Moles and skin cancer
How do you tell a normal mole from a dangerous one?
If you are concerned about the appearance of a mole, don’t put off seeing your dermatologist, as some moles can promote a form of skin cancer called melanoma. It develops when melanocytes (cells in the skin that produce pigment) multiply uncontrollably and invade other tissues. It can appear spontaneously as a new skin pigment spot (such as moles) or grow into an existing mark.
There is a system called ABCDE that can be helpful in distinguishing between a normal mole and one that might be a melanoma:
- Asymmetry : one half of the mole is not the same as the other half;
- Edges : irregular edges;
- Colour : pigmentation is varied and uneven and may contain shades of pigment – brown, black, pink, and sometimes areas of red, white or blue;
- Diameter : melanomas are usually larger than 6 mm in diameter when diagnosed, but can sometimes be smaller. If you notice a mole that is different from others or a mole that changes or itches or bleeds, even if it is smaller than 6 mm, consult your doctor;
- Evolution : change in the characteristics of a mole, such as size, appearance or sensitivity to touch.
How does the dermatological consultation go?
As a rule, the doctor confirms the diagnosis of melanoma by taking a biopsy of the skin lesion, and after all the tests have been done, the therapeutic options will be decided. The choice of treatment depends on the stage of the melanoma (has the cancer invaded only into the skin layers or has it spread to the lymph nodes or other organs or tissues), the existence of bleeding and ulceration in the lesion, the location and size of the tumour and the general health of the affected person.
Stage is determined by measuring how deep the melanoma has penetrated into the layers of the skin (Breslow scale), whether it is ulcerated (cracks or bleeding) and whether/how far it has metastasised (spread to lymph nodes or other organs). Correct and accurate staging of the disease is important because the treatment and prognosis of the disease varies depending on the stage of the disease at diagnosis:
In-situ melanoma
Melanoma is present in the upper layers of the skin;
Stage I A/B: the tumour is progressively thicker, is confirmed in the upper layers of the skin and has not metastasised;
Stage II A/B/C : Tumor has invaded deeper layers of the skin but has not metastasized;
Stage III A/B/C: Tumour can be of any thickness, has metastasised to regional lymph nodes. Patients with deep primary melanoma (Stage II B/C) or those with melanoma metastatic to loco-regional nodes (Stage III) are considered at increased risk of recurrence;
Stage IV: The tumor can be of any thickness, has metastasized beyond the regional lymph nodes to other tissues or organs, most commonly the lung, liver or brain.
To remember! Patients who have developed one melanoma are at risk of developing another subsequent melanoma, while other patients may develop metastases of the original melanoma. For this reason, all patients with melanoma require regular follow-up, the interval being determined by the stage of the disease, medical history and additional risk factors.
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