CBS Early Show: The ABC (D And E) Of Skin Cancer

[Editor-in-Chief]

The ABC (D And E) Of Skin Cancer
NEW YORK, Dec. 8, 2004


The sun can have serious consequences all year round when it comes to skin damage. The Early Show medical correspondent Dr. Emily Senay has the ABCs of skin cancer detection and prevention.

Ultraviolet radiation from the sun raises the risk of skin cancer later in life. The type of skin cancer that we worry about most is malignant melanoma, which can spread inside the body and kill you. Other kinds of skin cancer like basal cell cancer are much less dangerous than melanoma. The good news is that skin cancer is a visible cancer, and when melanoma is detected early and treated, it's very curable.

Risk factors include: a family history of skin cancer, people who have lots of moles on their bodies, and people who have had sunburns and sun exposure over their lifetime. People who have fair skin are at higher risk than those with darker skin pigmentation.

Warning Signs
Everyone should be on the lookout for what we call the ABCs of skin cancer detection.

A is for "asymmetry" - When you're looking at moles, you want to tell your doctor or dermatologist about moles that are asymmetric, or unevenly shaped and not the same size on all sides.

B is for "border irregularity" - Moles are suspicious if they have an irregular shape or fade into the background.

C is for "color" - You should check for moles that are more than one color. An even dark brown is considered normal. But moles that have multiple colors in them or black, red, white or pink moles are more worrisome.

D is for "diameter" - Moles greater than six millimeters, which is about the size of a pencil eraser, should be examined.

E is for "evolving" - Some experts are now adding a letter to the ABCs, which is an E for "evolving." Any changes you notice over time in a mole or a skin lesion with respect to size, color and shape should be evaluated promptly by your dermatologist. If a mole is changing color or shape or it's smaller than a pencil eraser diameter and getting bigger, it should be examined by a dermatologist. Other changes in moles like inflammation, pain, crusting or bleeding should also be examined, but not all changes in moles mean it's malignant melanoma.

The best way to prevent skin cancer is to stay out of the sun. If you do expose your skin to the sun, you need to wear sunscreen of SPF (sun protection factor) of 15 or higher.

Sunscreen is the most important and the simplest way to protect yourself. But it's important to remember that SPF is not complete protection. SPF refers to the amount of extra time you can spend in the sun without burning, so an SPF of 15 theoretically means you can spend 15 times longer in the sun than normal.

Sun exposure is cumulative, so to make sure the protection is constant, apply it on a daily regular basis whether or not you're outside all the time.


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[Editor-in-Chief]

Health
Addition Urged for Melanoma Memory Device
By Steven Reinberg
HealthDay Reporter

TUESDAY, Dec. 7 (HealthDayNews) -- An alphabetical mnemonic that dermatologists give to their patients to help identify melanoma, the most virulent form of skin cancer, needs a simple addition, researchers say.

When melanoma is caught and treated early, the survival rate can be as high as 96 percent. So it pays to look at the moles on your skin closely for any signs of cancer. One simple way of knowing when moles may be cancerous is the ABCD system, which has been used since 1985.

In the system, "A" stands for asymmetry, where one half of a mole doesn't match the other half. "B" is for border irregularity, where the edges are ragged, notched or blurred. "C" is for color that is a nonuniform mixture of brown, black, red, white or blue. And "D" is for diameter, especially when the mole is bigger than 6 millimeters, about the size of a pencil eraser.

Now researchers are recommending that "E," for evolving, be added to the list. An evolving mole is one that is changing in size, shape, and symptoms -- such as itching or tenderness, surface bleeding, or shades of color, according to their report in the Dec. 8 issue of the Journal of the American Medical Association.

There will be more than 50,000 new cases of melanoma diagnosed in the United States each year, according to the American Cancer Society, and more than 7,000 will die from the disease.

"This ABCD acronym has been in place for almost 20 years," said lead researcher Dr. David Polsky, an assistant professor of dermatology at New York University Medical School. "We decided to review the medical literature on the utility of the ABCD acronym."

