SPOTTING THE SUSPICIOUS SPOT: HOW TO TELL WHICH ONE IS DANGEROUS

The older you get, the more spotty you become. As the years pass, expanses of skin that were once clear can become covered in a range of blemishes, dots, spots, moles and freckles. It’s hard to keep track of them all because it seems that new spots can emerge overnight. While most of the spots are harmless, there is always a risk that a melanoma is lurking among them.

Melanoma is one of the commonest cancers in Australia. On average, Australians have one chance in 25 of developing a melanoma before the age of 75. Although people know that early detection is crucial in preventing death from melanoma, most would find it difficult to distinguish a melanoma from moles and other spots.

Even doctors sometimes fail to recognise melanomas on their own faces. There are cases of doctors who have spent months carefully shaving around the melanoma on their cheeks without being aware of what it was they were seeing in the mirror. By the time they realised, their melanomas had become quite thick and advanced.

Older men are at higher risk. Although men over 50 constitute only 14 per cent of the population, they account for more than 50 per cent of deaths from melanoma. Every day, on average at least one older Australian man dies from melanoma. Often the figure is two men a day.

Part of the problem is that in men, melanoma usually develops on the back, shoulders or scalp, where the men can’t see it, let alone identify it.

Another complication is that men often have a nodular form of melanoma, which is more difficult to recognise than the usual form.

Apart from moles, as people age they often develop four other kinds of spots, the most common of which are solar keratoses. These are flaky spots caused when the skin over-repairs sun damage.

Seborrheic keratoses arise from oil glands in the skin and form dark, raised patches that resemble cowpats and look as if they can be flicked off.

Liver spots (lentigo) are the true ageing spots and are just large dark freckles.

There are small red spots too, known as cherry angiomas, which are malformations of little blood vessels. The only danger with these different spots is that a genuine melanoma might be mistaken for one of them.

Men at high risk should have their skin checked regularly. You are at high risk if you have a family or personal history of melanoma, have more than 100 ordinary moles on your body or have more than 50 irregularly shaped and coloured atypical moles.

A fair complexion, a tendency to burn rather than tan, the presence of freckles, light eye colour, light or red hair colour and a history of nonmelanoma skin cancer are also risk factors.

Following are descriptions of some characteristics that may help you identify a melanoma.

Compared to other spots, a melanoma often stands out like an ‘ugly duckling’. It can arise from clear skin or from an existing mole. Hair can grow from it early in its development. This hair-falls out when the melanoma gets deep enough to destroy the hair follicles. Usually, the change in a melanoma is minor and takes place over 2 to 6 months. It can itch, rarely bleeds and doesn’t hurt. Irregularity of colour is significant: a variety of colours in one lesion is a key feature of melanoma.

Doctors use the following ABCD+E system as a guide to detecting melanomas:

A stands for asymmetry.

B stands for the border, which is usually irregular.

C stands for colour, which is usually variegated.

D stands for diameter, which is usually greater than 6 mm when the melanoma is first diagnosed.

E stands for evaluation against surrounding moles – the melanoma should stand out.

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