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The importance of ABCD

In my practice, I find the ABCD system is an excellent way to begin educating my patients about skin cancer. It’s not foolproof, but it’s easy to remember and a good jumping off point that helps people become more aware of skin cancer.

It was very interesting to read in this new study that dark color was an important characteristic in distinguishing melanoma from ordinary, noncancerous moles. This validates what I have found to be true in my own practice. Dark color is often a tip-off for me when investigating a lesion that turns out to be an atypical nevi or early melanoma.

Examine yourself
It’s important for people to perform a skin exam every few months or so, using mirrors or another person to check areas you can’t see. Doing it too often, however, may make it difficult to notice changes in your skin. Sometimes, when my patients feel overwhelmed by trying to examine every little freckle, I tell them to look at their leg, or their arm, and look for moles that really stand out because of their dark color or increase in size.

This study also agrees with past studies that the size of a lesion or mole is the weakest criteria. I tell my patients to have any and all suspicious moles or spots checked as soon as possible, no matter what size they are. When it comes to melanoma, the earlier a diagnosis is made, the better.

Look everywhere
Melanoma can occur anywhere — on the legs, arms, back, even on the soles of the feet or palms of the hand. For women, the back of the legs is a common area while with men it’s more frequently found on the upper shoulders and back. These are usually areas that have received sun exposure. It seems that people who have intermittent, intense sun exposure may be at higher risk than people who have more constant exposure. So the farmer may be at less risk than the fair-skinned person who gets burned every year on a tropical vacation.

Sometimes people ask me to remove all of the moles on their skin, but that’s not usually recommended. For one thing, that doesn’t offer guaranteed protection against melanoma, which can originate on its own, instead of at the site of a mole. We only remove moles if they look suspicious — again maybe because of color, or if the patient feels they have changed in some way. I often can remove most lesions right in my office, and the tissue is then sent off to a laboratory and analyzed to determine if cancer is present.

Skin cancer strikes all ages
Most people may think melanoma strikes only older people, but my youngest melanoma patient was a 17-year-old girl. In fact, melanoma is the most common cause of cancer death in women aged 25 to 29, and the second most common cause in women 30 to 35 years old. But by limiting sun exposure, wearing protective clothing, doing skin exams regularly and having any suspicious areas checked by a physician, we can make a real impact against this disease.

Dr. Bevilacqua is a dermatologist on the attending staff of Yale-New Haven Hospital.