The brown pigmented lesions called “moles” have been a fact of life for many individuals through history, but the rapid increase in melanoma rates have changed the importance of proper evaluation and treatment of them. In the latter part of the 20th century melanoma rates tripled among men, becoming the fifth most common malignancy in that group, and doubled among women, becoming their seventh most common malignancy. The goods news is that this trend has been noted to be slowing with decreased sun exposure of the type likely to cause melanoma, and that survival rates have been steadily improving due to earlier diagnosis.
Melanomas, when they occur, can grow from a pre-existing pigmented brown spot, (this happens about 1/3 of the time), or as a new lesion. After the age of 40, any new raised brown lesion is suspicious. As there are many pigmented lesions that are not melanoma, Education regarding which lesions may need monitoring or treatment is important.
The “ABCDE” rule is a guideline for evaluation:
A = Assymmetry
B = Border irregularity
C = Color Variegation ( Multi-color)
D = Diameter greater than 6mm
E = Elevation
Sharing many of these features is a mole called “atypical mole”, and as 5-10% of the population have these, they are of concern to many. Patients with 5 or more atypical moles have a six times higher incidence of developing melanoma than patients without them. In addition, there is a “Familial Atypical Mole and Melanoma Syndrome”, in which patients have more than 50 atypical moles, 2 or more family members with melanoma, and an attendant increased risk for melanoma.
So, if you, or your children, have a brown pigmented lesion that has any of the “ABCDE” characteristics, what should you do?
1-Have a physician who is skilled at evaluation look at your lesion(s) yearly, this clinician may use a “dermoscope”, which is a lighted magnifier, to take a good look at it.
2-Total body photography is used to document changes in lesions and detect new ones. This is especially useful for patients with many lesions to monitor.
3-AVOID SUN EXPOSURE, use sunscreen, (re-apply every 2-3 hours!), hats, and there is a “RIT” SPF rinse that can increase the sun protection of their clothing. For all adults responsible for children, note that 80% of lifetime sun exposure occurs before the age of 18!
4- Self Examination to note any CHANGES in your skin lesions – refer to the “ABCDE” rule above as “what to look for”, and go back to your clinician if you detect changes…and don’t forget to have someone “watch your back”!
If you do have a “suspicious” lesion that requires removal for diagnosis, remember that melanoma, if it is removed before invading the deeper layers of the skin is 100% curable, so do not delay if you or your family members need evaluation.