Is That Just a Freckle?

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You’ve seen it pop up over the last couple of years and it hasn’t bothered you much up until now. In fact, you’ve hardly noticed it, until it started catching on your clothing and now you notice it start to bleed. It’s looking much larger, now you think about it. You take yourself to your trusted GP and ask him for some advice. They take one look at it and let out a long whistle.

 

How to spot a melanoma

Melanomas are a type of skin cancer that normally appear brown or black on lightly coloured skin. They are commonly found on exposed surfaces such as arms, hands, the face and the back – especially after a long history of poor skin precautions. Such lesions can often look like a common mole or freckle, but look closer and you might find some tell-tale signs something more is going on.

 

Melanomas are distinguishable from other more benign skin spots using some key characteristics:

• Irregular borders of the spot
• A variety of colours and shades within the lesion
• Some may be painful or itchy, or even ooze blood
• Raised surfaces within the lesion
• Patches of white or scarring showing areas of regression
• A steadily growling, large lesion

 

Am I at risk?

Australia and New Zealand are the world capitals of melanoma due to our long periods of sunshine and outdoor culture. Melanoma is also the third most common cause of cancer behind bowel cancer and prostate cancer (men) and breast cancer (women). There are some key risk factors which mean that if you’re looking down at a mole and think it might be something more sinister, you might be right:

• Advanced age
• Previous melanomas
• Other previous types of skin cancer
• Multiple moles on skin
• Multiple ‘atypical naevi’ (atypical moles)
• Strong family history
• Caucasian descent or lighter-shaded skin that often burns in the sun
• Parkinson disease

 

What now?

When in doubt about a new growth or lesion, it’s always worth seeing your GP.

 

You might expect them to examine it under direct vision or using a dermatoscope (a magnifying glass specific for skin). They might decide to monitor it for a period of weeks or months, or cut out a small section for biopsy.

 

The best test for identifying a melanoma is an ‘excisional biopsy’ which means cutting the potential melanoma out under local anaesthetic with a few millimetres of margin either side and sending that off to a lab to be looked at under the microscope. From there, you may need to go under a knife again to make sure all the remaining parts of the melanoma are removed if any were missed the first time round.

 

Depending on where the lesion is, your GP might refer you to a dermatologist or surgeon (usually a plastic surgeon) to get it looked at and removed. This doesn’t necessarily mean your lesion is particularly advanced but that it might be an awkward spot that’s prone to scarring. That being said, most skin lesions can be removed at general practices with good cosmetic results.

 

If you have had a positive diagnosis of melanoma it is highly important to make regular visits to your GP for discussion of further testing to make sure the disease hasn’t spread and education on what to look for when doing self-skin checks and adjusting to life after diagnosis.

 

How bad is my melanoma?

Melanomas have the potential to spread far and wide within the body through the bloodstream or through special channels called lymph. They can form metastases (new pockets of disease) in the lung, brain, and bone.

 

The likelihood of having metastases depends on the thickness of the original lesion. For melanomas 0.75-1mm thick, the risk of metastatic disease is roughly 5%. This is compared to a 40% risk for melanomas more than 4mm thick.

 

Prevention is the best cure

Currently, Australia and New Zealand have no general population screening program for skin cancer, unlike bowel cancer. However, the medical community encourages patients to self-examine and discuss any lesions or get a skin-check whenever you happen to go to your GP, or you are more than free to schedule in a skin check with your GP at any time.

 

Yearly skin checks are recommended for high risk individuals, namely those with:

• Red hair
• Very light skin, over the age of 45 years old
• Family history (parent or sibling) of melanoma
• More than 100 moles (naevi)
• Past history of melanoma
• Past history of non-melanoma skin cancer, or more than 20 solar keratosis (a similar but benign condition)

 

Always ‘slip, slop, slap and wrap’:

• Slip – on a shirt with long sleeves, fabrics with a tighter weave and darker colours will give you better protection from the sun
• Slip – into the shade of an umbrella or a leafy tree, plan your outdoor activities for early or later in the day when the sun's UV levels are lower
• Slop – on plenty of broad-spectrum, water resistant sunscreen of at least SPF 30, apply 20 minutes before going outside and reapply every two hours and especially after being in water or sweating
• Slap – on a hat with a wide brim or a cap with flaps, more people are sunburnt on the face and neck than any other part of the body
• Wrap – on some shades, choose close fitting, wrap around style sunglasses. Not all sunglasses protect against UV radiation, so always check the label for the sun protection rating

 

References

The Royal Australian College of General Practitioners. Guidelines for preventive activities in general practice. 9th edn. East Melbourne, Vic: RACGP, 2016.

 

Oakley, A. (2015). Melanoma | DermNet New Zealand. [online] Dermnetnz.org. Available at: https://www.dermnetnz.org/topics/melanoma/ [Accessed 22 Mar. 2018].

 

Sinclair, R. (2012). Skin checks. Australian Family Physician, [online] 41(7), pp.464-469. Available at: https://www.racgp.org.au/afp/2012/july/skin-checks/ [Accessed 22 Mar. 2018].

 

Thompson, J., Scolyer, R. and Kefford, R. (2012). Melanoma: a management guide for GPs. Australian Family Physician, [online] 41(7), pp.470-473. Available at: https://www.racgp.org.au/afp/2012/july/melanoma-guide/ [Accessed 22 Mar. 2018].