Melanoma's "Ugly Duckling" Appearance

Do you have your ducks in a row when it comes to scanning your body for skin cancer? You may be familiar with the ABCDE's of melanoma (Asymmetry, Border, Color, Diameter, Evolving), but do you know about the "Ugly Duckling" concept? I love this one, because it echoes what I often say to patients when they ask why a certain mole looks "suspicious"- I tell them it's like the old Sesame Street concept that "one of these things is not like the others...one just doesn't belong"!

Like everything in medicine, each body has its own version of what we describe in textbooks. While diseases have a distinctive pattern, the actual specifics will vary from person to person. Along those lines, what we are looking for in melanoma is a mole that simply does not fit the PATTERN that your body has developed. For example, if you are covered in large brown moles, but you notice one small dark black one- it's that small one we worry about. If you have no moles at all except one medium light brown one, we worry about that medium-sized one, not because it is medium or brown, but because your "pattern" is NONE, and this is breaking that pattern. Make sense?


Here is a a graphic from the Skin Cancer Foundation that illustrates this concept. The arrows point to the odd man out, which is the mole that we would tend to prefer in a pathology lab than staying on your body.

BOTTOM LINE: Take a good look at your skin from top to bottom (use mirrors!) and learn to recognize the pattern of TYPES of moles that you have, so you will recognize that "ugly duckling" mole before it turns into full blown skin cancer!

Breaking News for SMOKERS

Last week we had an encouraging development for smokers- the National Cancer Institute prematurely stopped a study because they felt ethically obligated to let all the participants know that a low dose CT scan of the lungs as a screen for lung cancer was yielding a 20% decrease in mortality (as compared with screening chest xrays). What does this mean? Should every smoker get a lung CT scan?

Hold your horses- CT scans for all smokers is NOT the answer- though I wish it were that simple. What we know so far is that in this group of smokers, which was an older group that had a greater than 30 pack-year smoking history (smoking a pack per day for 30 or greater years), the CT scans apparently allowed earlier detection of lung cancers, enough that they had a significant (20%) decrease in deaths.

Over the years I have had many patients who smoke ask for annual screening chest xrays. I explain to them that this is NOT a good screening method, though often I have ended up ordering the xray, in the hopes that they might at least see some noncancerous damage from the smoking that might be enough to motivate them to QUIT. Now, however, we may be changing our recommendations, at least for the older smoker with an extensive smoking history.

Ultimately, though, the real answer is to never start smoking, and if you ARE smoking at ANY amount, find help asap to QUIT!
I'll spend more time this week discussing smoking cessation, but know that there are seven medical aids available through your physician that can help you quit for good.

BOTTOM LINE: Smokers with a greater than 30 pack-year history of smoking may indeed benefit from CT lung scans to detect early lung cancer- check with your doctor (and QUIT TODAY!!!)

Myth#6 "Normal Pap" = Disease-Free

Okay, the next myth surrounding sexually transmitted infections is that a "normal" report after a Pap smear means you are disease-free. Pap smears are wonderful- we are detecting cervical cancer earlier and curing it more easily. BUT- a Pap smear ONLY TESTS for cervical cancer, and possibly HPV (the human papilloma virus, which is the cause of both cervical cancers and genital warts.) Pap smears do NOT test for gonorrhea, chlamydia, HIV, herpes, etc.
Many women believe that they are automatically tested for all STDs when they have their "annual" exam. Certainly, this is a terrific time to be tested, but it is not a given. If you have had a new sexual partner since you were last tested for sexually transmitted diseases, PLEASE ASK your doctor to test you for all STDs.
Guys, you're not off the hook here. When you have YOUR physical exams, a "normal" report does not mean you are disease-free either, UNLESS you have asked your doctor to test you for STDs. The good news is that blood and urine tests together will do the trick- no swabbing necessarily needed.
BOTTOM LINE: Don't ASSUME you're being tested for STDs unless you specifically ask- and even then, make sure you know exactly which diseases were checked.