That doesn’t just mean a lot of people skipped out on Botox and cortisone injections. It also means that a lot of people missed screening for the most common cancer in the U.S. by far. More people are diagnosed with skin cancer every year than all other cancers combined. Since skin cancer is the only cancer we can all see, though, some of the onus gets put on us to catch it.
In the 1980s, dermatologists began advising patients to self-monitor—specifically for melanoma—using the ABCDEs: A for asymmetry, B for border, C for color, D for diameter, and E for evolving. Should any of these characteristics appear out of the ordinary, then you should see your dermatologist. The problem? According to the Skin Cancer Foundation, many melanoma and most nonmelanoma skin cancers fall outside of the ABCDEs criteria.
“I find that many people are accustomed to the ABCDEs as being important warning signs,” notes Laurel Geraghty MD, a Medford, Oregon dermatologist. “But it’s scary how subtle melanoma and other skin cancers can be in the early stages.”
Early detection, which relying solely on the acronym may not afford you, is a gamechanger: While the five-year survival rate for early-stage melanoma is 99 percent, it falls to 27 percent once it’s spread to other organs. And while basal and squamous cell carcinoma, more common forms of skin cancer, aren’t as deadly as melanoma, they’re somewhat more insidious. Basal cell carcinoma can appear to be a mere pesky pimple. Squamous cell carcinoma can just look like hyperpigmentation. So, they tend to get diagnosed at later stages, which is worrisome.
New York City dermatologist Orit Markowitz, MD, considers the acronym to be a last resort. “Once you notice something that irregular using this guide, it is typically a lesion that has progressed too far.” In addition to scanning your skin regularly for any abnormalities—whether they follow the ABCDEs or not—an annual skin cancer check with a board-certified dermatologist is a must. Particularly, says Dr. Markowitz, a derm that uses a dermatoscope.
A handheld device the size of a cell phone (which Dr. Geraghty calls her “third hand”), the dermatoscope uses light and magnification to provide an extreme close-up of skin. It allows dermatologists to better determine whether a spot is a cause for concern or not, increasing the sensitivity of diagnosis by 30 percent and catching cancers before they’ve gone too far.
A clinical review published in the journal Dermatology Practical & Conceptual found that while the majority of melanomas found using a dermatoscope were in situ (only in the epidermis), 40 percent of melanomas found during exams where the lesion was the reason for the visit had advanced to the lymph nodes.
By helping dermatologists tell if something is potentially malignant, says Dr. Geraghty, dermatoscopes can also avoid unnecessary biopsies—i.e. cutting away a skin sample for lab diagnosis—saving your skin in more ways than one.
While many dermatologists use them, not all of them do, which is why Dr. Markowitz says to ask for one when booking your exam. Oh, and to book your exam stat. The aforementioned JAAD study estimates that the height of the pandemic has led to a delay in diagnosis and treatment for over a million skin cancers. Like all of us, dermatologists are now trying to make up for lost time—and there’s not a moment to spare.
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