Suspicious Spots And Moles: How To Check For Skin Cancer

Dermatology Clinic, Skin Cancer Treatment

As the largest organ of the body, the skin is made of a variety of cells. At the epidermis, there are a number of cell populations such as Langerhans cells and melanocytes, where they are constantly in unsynchronised motion¹. But when these cells become damaged, they may develop into skin cancer.

Risk factors for skin cancer

Skin cancer can develop anywhere on your skin, primarily on sun-exposed areas like the scalp, face, arms, hands and on the legs. But it can also form in areas that barely get any sun, such as the spaces between your toes, beneath your nails, and your genital area.

Anyone can get skin cancer, but there are certain factors that put some individuals at a higher risk. These include people who have characteristics such as:

Light-coloured skin that freckles or burns easily
Green or blue eyes
Naturally blonde or red hair
A family or personal history of skin cancer
A large number of moles (i.e. more than 50)

Most basal cell and squamous cell skin cancers are caused by frequent and unprotected exposure to the sun’s ultraviolet (UV) rays, as well as tanning beds. While the risk of skin cancer increases as people get older, younger individuals can still get them if they spend a lot of time in the sun with their skin exposed.

Check your skin regularly

It is good practice to do a visual exam of your skin at home. In a well-lit room, look at your skin in front of a full-length mirror. Use a hand-held mirror to get a close-up look. Check everywhere from the spaces between your toes to the scalp – you can get someone to help you examine hard-to-see areas.

What to look for in melanomas:

Refer to the “ABCDE rule” to identify some of the common signs of melanoma, a serious type of skin cancer that can be dangerous and deadly.

Asymmetry: The mole shape does not match the other half.

Border: The mole has an irregular or ragged border.

Colour: Uneven and differing shades of brown, tan or black. Other colours like blue, red and white may also appear.

Diameter: The lesion grows in size to bigger than a pea or a pencil eraser (about 6mm).

Evolving: There are changes in shape, colour, size or elevation. There may be new symptoms present such as itching, bleeding and crusting.

What to look for in Basal cell carcinomas:

Appears non-pigmented in fair skin types and pigmented in Asians.
A scar-like area that is waxy, flat white or yellow in colour with poorly defined borders.
Reddish patches that may hurt, itch, or cause no discomfort.
An open sore that persists and comes back. It does not heal and may be bleeding, oozing or crusting.
Pink growths that are slightly raised with a crusted indentation in the center that may have tiny surface blood vessels spreading out.
Shiny or pearly bumps that are pink, red or white. In darker skin tones, they can appear as black, brown or tan which are easily mistaken for a normal mole.

What to look for in Squamous cell carcinomas:

Raised growths or lumps with a lower area in the center.
Scaly red patches that may crust or bleed.
Open sores that won’t heal or heals and returns.

Skin cancer appears on the body in many different ways, so you should also look for other indicators and point them out to your skin dermatologist. These include:

Any spot that differs from the others
Redness or swelling beyond the border of the mole
Any sore that doesn’t heal or returns after healing
Changes in the appearance including oozing, bleeding and scaliness
Dome-shaped growth

Skin cancer screening

Going for a skin cancer screening can help to detect cancer in its early stages, which makes it easier to treat. If you notice a suspicious-looking spot or encounter a symptom that concerns you, see a doctor who is specialised in skin cancer treatments.

Your health provider will conduct a thorough examination from head to toe. A special magnifying glass may be used to examine certain marks on your skin. Take note to remove nail polish from your fingers so the nails and nail beds can be properly examined. Wear your hair loose so the doctor can check your scalp, and remove your makeup before the exam so your bare skin can be looked at.

If skin cancer is suspected, a skin biopsy will be carried out to confirm the diagnosis and determine the type of cancer. This procedure involves removing a small sample of skin to be checked under a microscope for cancer cells.

Treatment options

Your treatment options for skin cancer depend on the histological subtype, size, location, and patient preference. Here are several common treatment options you might come across:

Mohs micrographic surgery: This procedure is suitable for recurring, large, or difficult-to-treat skin cancers, including basal and squamous cell carcinomas. During Mohs surgery, the doctor removes the skin growth layer by layer and examines them under the microscope. It is beneficial in areas where it is necessary to conserve as much skin as possible, such as the face and nose.

Cryotherapy: Liquid nitrogen is sprayed onto the lesion to freeze and destroy cancer cells. Once it thaws, the dead tissue will slough off. It is effective for small benign lesions such as actinic keratosis, a pre-cancerous skin condition that can develop into squamous cell carcinoma if left untreated. Skin cancer that only affects the top layer of the skin can also be removed with cryotherapy.

Topical chemotherapy: Topical therapies such as 5-fluorouracil cream, imiquimod or ingenol mebutate gel can be used for superficial skin cancers or pre-cancerous conditions. The medicine is applied on the skin and kills tumour cells, but it can’t reach cancer cells that occur deeper in the skin.

Photodynamic therapy: This two-stage treatment combines light energy with photosensitisers agents (drugs that are administered into the body). Photosensitisers are activated by a specific wavelength of light energy to create a photochemical reaction that kills cancer cells.

Excisional surgery: Malignant moles, lesions and tumors are surgically removed from the skin using a scalpel and local anaesthesia, including a margin of healthy tissue around the tumour. The remaining skin is then carefully stitched back together.

Keep an eye on your skin

Skin cancer screenings can help to catch melanoma and other skin cancers early and make treatment much easier. Get in the habit of checking your skin to notice changes. Report any unusual moles or concerning changes in your skin to your dermatologist and discuss if you are at increased risk of skin cancer.

Dr Angeline Yong is a dermatological surgeon and dermatologist in Singapore with subspecialty interests in skin cancers and Mohs Micrographic Surgery. As Dr Yong is fellowship-trained in the medical and surgical management of skin cancers, she is able to deliver holistic and comprehensive care for patients who have newly diagnosed skin cancers as well as those who are at risk of developing recurring skin cancers with long-term treatment plans.

If you notice any suspicious growths or changes on your skin, contact our dermatology clinic to discuss your concerns.

Reference:
1. Kolarsick, P.A., Kolarsick, M.A., & Goodwin, C. (2011). Anatomy and Physiology of the Skin. Journal of the Dermatology Nurses’ Association, 3, 203-213.

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Suspicious Spots And Moles: How To Check For Skin Cancer