Melanoma is the most common cancer in women ages 25 to 29 years and the second most common cancer in women ages 30-35 years. Due to ozone depletion, incidence has doubled every 10 years. Therefore, it is important that women be educated on the risk factors and signs of melanoma in order to identify a potential malignancy and monitor skin changes. Similar to self breast exams, women should become familiar with their skin and monitor for changes monthly.
Moderate risk factors include fair skin and a history of UV exposure (sun and tanning beds), particularly a history of blistering sunburns. Additional factors of higher risk include eight or more moles that are greater than 6 mm in diameter and a history of a changing mole.
Luckily, there is a mnemmonic that can help. The mnemonic is ABCDE. A, B, C, and D help to identify abnormal moles, while E helps to monitor for changes. A stands for asymmetry. An asymmetric mole is one that is not circular or eliptical. In other words, one half of the lesion differs from the other side. B stands for borders that are irregular or indistinct. A mole with indistinct borders may have blurred edges. C stands for color that is non-uniform (variable pigmentation involving at least two different colors). D stands for diameter over 5-6 mm – about the size of a pencil eraser. Lastly, E stands for evolution of a lesion – the evolution (or changes) in the size or features of a mole.
Changes to note include any variation in size, shape, color, or surface. Moles are often flat, but an abnormal feature that should draw attention is a flat mole with a raised center. This is known as the “fried egg sign.” Additional features to pay attention to include: an associated itch or altered sensation as well as inflammation, oozing, crusting, or bleeding. A basic starting point is to look for “ugly ducklings” – any mole(s) that stand out as being distinctly different than others.
Abnormal moles typically appear at puberty (as opposed to common moles that present in childhood) and continue to develop until age 40-50 years. More alarming is a new mole that appears after age 30. Abnormal moles most commonly appear on the back and particularly on the legs in women. Additionally, areas of the body that are typically covered from the sun have a higher incidence of abnormal moles, including the breasts, scalp, buttock, and groin.
The incidence of malignant melanoma is increasing, and as the first and second most common cancer in women under 35 years, it is important to maintain a higher level of suspicion. In addition to monthly at-home monitoring, women should have annual skin exams by an experienced healthcare professional.
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