by Dr. Nicholas Jansson As May is Melanoma/Skin Cancer Detection and Prevention Month, it is a good time to dedicate our attention to the biggest organ in our body that perhaps gets the least attention especially in older adults — the skin! Let’s focus on one of the most common skin cancers and most deadly: malignant melanoma. Malignant melanoma represents the fifth most common cancer in men and the seventh most common cancer in women. It is so common that most recent odds reported are that 1-39 Caucasian males and 1-58 Caucasian females are going to be diagnosed with melanoma. The incidence of melanoma is rising most rapidly in older individuals, which is likely a combination of the medical community’s enhanced ability to screen and diagnose melanomas, as well as people’s general increased awareness of its existence — an awareness we, as physicians, continue to try to counsel our patients about! Factors that increase an individual’s risk of melanoma are: Family history of melanoma Atypical nevi — moles that look irregular, raised and perhaps even symmetric, but when examined under a microscope turn out to be a precursor of melanoma Individuals who have several nevi (moles) History of excessive sun or UV light exposure Phenotypic traits — light or fair-skin, light hair color (red or blonde), freckles and light eye color The location on the body of the mole also has some association with potential for malignancy, although a melanoma can theoretically grow anywhere on the body, even under the fingernails. The back, abdomen and backs of the legs are places where melanoma often go undetected unless routine screening is done by a physician. These are areas that are hardest to see on ourselves. So how do we detect skin moles that may be a sign of trouble? In 1985, there was an evidence validated acronym designed to help physicians and lay people pay closer attention to moles that may need further diagnostic studies. This acronym was studied once again in 2004 and revised to the current version: A – Asymmetry – moles that aren’t nice and round but irregular and don’t’ look the same as each other are more likely to be dangerous B – Border irregularity – the borders of the mole are not smooth and round but have an irregular shape C – Color variegation – different colors within the same region or in the same mole D – Diameter – greater than 6mm E – Enlargement or “Evolution” of color, shape or symptoms – colors or shape of mole change over time or it begins to itch, bleed or hurt. are all warning signs Commonly seen in the elderly are raised, sometimes irregular, dark (with color variegation) and large moles which are typically benign and not worrisome. These moles are called seborrheic keratoses. These lesions have virtually no malignant potential and have a characteristic “stuck on, waxy looking” appearance. While these moles are typically benign, always bring them to the attention of a physician or dermatologist for confirmation because sometimes it is hard to distinguish them from something more dangerous. Prevention Screening and detecting potential melanomas are important; perhaps more important is to make attempts at preventing them from occurring in the first place! Even for those who are not in the high risk groups mentioned above, it is still vitally important to use sunscreen when exposed to sunlight for prolonged periods of time. Using a minimum of 30 SPF is recommended for good protection. Keeping covered with light clothing and brimmed hats are other non-sunscreen ways to keep skin protected from harmful UV rays. Ask your primary care doctor or dermatologist if you are in the high risk groups mentioned above to see if routine surveillance is appropriate for you! Dr. Nicholas Jansson is a board certified Internal Medicine physician practicing at Franciscan Medical Clinic – Seahurst in Burien, WA. He did his residency at the University of Connecticut, medical school at Ross University School of Medicine, and undergraduate studies at the University of Washington.