Summer skin: Dermatologists reveal how to stay safe and when to worry

Eleven years ago, when David Kantor had a mole removed by his dermatologist, his dermatologist ultimately decided the mole wasn’t skin cancer. But in May of 2021, Kantor went to a doctor about a lump on his groin. A biopsy revealed it was a melanoma. He had surgery to remove his lymph nodes, but eventually, the cancer came back.

Kantor passed away in early 2022, just a few days after his son was born. His wife, Anandhi Narasimhan, hopes Kantor’s story will help people understand the importance of sun protection, something she is now acutely aware of all the time.

“I live near the ocean and last week there were a bunch of white people doing lifeguard training. Their backs were bright red and I just wanted to cry,” Narasimhan tells Inverse. “People forget that skin is the largest organ and we have to protect it like we do other parts of the body. I think people underestimate what the sun does.”

According to the CDC, skin cancer is the most common type of cancer in the United States. Melanoma is less common than most other types of skin cancer (like basal cell carcinoma and squamous cell carcinoma), but more dangerous because of its ability to spread rapidly.

The American Cancer Society estimates that 2022 will see 197,700 new melanoma cases.

Sacharitha Bowers, a board-certified dermatologist and assistant professor in the dermatology division of the SIU School of Medicine tells Inverse that people can get plenty of weird skin growths that are completely harmless. But, she says “that’s all the more reason it’s important to know the signs and symptoms of skin cancer.”

What is melanoma?

Melanoma is a type of skin cancer that begins in pigment-producing cells called melanocytes, Melanie Palm tells Inverse. Palm is a board-certified dermatologist who practices in California. Melanocytes are found on the upper layer of our skin. Melanoma occurs when those cells become damaged, usually through UV radiation. That damage can sometimes result in mutations, causing “uncontrolled cellular growth,” according to The Skin Cancer Foundation. In fact, “eighty percent of melanomas are related to UV exposure,” says Palm, and they often arise from pre-existing moles.

Melanomas don’t have to start as a mole, however, and can happen anywhere on your body, says Bowers. They often develop on areas that get regular sun exposure like arms, legs, and face.

What does melanoma look like?

Bowers says there are two initial signs of melanoma:

• A change in an existing mole
• The development of a new pigmented or unusual-looking growth on your skin

“When you’re looking at your skin, you want to look both at moles that you already have to see if they’ve changed in some way, as well as if you have any new moles or unusual growths or discoloration anywhere on your skin,” Bowers says.

Paying attention to other growths as well as moles is important for skin cancer generally, but especially so because of a lesser-known, rare, but extremely dangerous kind of skin cancer called Merkel cell carcinoma.

“It’s more rare and lethal than melanoma, and increasing in incidence,” Palm says. “There is not a distinguishing feature of Merkel cell carcinoma. It is supposed to be a red bump on the skin, but the one I diagnosed presented as a noninflammatory cyst.”

For any skin cancer, dermatologists advise paying attention to the A, B, C, D, and Es of skin cancer:

Asymmetrical shape. Here, Bowers says, you’re looking for any changes to moles or growths that turn them asymmetrical. “For example, if you were to cut the mole in half, would both sides look the same? Is it symmetrical?” If it’s not, a visit to the dermatologist may be in order.

B stands for border. The Mayo Clinic advises looking for moles with “irregular, notched or scalloped borders,” which are characteristics of melanomas.

You also want to pay attention to any changes in C, color. “If the color varies at all, or there are multiple colors,” that’s something to get checked out Bowers says. The same is true for any mole that changes color.

Diameter may also be important. Bowers says dermatologists used to think of diameter in terms of a mole larger than a certain size, but current wisdom suggests it’s more about growth. “If you have a mole that was quiet and then all of a sudden it starts to grow on you, that’s something that should be looked at,” she says.

Both Palm and Bowers say the final letter, E, is the most important. E stands for evolving, or evolution. Bowers explains, “Evolution is kind of catch-all, which basically says, ‘if the mole looks different in some way — even if you’re not quite sure how — if it’s changing on you, then you should come in and have us take a look.’” It can be hard to monitor the border or symmetry of a mole, but simply the fact that it’s changing in some way is reason enough to get checked.

“If a mole is itchy, painful, bleeding, or sensitive, get it evaluated,” Palm says.

How often should I get checked for skin cancers?

Outside of changes to a mole or growth, routine skin cancer screenings are vitally important, the dermatologists say.

Some people may need to go in more often than others.

“For adults without a history of skin cancer, an annual skin exam is great,” Palm says. “For someone with a history of skin cancer, many abnormal moles, or a family history of melanoma may need a full skin exam every six months.”

Someone with a recent skin cancer diagnosis should be seen frequently in the first year, “such as quarterly skin exams,” she adds.

In addition to family history, “a significant history of blistering sunburns, tanning bed use, or tanning more generally, should get skin checks more frequently,” Bowers says. “The same is true if you’re on any medications that might suppress your immune system.”

Most importantly, Bowers says, you don’t have to figure this calculus out on your own. “When you go in for your first skin check, your dermatologist will talk to you about all this and give you guidance about how frequently you should come in to get checked.”

Bowers also recommends people pay attention to their skin so they can be more attuned to any changes that might appear.

“We recommend everybody to get really comfortable with examining their own skin. I tell patients you are your first line of defense. I'm only going to see you at one point in time and…you're going to look at yourself every day,” she says.

The sooner your notice something, the sooner it can be biopsied and removed with a smaller surgery as well as a lower risk of it spreading.

Bowers advises taking pictures of your moles, especially the ones on your back, the back of your legs and neck, and anywhere else you might not otherwise see very often.

“Try to take pictures the same distance away, in roughly the same light each time. That will make it easier to see any changes.”