Spotting Abnormalities, Misinformation Sun Exposure

I know that this probably varies by skin color/type/age, but what are some of the first signs of skin abnormalities that warrant a trip to the derm?

Anything that does not go away could be a sign of something that warrants a trip to the dermatologist. We all get lumps, bumps, scabs and don't know what they are from, but they should resolve. I always tell my patients, give it a month, and if it is still there, I should see it.

As a follow-up, would a mole or hyperpigmentation getting more extensive warrant a trip? Or is it just something to monitor? Is there a growth rate to use as a general guideline?

The most concerning thing is a growing spot, be it red, pink, brown, or black.  We continue to make new spots (first moles, then cherry angiomas, seborrheic keratoses, and then lentigos/sun spots) for our entire lives.  Most show up and then stay. If they continue to grow and change, they can still be benign, but it is better to get the spot doubled checked. 

Can you clear up any misinformation about how a single bad sunburn can cause skin cancer?

We know the sun and tanning beds expose us to ultraviolet (UV) radiation. UV radiation causes mutations in our skin cells' DNA that increase our risk of developing skin cancer. It is estimated that 90 percent of basal and squamous cell carcinomas and 86 percent of melanomas can be attributed to ultraviolet radiation1. Studies have shown a person's risk for developing melanoma doubles if he or she has had more than five sunburns as an adult or even one blistering sunburn as a child2,3. Despite widespread public knowledge about the sun's dangers, we as a nation continue to tan and use tanning beds. Half of adults report at least one sunburn in the past 12 months4!  There is a commonly held view that most sun damage occurs before 18, and as adults "the damage is already done”.  This is not true!  Adults over the age of 40, especially men, have the highest annual UV exposure and therefore need to continue to protect themselves5. 

1. Koh HK, Geller AC, Miller DR, Grossbart TA, Lew RA. Prevention and early detection strategies for melanoma and skin cancer: Current status. Archives of Dermatology. 1996; 132: 436-442
2. Pfahlberg A, Kolmel KF, Gefeller O. Timing of excessive ultraviolet radiation and melanoma: epidemiology does not support the existence of a critical period of high susceptibility to solar ultraviolet radiation-induced melanoma.Brit J Dermatol March 2001; 144:3:471.
3. Lew RA, Sober AJ, Cook N, Marvell R, Fitzpatrick TB. Sun exposure habits in patients with cutaneous melanoma: a case study. J Dermatol Surg Onc 1983; 12:981-6.
4. Gellar AC, Colditz G, Oliveria S et al. use of sunscreen, sunburning rates, and tanning bed use among more than 10,000 US children and adolescents. Pediatrics 2002; 109(6):1009-1014.
5. Centers for Disease Control and Prevention. Sunburn and sun protective behaviors among adults aged 18-20 years – United States, 2000-2010. MMWR Morb Mortal Wkly Rep 2012; 61:317-22.

For men and women of color, is there anything different you may need to do when conducting a skin check?  We read that these skin cancers can be more advanced at the time of diagnosis.

The risk of getting skin cancer is very real regardless of your skin color.  Providers need to be thorough during skin exams and educate people of color to examine their skin regularly for changes that might be more subtle.  This is the first hurdle improve early diagnosis. Darker skinned people are more prone to melanomas and squamous cell carcinomas, whereas lighter skinned people make basal cell carcinomas most commonly, followed by squamous cell carcinomas, and then melanoma. 

Are there certain types of people who are more prone to skin cancer?

There are several risk factors associated with skin cancer. For basal cell and squamous cell skin cancers, having fair-colored skin, a family history of skin cancer, and extended sun exposure are all risk factors.  For melanoma, having more than 100 atypical moles, a first-degree relative with a history of melanoma, and multiple sunburns all increase your risk of developing melanoma. 

What are the best ways to prevent skin cancer? 

Don't get sunburned and don't tan!  I don't mean to ruin the sun for people, but there is never a good reason to lay in the sun or in a tanning bed.  And there is no such thing as a ‘healthy tan’.  Get outside and be active by all means but always remember your sunscreen, sunglasses, and a hat.

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Meet the author: Board-certified and practicing dermatologist, Dr. Heather D. Rogers, MD, is the founder of Doctor Rogers Skin Care and Modern Dermatology in Seattle, Washington. She studied at Stanford, University of Washington School of Medicine and Columbia University Medical Center. She lectures nationally, is well published, and an active member of the American Academy of Dermatology. Highly respected among the skin care community, Dr. Rogers has been annually named “Top 1% of Most Honored Doctors in the US” by Castle Connolly.