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Keep an eye on those changing moles: Skin cancer worries

Once she turned 40, Melanie Schacher's general practitioner suggested she go see a dermatologist for a yearly cancer screening due to her skin type. That suggested doctor visit caught skin cancer that she didn't even know she had.

Schacher, who lives in West Fargo, said her complexion was the reason for the suggestion, since she has a lot of moles.

"I had something on my side (near her hip) that I wasn't quite sure what it was and they removed that and it came back," she said. She added that it was a frozen off, not surgically removed.

She described is as, "kind of like a mole and kind of like a wart."

Doctors took the mole off her again and biopsied it. It came back Level 4 melanoma.

Erin Hegge, PA-C, Sanford Health dermatology, was the provider that helped catch Schacher's melanoma and said there are warnings for people to watch for when they notice changing moles.

"The ABCDE rule can help you tell a normal mole from an abnormal mole," she said.

She gives this description for the ABCDE rule:

A for asymmetry: A mole that, when divided in half, doesn't look the same on both sides.

B for border: The edges are irregular, ragged, notched or blurred.

C for color: The color is not the same all over and may include shades of brown or black, or sometimes even red, white or blue.

D for diameter: A mole larger than ¼ inch in diameter (about the size of a pencil eraser) but melanomas may be smaller than this.

E for elevation or evolving: A lesion that looks different from the rest or is changing in size, shape, or color. Any new or changing lesion should be evaluated by your healthcare provider.

Other warning signs include: A mole that bleeds, itches or is painful, a fast growing mole, a scaly or crusted growth on the skin, a sore that won't heal, a place on your skin that feels rough, almost like sandpaper, she said.

"I guess I hadn't really thought anything about it," Schacher said of the mole before she went to the dermatologist. "They had taught me how to check for changes, but this was kind of more of a nuisance than anything."

This wasn't the first mole of concern for Schacher though. She said she had one previously removed from her upper chest that was sent to Mayo Clinic in Rochester.

There were some cells of concern on that biopsy but it turned out to be cancer free.

Hegge said people are becoming more and more aware of their skin and any changes that may occur so she's seen an increase in the number of people coming into the office asking for both full body exams and individual lesion exams.

"We try to encourage anyone coming into the office to have a full body skin exam because there are areas on the body that are difficult for people to evaluate by themselves," she said.

"Also, a healthcare provider may pick up on something they may not."

Hegge said there is misinformation and misconceptions about skin cancer.

"I think that most people are surprised when they are diagnosed. There is still a lot of misinformation out there that skin cancer is only seen in the elderly or people believe that it won't ever happen to them. Skin cancer can happen to anyone and it is the most common type of cancer that people can develop."

When Schacher got the diagnosis of melanoma, her dermatologist set up and appointment for her with a surgeon and within a couple weeks -- last September -- she was having surgery to remove the mole.

Now she has a follow-up appointment every three months and is more cautious with her own skin practices. She uses sunscreen with SPF of at least 55 at all times.

"I'm wearing sunscreen on my face, even in the wintertime," she said.

"If I see anything, as far as something that may have changed, as a precautionary, I have them check everything now."

Schacher admits that she didn't used to be so concerned and didn't wear sunscreen. She also spent time in tanning beds.

And while her doctor suggested once a year screenings, her dermatologist suggests twice a year.

"I guess we'd rather be safe than sorry."

Frequent sun expose is the biggest concern when it comes to skin cancer. Hegge explained that there are non-melanoma skin cancers called basal and squamous cell carcinoma.

"Basal cell carcinoma is the most common type of skin cancer. It tends to develop on skin that gets frequent sun exposure such as the head, neck, trunk and upper and lower extremities," she said.

That carcinoma appears as a pearl-like bump, a non-healing lesion of a red patch of skin and is slow-growing. While it doesn't spread to other areas of the body, it should still be treated early.

Squamous cell carcinoma is also a form of skin cancer that usually develops in areas of the body with sun exposure. It looks more like a firm bump, scaly or crusted patch of skin and non-healing ulcer.

Both Hegge and Schacher warn against tanning beds and sun exposure without sunscreen.

Hegge recommends sunscreen with at least 30 SPF (sun protection factor) and for people to "get to know your moles. Know their size, color and location."

Schacher said the two pieces of advice she'd give as someone who's gone through the process, she said wear sunscreen year round and stay away from tanning beds.

"I just think that's so dangerous. There are other ways to get skin color. You can be wearing sunscreen or you can get a spray tan. It's just not worth it."

She said her white, untanned legs this summer are just fine with her.

"And I don't even care."