How Can I Tell If I Have Skin Cancer
Skin cancer is actually one of the easiest cancers to find. Thats because skin cancer usually begins where you can see it.
You can get skin cancer anywhere on your skin from your scalp to the bottoms of your feet. Even if the area gets little sun, its possible for skin cancer to develop there.
You can also get skin cancer in places that may surprise you. Skin cancer can begin under a toenail or fingernail, on your genitals, inside your mouth, or on a lip.
Four Main Types Of Skin Melanoma
There are four main types of skin melanoma.
The Abcdes Of Melanoma
The first five letters of the alphabet are a guide to help you recognize the warning signs of melanoma.
A is for Asymmetry. Most melanomas are asymmetrical. If you draw a line through the middle of the lesion, the two halves dont match, so it looks different from a round to oval and symmetrical common mole.
B is for Border. Melanoma borders tend to be uneven and may have scalloped or notched edges, while common moles tend to have smoother, more even borders.
C is for Color. Multiple colors are a warning sign. While benign moles are usually a single shade of brown, a melanoma may have different shades of brown, tan or black. As it grows, the colors red, white or blue may also appear.
D is for Diameter or Dark. While its ideal to detect a melanoma when it is small, its a warning sign if a lesion is the size of a pencil eraser or larger. Some experts say it is also important to look for any lesion, no matter what size, that is darker than others. Rare, amelanotic melanomas are colorless.
E is for Evolving. Any change in size, shape, color or elevation of a spot on your skin, or any new symptom in it, such as bleeding, itching or crusting, may be a warning sign of melanoma.
If you notice these warning signs, or anything NEW, CHANGING or UNUSUAL on your skin see a dermatologist promptly.
A is for Asymmetry
D is for Diameter or Dark
E is for Evolving
E is for Evolving
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Tools That Can Help You Find Melanoma On Your Skin
To help you find melanoma early, the American Academy of Dermatology developed the following:
Melanoma can look different on a childs skin. Taking this short quiz can help you hone your skills at finding childhood melanoma.
ImagesImages 1,3,4,5,6,7,8,10: Images used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.
Image 2: Developed by the American Academy of Dermatology
Image 9: Used with permission of the Journal of the American Academy of Dermatology.
ReferencesBarnhill RL, Mihm MC, et al. Malignant melanoma. In: Nouri K, et al. Skin Cancer. McGraw Hill Medical, China, 2008: 140-167.
Gloster HM Jr, Neal K. Skin cancer in skin of color. J Am Acad Dermatol 2006 55:741-60.
National Comprehensive Cancer Network. NCCN guidelines for patients: Melanoma. 2018. Last accessed February 12, 2019.
Squamous Cell Skin Cancers
Squamous cell skin cancers can vary in how they look. They usually occur on areas of skin exposed to the sun like the scalp or ear.
Thanks to Dr Charlotte Proby for her permission and the photography.
You should see your doctor if you have:
- a spot or sore that doesn’t heal within 4 weeks
- a spot or sore that hurts, is itchy, crusty, scabs over, or bleeds for more than 4 weeks
- areas where the skin has broken down and doesn’t heal within 4 weeks, and you can’t think of a reason for this change
Your doctor can decide whether you need any tests.
Cancer and its management J Tobias and D HochhauserBlackwell, 2015
Cancer: Principles and Practice of Oncology VT De Vita, TS Lawrence and SA RosenbergWolters Kluwer, 2018
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Melanoma: The Deadliest Skin Cancer
Melanoma is the most serious type of skin cancer, because it tends to spread if its not treated early.
This cancer starts in the melanocytes cells in the epidermis that make pigment.
About 100,350 new melanomas are diagnosed each year.
Risk factors for melanoma include:
- Having fair skin, light eyes, freckles, or red or blond hair
- Having a history of blistering sunburns
- Being exposed to sunlight or tanning beds
- Living closer to the equator or at a higher elevation
- Having a family history of melanoma
- Having many moles or unusual-looking moles
- Having a weakened immune system
Melanoma can develop within a mole that you already have, or it can pop up as a new dark spot on your skin.
This cancer can form anywhere on your body, but it most often affects areas that have had sun exposure, such as the back, legs, arms, and face. Melanomas can also develop on the soles of your feet, palms of your hands, or fingernail beds.
Signs to watch out for include:
- A mole that changes in color, size, or how it feels
- A mole that bleeds
Where Do Skin Cancers Start
Most skin cancers start in the top layer of skin, called the epidermis. There are 3 main types of cells in this layer:
- Squamous cells: These are flat cells in the upper part of the epidermis, which are constantly shed as new ones form. When these cells grow out of control, they can develop into squamous cell skin cancer .
