What do your moles look like? White moles are usually harmless; sometimes skin cancer develops in or near a mole. If you know where you have moles and what they look like, it can help to find skin cancer early. Which is important. When found early enough and treated, skin cancer has a high cure rate.
Colors: A mole can be: One color - Usually borwn, but can also be tan, pink, skintoned, blue, pink, or flesh-tone. They can be round or oval, flat or raised. They can look the same, month to month. Many can differe in size shape and color. If they have hair, it is not a sure sign that they are harmful or not. Some moles will change clowly, sometimes even disappearing. The most important thing is to notice whether they are changing in shape, size, color, border, or sensation. These changes may indicate a need for biopsy or removal to be sure they are not on the way to becoming harmful. The usual custom here is to fully remove questionable moles; that way the pathologist has the full picture and a significant area is not missed.
How to check your Moles: By checking your skin as a habit, once a month or so, you can learn what your moles look like. Once you do, it is easier to spot changes. In adults, a change to a mole or sudden appearance of a new mole can be a sign of melanoma. Melanoma is a type of skin cancer that can be deadly if not caught early and treated.
Finding melanoma early is essential. Melanoma has a cure rate of nearly 100% when found early and removed. The best way to check your skin is to perform a skin self-exam. You can perform the exam at home, with a room where you can undress privately and have access to at full length mirror and a hand-held mirror. It is also helpful to use a body mole map to track changes on your skin. A skin self-exam means you need to look at all of the skin surface. Moles and melanomas can appear anywhere on your skin: scalp, fingers, toes, sole of the foot, under a nail, or in the bathing suit areas. Warts are multi-sized, growths, often on the hands and feet . Sometimes they look flat and smooth, other times they have a dome-shaped or cauliflower-like appearance.
As you examine your skin, look at each individual mole. As you do, look for the following signs we refer to as the ABCDE's:
A=Asymmetry: Is one-half of a mole unlike the other half?
B=Border: Does a mole or freckle have an irregular, scallped, or poorly defined border?
C=Color: Is there more than one color, such as shades of tan, brown, black, red, white and/or blue?
D=Diameter: Do you have one bigger than a pencil eraser (about 6mm)? Melanomas are usually over 6mm but can be smaller.
E=Evolving: Do you have a mole that is changing in color, sizne, or shape?
WHEN TO SEE A DERMATOLOGIST While examining your skin if you answered yes to any two or more of the above (Or to E, above), you should see your dermatologist in days to weeks if possible. While you might have melanoma, if found early, it is highly treatable and has a high cure rate. Very helpful in preventing melanoma or skin cancer is to avoid indoor tanning, use an SPF above 20, use protective clothing, and avoid strong direct or indirect sunlight (9am-3pm). Ultraviolet from the sun is not prevented by clouds, and is reflected off of the ground and water. We don't recommend avoiding all sunlight and recognize the importance of Vitamin D3.
REMOVING A MOLE If your dermatologist sees a mole or other spot that looks abnormal, he or she may recommend removing it.
"Never try to remove a mole at home, even with ever-popular, internet-recommended remedies. You risk infection, scarring and most importantly, incomplete removal of what may be a dangerous lesion."
If you have a mole removed in the office, the first step normally is to discuss the risks, benefits, and alternatives of the procedure. Then you may be asked to sign a consent for the procedure. This is usually followed by having the area numbed with a small amount of local anesthetic, that just puts the area of and around the mole to sleep. The specimen removed will be sent for analysis by a pathologists, in the case of our office, only a dermato-pathologist is chosen to look at specimen on a microscopic slide. A report is posted to your account with the lab, and we can access the results from there. It usually takes 7-9 days for a result to be available. The process of removing the skin and examining it under the microscope is called "removal with a biopsy". If you see a mole or other spot reappear after a skin biopsy, immediately make an appointment to see your dermatologist for follow-up evaluation.
UNDERSTANDING THE BIOPSY (PATHOLOGY) REPORT
Atypical/Dysplastic Nevus: If the biopsy report says your mole showed atypical or dysplastic features, this does not mean that you have skin cancer. However, the features seen on the microscope may indicate that the lesion could be transforming, or may need a larger safety margin of normal tissue, than originally taken, to be sure no abnormal cells have separated from the main mass, or to remove what may have been a microscopic melanoma which left to itself, would become problematic. Your dermatologist will determine if the mole requires any further treatment.
You can learn more by visitng SPOT Skin Cancer(R) at www.SpotSkinCancer.org. Here you can learn how to perform a skin self- exam, download a body mole map, to help you track changes on your skin, and find free skin cancer screenings in your area. Additioinal information is available at the American Academy of Dermatology's web-site: www.aad.org
WARTS (Verrucae: pronounced: vah ru kee) = Human papilloma virus or HPV infection
Warts can be surrounded by skin that is either lighter or darker. They are caused by different forms of Human Papilloma Virus (HPV). Verrucae occur in people of all ages and can spread from person-to-person and from one part of the body to another. Warts are usually benign (noncancerous) and generally painless. They may disappear without any treatment. However, in most cases eliminating warts takes time. The location of a wart often characterizes its type, or sub-type:
Common warts can appear anywhere on the body, although they most often appear on the back of fingers, toes and knees. These skin-colored, dome-shaped lesions usually grow where the skin has been broken, such as a scratch or bug bite. They can range in size from a pinhead to 10mm and may appear singly or in multiples.
