Imagine YourHealth

Ten years ago, just before her wedding, Becker (not her real name) decided to go in for a complete physical. "I thought it would be a good thing to do, because I was getting married and I'd never had a real physical before." It was one of the smartest moves she ever made.

"I had a mole on the inner calf on my left leg. I had noticed it, but I didn't think twice about it, except that I was glad my wedding dress would cover it up because the mole was so ugly," the 33-year-old mother of two now says. "The doctor asked if I had ever had the mole biopsied, but it had never crossed my mind. She said it looked suspicious, and that I should see a dermatologist." Despite her doctor's concern, Becker didn't feel a real sense of urgency. " I was really busy and thought about not doing it; I still don't know what made me decide to go in and have it biopsied," she says. She got a call from the lab the very next day. "They said, 'You get in here, right now. You have melanoma.'"

Becker scheduled surgery almost immediately, had the melanoma removed, and had her lymph nodes biopsied. Fortunately, the cancer hadn't spread. "I was pretty uneducated about melanoma at the time. I didn't realize the seriousness of it until after the surgery," she says. "Afterwards, it dawned on me that I had one foot in the grave."

An Often Silent Killer

The skin is composed of many layers. The top layer is called the epidermis. "Within the epidermis, there are pigment cells called melanocytes," explains Tiffani Hamilton, MD, a dermatologist with Dermatology Associates of Atlanta. "Melanoma is a skin cancer of those melanocytes, and has a very high rate of metastasis (spreading from the original cancerous area)," she adds.

Superficial spreading melanoma, which accounts for nearly 70 percent of all cases, and travels along the top layer of skin before invading more deeply. It has irregular borders and various colors, including tan, brown, black , blue, red, and sometimes white.

Acral lentiginous melanoma, which also spreads superficially before penetrating. The most common melanoma in African-Americans and Asians, it appears as black or brown discoloration on the soles of the feet or palms of the hands.

Lentigo maligna, an invasive form of melanoma, is a flat or slightly elevated tan, brown, or dark brown discoloration, which appears on the face, arms, ears and neck. It is most commonly found in the elderly.

Nodular melanoma is the most aggressive of the four, and can be found on the trunks, legs, and arms, and, in men, on the scalp. It is usually black, but can also be blue, gray, white, brown, skin tone, red, and tan.

"Almost everybody is at risk these days," notes Dr. Hamilton. "While the risk for everyone has gone up dramatically, we do know that there are several specific factors. The most important is a family history. A first-degree relative with melanoma really puts you at high risk." Becker concurs. "After my surgery, I did some research and found out that my grandfather also had melanoma," she says.

"Having a large number of moles--greater than 100--is considered to be a risk factor," Dr. Hamilton continues. "Also, having very large and funny looking moles and a history of blistering sunburns are factors." Risk can also increase with age, Dr. Hamilton adds. "Lentigo maligna occurs commonly in the older population, on the face and sun-exposed areas, whereas more common melanomas occur in younger people and either rise within common skin or on a pre-existing mole."

"The majority of our lifetime sun exposure [occurs] before age 20," notes Dr. Hamilton, and good sun protection at a very young age is the most imprint factor in preventing melanoma. "If I go out in the garden I always wear a hat and a lot of sunscreen, and I make sure my kids are well lathered up with sunscreen, too," adds Becker.

"It's important to do a monthly self-skin-exam, and to know what's on your body," says Dr. Hamilton. "Also, any new mole that develops after age 30 is really suspect. We don't tend to develop any true moles after age 30, although we develop a lot of other benign growths that can be confused with moles. So any new growth or any change in a mole are suspect, and that mole should be looked at," she says.

Many melanomas can be spotted as soon as they arise, and are almost completely curable if diagnosed and removed while still on the outer skin layer. The key is knowing what to look for. The Skin Cancer Foundation recommends that you check the following warning signs:

A--Asymmetry. One half is unlike the other half. In a benign mole, both sides are symmetrical.

B--Border. An irregular, scalloped border is a warning sign. A benign mole has a smooth border.

C--Color. Melanoma has colors that vary from one shade to another, and can include tan and brown colors, as well as red, white, and blue. Healthy moles are usually an unvaried shade of brown.

D--Diameter. Usually, melanoma is larger than 6 millimeters, or the diameter of a pencil eraser.

Also, be sure to watch for any changes in a mole, such as rapid growth or itching and bleeding.

If any of the above factors are present, be sure to have them checked out by a physician immediately. While Claudia Becker was extremely lucky with her experience, she'll be the first to tell you not to take that chance. "Be conscious" is her new motto.