- Basal cells: These cells are in the lower part of the epidermis, called the basal cell layer. These cells constantly divide to form new cells to replace the squamous cells that wear off the skins surface. As these cells move up in the epidermis, they get flatter, eventually becoming squamous cells. Skin cancers that start in the basal cell layer are called basal cell skin cancers or basal cell carcinomas.
- Melanocytes: These cells make the brown pigment called melanin, which gives the skin its tan or brown color. Melanin acts as the bodys natural sunscreen, protecting the deeper layers of the skin from some of the harmful effects of the sun. Melanoma skin cancer starts in these cells.
The epidermis is separated from the deeper layers of skin by the basement membrane. When a skin cancer becomes more advanced, it generally grows through this barrier and into the deeper layers.
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Should I See My Doctor
Go and see your GP if:
- you have any of the ABCDE signs
- a mole is itching or painful
- a mole is bleeding or becoming crusty
- a mole looks inflamed
- you have an unusual mark or lump on your skin that lasts for a few weeks
- you have a dark area or line under a nail that is not due to an injury
The earlier a melanoma is picked up, the easier it is to treat and the more likely treatment is to be successful. So go to your GP as soon as possible.
Causes Of Nail Fungus
With fungal nail infections, the main cause is typically
Certain behaviors and preexisting conditions that can affect your risk of nail fungus include:
- old age
There are many overlaps between nail fungus and nail cancer. Since its easy to mistake cancer of the nail for a fungal infection, you should see a doctor immediately to get a definitive diagnosis.
See a doctor immediately if you suspect you have toenail fungus or subungual melanoma.
Since the prognosis of subungual melanoma gets worse the longer it takes to diagnose, its better to be safe and get any possible symptoms checked out and cleared as soon as they appear.
Fungal infections are not considered life-threatening, but the 5-year survival rate for subungual melanoma can vary dramatically depending on how early the cancer is identified. According to the Canada Dermatology Association, chances of recovery can range anywhere from 16 to 80 percent .
If you wait too long for diagnosis and treatment, theres a risk of the cancer spreading throughout the bodys organs and lymph nodes.
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How Are Moles Evaluated
If you find a mole or spot that has any ABCDE’s of melanoma — or one that’s tender, itching, oozing, scaly, doesn’t heal or has redness or swelling beyond the mole — see a doctor. Your doctor may want to remove a tissue sample from the mole and biopsy it. If found to be cancerous, the entire mole and a rim of normal skin around it will be removed and the wound stitched closed. Additional treatment may be needed.
Looking For Signs Of Skin Cancer
Non melanoma skin cancers tend to develop most often on skin that’s exposed to the sun.
To spot skin cancers early it helps to know how your skin normally looks. That way, you’ll notice any changes more easily.
To look at areas you cant see easily, you could try using a hand held mirror and reflect your skin onto another mirror. Or you could get your partner or a friend to look. This is very important if you’re regularly outside in the sun for work or leisure.
You can take a photo of anything that doesn’t look quite right. If you can it’s a good idea to put a ruler or tape measure next to the abnormal area when you take the photo. This gives you a more accurate idea about its size and can help you tell if it’s changing. You can then show these pictures to your doctor.
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Amelanotic Melanoma: It Doesnt Look Like Other Melanomas
Odds are, if you have spent time on SkinCancer.org, you know the classic ABCDE warning signs of melanoma: Asymmetry, Border irregularity, Color variations, Diameter over ¼ inch or Dark in color, and Evolution or change. But did you know that some melanomas have very different features?
For example, certain melanomas may have no color at all. Physicians refer to these as amelanotic melanomas, because they are conspicuously missing melanin, the dark pigment that gives most moles and melanomas their color. These unpigmented melanomas may be pinkish-looking, reddish, purple, normal skin color or essentially clear and colorless.
- An example of a flat, amelanotic, superficial spreading melanoma on the leg.
- A nodular melanoma developing within an amelanotic melanoma in situ on the scalp.
While these melanomas lack pigment, they may have other melanoma warning signs to stay on the lookout for, such as asymmetry and an irregular border. In addition, more and more physicians today stress the importance of the E in the ABCDEs evolution or change. The Skin Cancer Foundation recommends that you examine your skin head to toe every month, especially looking for any new mole or any sign of change in an existing mole. If you spot any change that you consider suspicious, see a skin specialist without delay.
To help you spot unusual melanomas, you can also use early recognition strategies beyond the ABCDEs, such as the Ugly Duckling sign.
What Are The Signs And Symptoms Of Melanoma
Melanoma is a skin cancer that can show up on the skin in many ways. It can look like a:
Spot that looks like a new mole, freckle, or age spot, but it looks different from the others on your skin
Spot that has a jagged border, more than one color, and is growing
Dome-shaped growth that feels firm and may look like a sore, which may bleed
Dark-brown or black vertical line beneath a fingernail or toenail
Band of darker skin around a fingernail or toenail
Slowly growing patch of thick skin that looks like a scar
This early melanoma could be mistaken for a mole, so its important to look carefully at the spots on your skin.
