose, or eyelid, cutting them out can be cosmetically tricky.
Another sign of sun damage that can lead to cancer is solar (or actinic) keratoses, which are little rough patches that start on areas of the skin that are most exposed to the sun – generally the face or hands. Initially, you scratch at it and it comes off, so you think there’s nothing, but the scab or rough spot returns. These can lead to squamous cell carcinoma. We need to remove those too as they are pre-cancerous lesions.
But if you come for annual check-ups these types of skin cancer shouldn’t be a serious problem as your dermatologist will catch them early on.
Is there a ray of hope in beating melanoma?
Dr Ordemann: We’ve made great strides in understanding melanoma in the past five years – there are lots of new studies, and lots of new drugs are being tested – but we’re not there yet. As the saying goes, prevention is better than cure.