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Most children are taught the ABC’s of the alphabet at a very young age. However, in the medical community, and more specifically the specialty of dermatology, we have a different set of ABC’s that can alert a person or a provider of an abnormal lesion and more importantly can save a patient’s life if detected early enough.
A stands for Asymmetry. If you were to hypothetically cut a mole in half, a normal mole typically should look the same on both sides or in other words be symmetrical, therefore asymmetry of a lesion is a sign of abnormality.
B stands for Border irregularity. The border of a normal mole is usually smooth, circular and well defined. If the borders of the mole in question are notched, uneven, blurred, scalloped, or poorly defined in any way, this is a potential sign of abnormality.
C stands for Color variegation or variations in color. A normal mole is typically either skin colored, or a light/chocolate brown. In addition, a normal mole should be 1 color. An abnormal mole will usually have more than one color, and will have different shades of brown, tan, blue, white, black, red or a combination of these.
D stands for Diameter. Most normal moles are less than 6 millimeters or the size of a pencil eraser. Melanomas tend to be bigger than 6mm, however the diameter criteria is a weakness in this system because when melanomas begin, they can start off as small as a pinhead and grow from there. Also, many atypical moles are smaller that 6mm and need to be removed regardless of size.
E stands for Evolution or Evolving. Any mole that has changed or evolved in color, size, shape, and/or border irregularity should be looked at by a dermatologic provider. More recently F and G were added to the criteria.
F stands for Firm. New moles that are firm to the touch as opposed to soft and fleshy may need to be evaluated.
And finally, G stands for Growing. If a mole is rapidly growing, it may need to be evaluated. Other warning signs of abnormality include the appearance of a new bump or nodule, color spreading into surrounding skin, redness or swelling beyond the mole, pain, tenderness, itching, bleeding, oozing, or a scaly appearance.
Malignant melanoma is a malignant tumor of the melanocytes, which are the cells in the skin that make the pigment melanin and give skin its color. Around 60,000 new cases of invasive melanoma are diagnosed in the United States each year, more frequently in males and in Caucasians. According to the World Health Organization, about 48,000 melanoma related deaths occur worldwide per year.
The causes of melanoma are complicated but most health experts agree that the majority of tumors are caused by genetic factors and/or ultraviolet (UV) radiation either due to the sun, tanning beds, or other forms of ionizing radiation. A family history of melanoma greatly increases a person’s lifetime risk of developing melanoma. While one cannot change their genetics, the amount of UV radiation that a person accumulates over a lifetime can be drastically reduced. UV radiation causes damage to the DNA of cells, which when unrepaired can create mutations in the cell’s genes causing cells to divide at an abnormally uncontrolled high rate, leading to the formation of a tumor. Furthermore, occasional extreme sun exposure or the use of a tanning bed resulting in “sunburn” is causally related to melanoma. Also, UV exposure during childhood is an important risk factor, and individuals with blistering or peeling sunburns have a significantly greater risk for melanoma.
Diagnosis of melanomas and dysplastic nevi (moles) is almost always achieved by tissue biopsy and subsequent pathological microscopic examination. Treatment typically involves an excision in a dermatologist office or in the operating room with or without lymph node dissection. Other treatment options include radiation, chemotherapy or immunotherapy.
You can lower your lifetime risk of developing a melanoma by decreasing the amount of UV radiation that your skin receives. This includes but is not limited to wearing sun protective clothing, wearing sunscreen with UVA and UVB protection, and avoiding tanning beds.
These guidelines will help you determine if you believe a mole needs to be evaluated. We recommend having an experienced dermatology provider look at any mole that you think might exhibit any of these signs.