After the review, Polsky and his team are recommending that E for evolving be added to the ABCD acronym. "This recognizes the changing nature of melanomas," he said. "We want to recognize that more, because we think that this is a very critical element of melanomas. We want the public to pay more attention to changing moles."

One type of melanoma, called nodular melanoma, represents about 15 percent of this form of cancer, Polsky explained. "Nodular melanomas don't have the ABC characteristics, but they tend to grow rapidly," he added.

By adding "E" to the acronym, Polsky hopes these melanomas can be diagnosed earlier. "Oftentimes because they don't have the ABC characteristics, they're diagnosed at a more advanced stage. Since nodular melanoma is an aggressive form of cancer, we wanted to emphasize the changing nature of melanoma in general, and hope that this would capture nodular melanomas earlier," Polsky explained.

"People should be examining their skin periodically," Polsky said. "Lesions that are changing should be brought to the attention of their doctor."

"The authors have previously made a tremendous contribution to melanoma awareness and earlier diagnosis with their ABCD criteria," said Dr. Jeffrey Salomon, an assistant clinical professor of plastic surgery at Yale University School of Medicine. "Make no mistake about it, that contribution has translated into countless lives saved."

However, Salomon cautions that the epidemic of melanoma continues and doctors and their patients must be on the lookout for this deadly cancer. "The addition of E is another critical stone in the wall that separates more reliably screened people from less reliably screened people. The recommendation is timely and should be well received and appreciated by physicians and the lay public alike," Salomon said.

Not everyone agreed with that assessment, though.

"I think that it [adding E] is a poor suggestion," said Dr. Martin A. Weinstock, a professor of dermatology and community health at Brown University and chairman of the American Cancer Society's Skin Cancer Advisory Group.

Weinstock believes that the current ABCD criteria describes some but not all melanomas. However, tinkering with it only adds confusion, he said.

"The most important warning sign for melanoma is change in size, shape or color of an existing mole," Weinstock said. And one should not worry about whether it meets the ABCD criteria. "ABCD can be noted as a description of some melanomas, but certainly not all."

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[stan@sunsys]

Early Diagnosis of Cutaneous Melanoma



Revisiting the ABCD Criteria

Naheed R. Abbasi, MPH, MD; Helen M. Shaw, PhD; Darrell S. Rigel, MD; Robert J. Friedman, MD; William H. McCarthy, FRACS; Iman Osman, MD; Alfred W. Kopf, MD; David Polsky, MD, PhD


JAMA. 2004;292:2771-2776.

Context The incidence of cutaneous melanoma has increased over the past several decades, making its early diagnosis a continuing public health priority. The ABCD (Asymmetry, Border irregularity, Color variegation, Diameter >6 mm) acronym for the appraisal of cutaneous pigmented lesions was devised in 1985 and has been widely adopted but requires reexamination in light of recent data regarding the existence of small-diameter (6 mm) melanomas.

Evidence Acquisition Cochrane Library and PubMed searches for the period 1980-2004 were conducted using search terms ABCD and melanoma and small-diameter melanoma. Bibliographies of retrieved articles were also used to identify additional relevant information.

Evidence Synthesis Available data do not support the utility of lowering the diameter criterion of ABCD from the current greater than 6 mm guideline. However, the data support expansion to ABCDE to emphasize the significance of evolving pigmented lesions in the natural history of melanoma. Physicians and patients with nevi should be attentive to changes (evolving) of size, shape, symptoms (itching, tenderness), surface (especially bleeding), and shades of color.

Conclusions The ABCD criteria for the gross inspection of pigmented skin lesions and early diagnosis of cutaneous melanoma should be expanded to ABCDE (to include "evolving"). No change to the existing diameter criterion is required at this time.


Author Affiliations: Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY (Drs Abbasi, Rigel, Friedman, Osman, Kopf, and Polsky); and Sydney Melanoma Unit, Royal Prince Alfred Hospital, Sydney, Australia (Drs Shaw and McCarthy).