HEALTH ; Suspicious moles should be checked by a doctor | Community

“Doc, I have some kind of barnacles growing on my back; could you check them? »

It was the unvarnished request of Don, 52, to examine the skin changes he had noticed but could not see clearly. These turned out to be what are called seborrheic keratoses. These are strictly aesthetic nuisances, very frequent, and without precancerous potential. They can be removed in several ways, including freezing with liquid nitrogen. However, Don was fine with leaving them alone once he knew they posed no danger.

With new or changing skin lesions, it’s usually the first question: could it be skin cancer or pre-cancer? There are three main types of skin cancer. The least aggressive is basal cell cancer (BCC). These often occur in sun-exposed areas such as the face, neck, shoulders, and extremities. They often start as a small, smooth, shiny bump that grows slowly. Although they are the least dangerous, they can still require major surgery if they grow too long without intervention, especially if they are on the face.

The next level of aggressiveness are squamous cell cancers (SCCs). These often start as small crusty bumps, also on sun-exposed areas. These scaly bumps are called actinic keratoses (AK) when they are in the precancerous stage. Over time, a percentage of them can slowly turn into SCC. AKs can be treated with liquid nitrogen to remove them. However, if they have become SCCs, they must be excised, usually by office surgery.

The final, slightly less common but much more serious skin cancer is melanoma. They are usually irregular-looking moles ranging from dark brown to black (although other colors are possible). Benign (harmless) moles (nevi) are often uniformly light to medium brown with sharp edges and a symmetrical shape. Another characteristic of melanomas is that they tend to be the ugly duckling, different from other moles a person may have. Often they show changes over time.

Of course, a person can’t see their back well, so I try to look closely at that area during physical exams. For moles that look suspicious, we bring the person back soon for a biopsy. These are simple office procedures that allow us to get a pathology reading within days. Those found to be full-blown melanomas are referred immediately to local dermatologists for complete excisions with a wide margin.

Apart from skin cancers, there are common skin growths such as warts, skin tags, dermatofibromas, hemangiomas, lipomas, epidermal cysts and many more with long medical names. I like dermatology partly because the problem is there, on the surface, to be seen. Plus, after spending 12 years practicing in South Florida, it seemed like almost everyone who walked through the door had skin issues that needed attention.

Ultimately, if you notice a rash or a patchy or changing skin lesion, don’t delay in getting yourself checked out. Dealing with them, or at least evaluating them, when they are small prevents them from becoming bigger business later. And even if it is not pre-cancer or cancer, you can reassure yourself, or even have it removed if it is a particularly unattractive barnacle.

Dr. Andrew Smith is Board Certified in Family Medicine and practices at 2217 East Lamar Alexander Parkway, Maryville. Contact him at 982-0835.

Dr. Andrew Smith is Board Certified in Family Medicine and practices at 2217 East Lamar Alexander Parkway, Maryville. Contact him at 982-0835.

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