Flat (plane) warts appear on the face and forehead. They are flesh-colored or white, with a slightly raised, flat surface and they usually appear in multiples. Flat warts are more common among children and teens than adults.
Genital warts appear around the genital and pubic areas. It is also possible to get genital warts inside the vagina and anal canal or in the mouth (known as oral warts). The lesions start small and soft, but they can become quite large. These warts often grow in clusters. They are both sexually transmitted and highly contagious. It is recommended to avoid sexual contact with anyone who has a visible genital wart, or with whom you are not completely exclusive, due to the high risks. Genital warts should always be treated by a physician. A vaccine, known as Gardasil (Merck), conveys some protection agains the most dangerous strains, which can cause cervical cancer in females, and it is generally given by your primary physician. This vaccine must be given in three stages, and prior to exposure to a wart virus, to be effective. Emerging evidence indicates this vaccine is now recommended if possible, before puberty.
Plantar warts appear on the soles of the feet and can be painful since they are on weight-bearing surfaces. They have a rough, cauliflower-like appearance and may have a small black speck in them. They often appear in multiples and may combine into a larger wart called a mosaic wart. Plantar warts can spread rapidly.
Subungual and periungual warts appear as rough growths around the fingernails and/or toenails. They start as nearly undetectable, pin-sized lesions and grow to pea-sized with rough, irregular bumps with uneven borders. Subungual and periungual warts can impede healthy nail growth. Because of their location, they are difficult to treat and generally require medical attention.
Most warts respond to straight-forward treatments including:
- Salicylic acid preparations, which dissolve the protein (keratin) that makes up the wart and the thick layer of skin that covers it. Salicylic acid comes in gels, pads, drops and plasters. When we use the 40% prep is usually takes 5 to 7 weeks to eradicate the warts. Often we will assist patients using this method by paring down (debridement) of excessive or stubborn tissue, usually after 2-3 weeks of treatment. Salicylic acid, with or without debridement, is our most commonly recomended method because of less pain, expense, scarring and lower recurrence rates. However, it cannot be used for genital warts (see below).
- Cryotherapy, which "freezes off" the wart using liquid nitrogen. Advantage: Faster resolution when it works. Can be used jointly with a topical Rx (see below). Disadvantages: This method is more painful, often has a higher recurrence rate than the salicylic acid preps, and can easily lead to temporary or permanant discoloration.
- Nonprescription freezing products (dimethyl ether), aerosol sprays that freeze the warts and causing them to peel off. Advantages and Disadvantages: similar to the above, but less powerful and often fewer side effects.
- Prescription creams and gels: There are two main prescription items used for genital warts, available under the names: Aldara, Zyclara, or imiquimod (the generic of the above two). They are applied as directed, and work by causing the body's immune system to mount an attack on the warts. Another plant-based agent, Veregen, has been found useful where the above two have not been effective. Sometimes, an older tree-derived agent, podophyllin is used.
If self-treatments don't work after a period of about 4 to 12 weeks, or you are concerned nonetheless, contact our dermatologist. We'll assess your warts and recommend the best option. Always contact your dermatologistsooner than that, if a wart is causing pain, changes in color or appearance and for all genital warts.
CYSTS: Skin cysts can be anywhere on the body from scalp, to toes. They are usually benign (not harmful), and are usually considered cosmetic (non-insurance covered) items, unless they are clearly inflamed, infected, or interfering with a bodily function. When the cysts are large (over 1.5cm) and on the scalp, neck or back, we often drain them first, then wait 7-10 weeks for nature to shrink them, before offering the elective (optional) removal of the wall of the cyst. If and when they are removed, we usually submit them for histological analysis if over 1cm, as there is a small, but significant incidence of worrisome transformation of the cells. Sometimes, the wall of the cyst can be removed at the same time as the drainage. When this is possible, we will advise you. Cyst drainage and/or removal only requires local (at the site) anesthetic. If there is probable inflammation or infection, we will usually recommend an antibiotic first for 24-48 hours to reduce the bacterial counts, before initiating the procedure. This helps reduce the risk of a heart valve infection. Sometimes inflamed or painful cysts must be drained on an urgent basis. If we feel your cyst is urgent or extremely urgent, we would shorten the anti-biotic pre-treatment period to 1-2 hours.
For an evaluation or treatment of your moles, cysts, or warts in the Edmond/Oklahoma City Metro area call us at Silver Leaf Dermatology: (405) 216-0100. In Northwest Oklahoma call us at Graham Dermatology Center in Enid at (580) 234-4861. We visit the Enid Office on Mondays and Tuesdays.