During the shorter days and longer nights of fall and winter, it’s easy to think “out of sight, out of mind” when it comes to the sun. But not so fast.
“Harmful ultraviolet rays are still present year-round, despite changes in the weather,” says Northwestern Medicine’s Dr. Jill Cotseones. “In fact, there are some studies that suggest cloudy days may actually enhance UV exposure and increase the risk for sunburn.”
I’m fair-skinned, have many moles, and had a handful of serious sunburns growing up, all of which are risk factors for melanoma, one of the deadliest forms of skin cancer.
That said, I still (incorrectly) feel less of a need for sun protection starting in the fall, routinely pack away my sunscreen in September, and figuratively “lose” my dermatologist’s number around the same time.
Until recently, that is, when I scratched a mosquito bite (mosquitos and melanoma — thanks, summer!) on my arm so voraciously that I developed a scab.
A nearby mole scabbed, too, and I remembered the Skin Cancer Foundation’s ABCDEs of melanoma:
|A is for “asymmetry”||Most melanomas are symmetrical. If you draw a line through the middle of the lesion, the two halves don’t match, so it looks different from a common round or oval mole.|
|B is for “border”||Melanoma borders tend to be uneven and may have scalloped or notched edges, while common moles tend to have smoother, more even borders.|
|C is for “color”||Multiple colors are a warning sign. While benign moles are usually a single shade of brown, a melanoma may have different shades of brown, tan, or black. As it grows, the colors red, white, or blue may also appear.|
|D is for “diameter” or “dark”||While it’s ideal to detect a melanoma when it’s small, it’s a warning sign if a lesion is the size of a pencil eraser (about 6 millimeters or ¼ inch in diameter) or larger. Some experts say it’s also important to look for any lesion, no matter what size, that is darker than others. Rare amelanotic melanomas are colorless.|
|E is for “evolving”||Any change in size, shape, color, or elevation of a spot on your skin or any new symptom in it, such as bleeding, itching, or crusting, may be a warning sign.|
Since the mole was now itching, too, whether because of the bite or something else, I went to see a new doctor. She confirmed it was just that pesky mosquito bite.
But, on a whim, I also asked her to take a look at a fairly large and dark (but perfectly round and symmetrical) mole on my chest. (My former dermatologist in Chicago had seen it a few times already and said it wasn’t anything to worry about.)
In her eyes, the mole looked like it was growing. She wanted to remove it immediately.
A week later the results were back: It wasn’t cancerous, but it wasn’t benign either. It was an atypical lesion with spitz features (generally OK in children but worrisome in adults, as they mimic the look of melanomas) and would need to be excised by a dermatological surgeon in another visit to ensure complete removal.
Your intuition is as important as rules and guidelines
For board certified dermatologist and Royal Fern founder Dr. Timm Golueke, this story emphasized another warning sign, separate from the ABCDEs.
“I first ask my patients if there is a mole on your skin that you are concerned about,” he said. “I believe personal intuition is extremely important. To me, it’s almost as important as the ABCDEs rule.”
While this wasn’t the case for my mole, board certified dermatologist Dr. Marnie Nussbaum says to watch out for new lesions, which can be pink or flesh-colored, not just brown or black, and flat or raised.
Although the ABCDEs are universal and any skin type can get melanoma, Dr. Nussbaum says people with darker skin tones must be particularly careful with the acral areas (palms and soles) as well as the nails.
People with darker skin tones are at higher risk for acral lentiginous melanoma, which is melanoma involving the acral surfaces of the hands and feet.
“If any new lesion is there for longer than 2 weeks, always get it checked,” she says.
As with most things, the anticipation of the excision was scarier than the reality of it. But I still badgered my doctor with questions about what exactly she was doing — hey, knowledge is power, right? — to make the process less intimidating.
“Excisions of skin lesions can be done within the office with local anesthesia,” says Dr. Cotseones. “A diagram in the shape of an ellipse is typically drawn around the skin lesion being removed, with variable margins of healthy tissue as well, depending on if the lesion is considered benign or malignant.”
“The area is then anesthetized with an injection of lidocaine with epinephrine and cleansed thoroughly with topical antiseptics. Using sterile technique, the lesion is removed from the tissue and bleeding is stopped using a device called electrocautery.”
“The skin is then closed with sutures underneath the skin and on top of the skin for further reinforcement. A pressure bandage is placed onto the skin and is to remain in place and kept dry for 24 to 48 hours.”
The mole is then sent to a lab to ensure that a) it was completely removed and b) no malignant cells were present.
Certain areas of the skin, such as the scalp and lower leg, don’t heal as easily as others because of tightness, or the lack of laxity, in the skin. Limiting movement around the incision helps. If, for example, your mole was surgically removed from your shoulder, avoid lifting heavy items.
I wore a sports bra full time for a week or so (because, you know, breasts sag) and ultimately had a fairly simple recovery. I did experience significant bruising, which caused a fair bit of pain — nothing a few Tylenol couldn’t fix, though!
If your mole is on your leg, wearing Spanx or compression stockings also helps increase circulation and aids healing.
I immediately felt better when I received the call from my doctor a few days later, saying that the mole had been completely removed and was benign.
But the calm didn’t cover the cost: I recommend shopping around before signing up for the excision, because my surgery and subsequent pathology cost $250. I ended up going back to my Chicago-based dermatologist, who didn’t take insurance but had the hospital bill pathology to her so my bill would be cheaper than the projected $800.
Also, the doctor who biopsied my mole ended up being out of network, which meant my initial visit and biopsy cost me nearly $1,500!
Fortunately, according to Dr. Cotseones, skin screening exams are typically covered by insurance.
“[They are covered] on an annual basis if the patient has a history of blistering sunburns or is at a high risk for skin cancer,” she says. “Although, if the patient has a previous history of skin cancer, insurance will cover skin checks more frequently, such as on a biannual basis.”
“Excisions are typically covered by insurance unless it’s for removal of a benign lesion for cosmetic reasons or for removal of skin tags, which are often not covered by insurance. Be cautious if you’re waiting until you’ve met your deductible before coming in for a skin exam, because the end of the year is the busiest and it may be difficult to get in.”
After having a mole removed, it’s recommended that you have your skin and body, including your scalp, mouth, genitals, and eyes, checked at least once a year. But get checked more often if you notice anything new or changing, have many moles, or have a family history of melanoma.
“The best way to make sure your doctor isn’t missing anything is to ask if they use photo mapping,” said Dr. Golueke.
“We photo map the entire body so, when you come in, the computer can compare the old images to the current skin surface. We will be able to determine if there’s a new mole we need to pay close attention to or if there are any irregularities.”
And Dr. Nussbaum says two sets of eyes are always better than one for patients with a history of lots of moles or of melanoma.
“If you are getting quarterly checks, see one dermatologist every 6 months and a different dermatologist every 6 months. However, those dermatologists should be in constant communication with photos.”
I now plan to have my moles checked twice a year. In the meantime, though, I’ll start with unpacking my sunscreen.
Allison Duncan is a freelance journalist based in Minneapolis, Minnesota. Her work has appeared in The New York Times, The Wall Street Journal, Vogue, Fast Company, and the Cut, among others. Read more of her work here and follow her on social media at @allisonpduncan.