FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

QUESTIONABLE SKIN "SPOT" SHOULD PROMPT QUICK TRIP TO DOCTOR

Question: I have a spot on the skin of my lower arm that could be a cancer, but I'm unable to afford going to the doctor right now. Can you give me any tips on how to decide if this is a cancer?

Answer: Non-cancerous skin growths are far more common than skin cancers. That means, from a statistical point of view, it is most likely that you have a non-cancerous growth. However, since skin cancers can be deadly, I strongly recommend that any skin lesion that worries you be evaluated by a physician.

If you can't afford the cost today, explain this to the doctor beforehand. Most are quite willing to set up a payment plan that fits your needs.

A visual inspection and a careful patient history are often sufficient for a well-trained physician to make a diagnosis. It is frequently necessary, however, to remove at least a portion of the lesion to obtain a specimen that can be studied under the microscope. From this study, your doctor can determine precisely the type of growth and if further treatment is warranted.

One important clue in telling when a spot what we doctors call a lesion might need further study is its history. That is, how it developed and how it has changed over the last few months. Most non-cancerous growths have a smooth border where they join normal appearing skin and are symmetrical in shape. Their coloration is uniform across the lesion, and the growth is so slow that it is hard to say that they are growing --they just weren't there last year.

The most common form of skin cancer, and also the most prevalent cancer in humans, is basal cell carcinoma. These raised, "waxy-appearing" skin growths usually develop on the head, neck, hands and trunk the areas that get exposed to the sun. They develop a rolled border with an open, unhealing sore in the center. Over a course of years, if left untreated, the cancer slowly gets larger. The Skin Cancer Foundation predicts more than 500,000 cases of basal cell cancer nationally this year.

The next most common skin cancer squamous cell will affect 100,000 people this year, predominantly those over 60. These growths are reddish or pink and appear as raised, irregularly shaped, scaly or ulcerated nodules. Often found on areas like the lips, face, mouth, hands and ears, they may appear as a new growth or inside of an existing pre-cancerous skin lesion. Old scars or areas of chronic skin infection are also common sites. Left untreated, squamous cell cancer can spread to other parts of the body a process called metastasis and can cause new cancerous growth in other organs or tissues.

These two types of skin cancer are very curable and recovery is almost certain, if treatment is begun when the growth is small. However, failure to treat these common skin cancers can lead to serious problems. In fact, about 2,000 people will die of untreated basal or squamous cell cancers this year.

The deadliest of all skin cancers is melanoma. While it is still the rarest type, it has become increasingly common because of the popularity of the "sun-tanned" look. Exposure to the sun is a known risk factor.

A melanoma, in its early stages, is a multicolored growth with a cobblestone-like surface that may be confused with a common mole. It is usually multicolored including black, brown, blue, red, or even with areas of almost no pigment at all. The border between colors is usually indistinct. As the melanoma enlarges, it becomes raised above the surface of the skin. At the same time, it penetrates more deeply into the skin, and this is quite serious. Melanoma that penetrates less than .75 mm (about 1/32 of an inch) is usually cured by simple removal. Deeper growth often indicates that metastasis has occurred, and a cure is less likely. Yes, people regularly die from untreated melanoma! So if your skin lesion has any of the features of melanoma, please go see your family doctor or a dermatologist immediately.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.