ABCs important for good health

"The four items on the ABCD checklist are all physical examination features, and referral for biopsy is recommended if one or more of the elements are suspicious. It is also important to note any recent changes in size, shape, or color of the moles or lesions. We also utilize E –  the Epiluminesence microscope." - Dr. Mark Kaminski

Knowing ones ABCs takes on a whole new meaning when it comes to health.

"There are checklists which serve as diagnostic aids when determining if a lesion or mole is normal or abnormal," said Dr. Mark Kaminski, Dermatologist.

The checklists, utilized by health professionals, are the ABCD and the revised 7-point. A when referring to the ABCD, indicates asymmetry; B, border irregularity; C, irregular color; and D, diameter – all indicators which a patient themselves could watch for.  Kaminski takes the letters up one notch.

"The four items on the ABCD checklist are all physical examination features, and referral for biopsy is recommended if one or more of the elements are suspicious," Kaminski explained. "It is also important to note any recent changes in size, shape, or color of the moles or lesions. We also utilize E –  the Epiluminesence microscope."

"Epiluminescence Microscopy allows for a detailed surface analysis of a suspicious skin lesion by using a handheld device emitting incident light from a light source penetrating the epidermal skin layer," Kaminski explained. "The focus is the epidermo-demal junction zone, where melanomas do arise from, which can be thoroughly analyzed in detail."

The seven-point checklist assigns two points for each major criterion noted at the lesion, including change in size, shape, or color, and one point for each of the minor criteria at the site, including inflammation, crusting, or bleeding; sensory change; or diameter equal to or greater than 7 mm.

"If a score of three points or more is noted, a referral for further evaluation is warranted," Kaminski said. "Regardless of the screening method used, the gold standard for diagnosis is the histopathological evaluation of excised tissue."

Knowing what is going on with one’s own body is crucial

Skin cancer is the most common malignancy occurring in humans, affecting 1 in 5 Americans at some time during their lives.

"Early detection of cancerous lesions is important for reducing morbidity and mortality," Kaminski said. "Early detection of this type of lesion can allow for complete excision, which can result in no further treatment of the area warranted."

Lifetime risk for malignant melanoma has increased from 1 in 1500 in the United States in 1930 to 1 in 75 for the year 2000.

"Because the tumor's thickness at excision is the primary prognostic determinant, early detection through the history and physical examination can play an important role in the patient's clinical course," Kaminski said.

There is another course of defense available for some people. Because millions of Americans are seen daily by health care practitioners other than physicians, screening of the skin by these professionals is warranted.

"Physical therapists can aid in detection of suspect lesions with knowledge of the basic screening techniques for skin cancer, which may help reduce the morbidity and mortality caused by these lesions," Kaminski said.  "These therapists can perform a dermatologic screening as part of their routine examination of patients."

Skin malignancies can be divided into two categories: melanoma and nonmelanoma cancer. In 2000, the American Cancer Society estimated that 53,600 new cases of melanoma were diagnosed in addition to more than 1 million cases of nonmelanoma (basal and squamous cell) skin cancers. This was an increase from the 27,600 cases of melanoma and 600,000 cases of nonmelanoma skin cancers estimated in 1990.

Melanoma accounts for three quarters of the deaths caused by skin cancer each year, whereas the mortality rate for those diagnosed with nonmelanoma skin cancer is relatively low, with an estimated 95 percent, five-year survival rate. Nonmelanoma skin cancer can be locally aggressive, however, and can result in considerable disfigurement, loss of function, and health care costs. Also of concern is that patients diagnosed with basal cell carcinoma have an almost 50 percent risk for a second primary nonmelanoma skin cancer developing within a 50-year period. These patients are also three times more likely to develop melanoma later.

The risk factors and warning signs of melanoma and nonmelanoma skin cancer have been described by the American Academy of Dermatology and Center for Disease Control and Prevention and include the following: age greater than 15 years, fair complexion, persistently changed or changing mole, many moles, atypical moles, personal or family history of melanoma, sun sensitivity, and excessive sun exposure. Warning signs for melanoma include new, changing, or changed moles; unusual moles; or symptomatic moles (i.e., pain, itching, burning).

Risk factors for nonmelanoma skin cancer include older age, fair complexion, male sex, inability to tan, and prolonged redness after exposure to the sun. Warning signs for nonmelanoma skin cancer include a sore that will not heal, a scaly spot, an enlarging pink or red growth, or a pearly bump.

Both types of malignancies have been shown to have a greater incidence in white people living near the equator because of greater ultraviolet light exposure per unit of time. Outdoor workers have an increased incidence of nonmelanoma skin cancer, and intense, intermittent exposure and blistering sunburn episodes in childhood and adolescence are associated with a greater risk of melanoma skin cancer.

In a survey done to determine the patients' role in finding their own lesions, it was found that approximately half (53 percent) of melanomas were self-discovered, and the remaining cases were detected by medical providers (26 percent), family members (17 percent), and others (3 percent). Nearly one third stated they could not see their own lesions easily. Medical personnel detected the lesions most often in older patients.

No matter who finds it, however, it is vital that someone be watching.

"Again, early detection is vital in reducing morbidity and mortality from skin cancers," Kaminski reiterated.