What is that thing on my skin? Is it normal? Could it be cancer? How can I tell?
These are questions commonly asked by our patients, so I thought I would cover the basics of your external covering. I have never seen someone who had entirely smooth, uniformly colored skin all over their body, unless they were airbrushed in a magazine. Nature decorates us in myriad ways, and no two of us are alike. I will start with normal skin variations and move to abnormal skin changes.
Normal:
Birthmarks come into the world with you, or arise shortly after. They can occur on any part of your body. Common names include port wine stains, Mongolian spots and stork bites. They are either vascular, made of blood vessels, or pigmented, made of colored cells. Neither is dangerous, but they can be unsightly, and some people choose to have the vascular ones removed with lasers if they don’t fade.
Freckles are tiny patches a little darker than skin color. They usually come in clusters, and can be present at birth or develop later, especially in sun-exposed areas. The technical name for a freckle is lentigo. These are benign, meaning they won’t turn into cancer.
A mole is the common name for what doctors call a nevus. Why a brown bump on our skin has the same name as a furry burrowing insectivore beats me, but I guess it makes as much sense to call it a mole as a nevus. You can be born with moles (plural is nevi) or grow new ones up until you are about 30. A mole can be flat or raised, pink, tan, brown, blue or black. The average number of moles per person is 40, but some people have many more. A mole as such is benign, but they can turn outlaw, as I will describe below.
Acne. All right, you might not think acne is normal or benign, but believe me, it is both. Everybody gets acne in some form at some point, and nobody ever died of zits. Still, I know it can be awful, and there is treatment, so if you have it bad, come see us.
Seborrheic keratoses look like little pieces of bark stuck on the body, usually of a person older than 50. These are not dangerous, just another badge of honor, like age spots. “Seb K’s” can be frozen off, and age spots can be bleached if you don’t want to flaunt those particular medals.
Abnormal:
A wart is a rough bump, often with little dots in it, most commonly found on the hands, feet, or genitals. Warts are caused by viruses, so they are contagious and can multiply. I recommend you get them treated if you have them. We use liquid nitrogen to freeze them or chemical warfare to acid-burn them. Yes, it hurts, but only for a second.
Actinic keratosis sounds like that bark thing, but this is a precancerous lesion that often occurs on the forearms and face — areas most exposed to sun. If your grandfather goes to the dermatologist to have things burned off, this is probably what he has. They are more easily felt than seen; small rough patches that don’t go away. They are usually the color of your skin or a little lighter.
Skin cancer. The buried lead. Most people worry about skin changes because they fear skin cancer, especially in this sunny climate, and rightly so. Skin cancer is the most common kind of cancer, and one in five Americans will develop it in their lifetime. There are three basic kinds.
Basal cell cancer is the most common kind of skin cancer, especially in fair-skinned people and those with blue or green eyes. This is typically a pearly white or gray bump, but it can also be brown or skin colored. It might have blood vessels in it. Although it rarely spreads and is almost never lethal, it should be removed so it won’t cause damage.
Squamous cell cancer made the news in New Mexico in 1998 when it killed one of our legislators, Steve Schiff, at the age of 51. Contrary to the sad impression that story made, this kind of cancer is rarely fatal, though it is more dangerous than basal cell cancer. Squamous cell cancer is the most common skin cancer in African Americans and Asian Indians. This kind of cancer might look like a never-healing sore, or an eroded bump.
Melanoma is the worst kind of skin cancer, the deadliest kind, killing one person every hour of the day. It arises from cells that produce melanin, or pigment. Hence, it is a colored cancer, usually several shades of brown and black. This is the mole gone outlaw. This fiend is why you need to watch your moles, and why we remove moles that have changed. Melanomas can arise on their own, or within an existing mole. They look like a mole gone awry — think dark and ugly. Irregularly shaped, often multi-colored, they reflect what they are: cancer cells growing wild.
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What can you do to sort out all these blemishes and bumps? Just keep an eye on your skin. Pay attention when you bathe and dress. It’s your body, beautiful, so give it some loving attention. If you have moles on your back, use a mirror or ask someone else to look at them from time to time. If you have a family history of melanoma, this is especially important.
If a mole changes color, shape, size or contour, it could be going rogue. If a mole itches, hurts or bleeds, same thing. If you get a new mole after age 30, or at any time if you notice something new or something changing, see your doctor. When in doubt, check it out. Call SHAC at (505) 277-3136 for an appointment. We even have a dermatology clinic where we can send you if necessary. For more information, check out to the Skin Cancer Foundation at SkinCancer.org.
Peggy Spencer is a student-health physician. She is also the co-author of the book “50 ways to leave your 40s.” Email your questions directly to her at pspencer@unm.edu. All questions will be considered anonymous, and all questioners will remain anonymous.