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The Ugly Duckling Method
The ugly duckling method works on the premise that a personâs moles tend to resemble one another. If one mole stands out in any way, it may indicate skin cancer.
Of course, not all moles and growths are cancerous. However, if a person notices any of the above characteristics, they should speak with a doctor.
Types Of Skin Cancer:
Basal Cell found mainly in areas exposed to the sun, very common and usually very treatable. Detected at an early stage and removed promptly are almost always curable and cause minimal damage.Squamous Cell typically develops in chronic sun-exposed areas of your body.Melanoma more likely to grow and spread than the more common typesMerkel Cell very rare and tends to grow quickly, may be hard to treat if it spreads past beyond the skin
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Prevention And Early Detection
The exact cause of subungual melanoma is unknown, meaning that patients cannot take specific steps to prevent this condition. However, because it may be associated with trauma to the hands and feet, you may want to keep yours hands and feet protected.2 For example, you can protect your hands and feet by wearing gloves during heavy labor, or wearing protective gear and sturdy shoes during sports.
Early detection is crucial to the treatment of subungual melanoma, so be sure to tell your doctor about any changes to your nails.1 You can regularly check your nails, fingers, and toes for any bruising, streaking, or changes.3
Sores That Dont Heal In Hidden Areas
Mucosal melanoma can appear as sores that dont heal in your mouth or nasal passages, or in other areas of the body that produce mucus, such as the vagina and anus. If you notice any of these melanoma symptoms in these areas that dont heal and cannot be explained by other causes, visit your doctor as soon as possible.
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What Age Spots Look Like
Age spots occur as the skin ages and thins. As the outer layers of the skin become thinner, the melanin in the skin comes to the surface more easily, resulting in spots. The more sun exposure the skin has, the more melanin will be produced, causing more age spots. This is why many people have age spots on the backs of their hands. Since the skin on the backs of the hands is thin anyway, plus these areas are not usually covered by clothing or sunscreen, this skin is more likely to see spots. Age spots are flat on the skin and can vary in coloring from light brown to dark brown. The spots can be a variety of shapes, but often look like freckles or simply areas of discoloration. Age spots are harmless, but they can be treated with skin lightening agents if a patient desires.
Look Out For An Ugly Duckling
The Ugly Duckling is another warning sign of melanoma. This recognition strategy is based on the concept that most normal moles on your body resemble one another, while melanomas stand out like ugly ducklings in comparison. This highlights the importance of not just checking for irregularities, but also comparing any suspicious spot to surrounding moles to determine whether it looks different from its neighbors. These ugly duckling lesions or outlier lesions can be larger, smaller, lighter or darker, compared to surrounding moles. Also, isolated lesions without any surrounding moles for comparison are considered ugly ducklings.
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How Common Is Melanoma
Melanoma accounts for only about 1% of all skin cancers, but causes the great majority of skin cancer-related deaths. Its one of the most common cancers in young people under 30, especially in young women.
Melanoma incidence has dramatically increased over the past 30 years. Its widely accepted that increasing levels of ultraviolet exposure are one of the main reasons for this rapid rise in the number of melanoma cases.
Less Common Skin Cancers
Uncommon types of skin cancer include Kaposi’s sarcoma, mainly seen in people with weakened immune systems sebaceous gland carcinoma, an aggressive cancer originating in the oil glands in the skin and Merkel cell carcinoma, which is usually found on sun-exposed areas on the head, neck, arms, and legs but often spreads to other parts of the body.
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Some Melanomas Are Flesh Or Pink In Color Not Always An Ugly Black Or Scary Brown
So how can we spot a pinkish-beige melanoma during self-exams of the skin?
An amelanotic melanoma can appear pink or flesh colored and is very difficult to diagnose on clinical grounds alone, says Adarsh Vijay Mudgil, MD, double board certified in dermatology and dermatopathology, and founder of Mudgil Dermatology in NY.
In a high-risk individual, strong genetic history of melanoma and lots of sun damage, biopsying any new, flesh or pink colored bump is generally good practice.
University of North Carolina Lineberger Comprehensive Cancer Center scientists wanted to find out just how to spot an amelanotic melanoma.
A melanoma thats described as being flesh colored or the same tone as ones skin is called an amelanotic melanoma because the a means the opposite of, and melanotic refers to pigment.
Due to the relative invisibility of amelanotic melanomas, they are more often diagnosed at advanced stages when compared to tumors in a brown or dark range of hues.
This means that this particular melanoma is associated with poorer survival rates.