Someone trying on outfits for the upcoming fall season who sees a new dark spot on her shoulder that she hadn’t noticed before should take a closer look.
Is it a sun-related freckle, or possible early melanoma?
“Fall is a common time that people notice new lesions on their skin,” says Dr. Saif Syed, a dermatologist and Mohs surgeon with Skin Care Specialty Physicians, a comprehensive dermatology practice in Lutherville, Maryland. Syed is a specialist dermatologist who performs skin cancer surgeries on many different types of skin cancer.
“As a dermatologist, we see people come in all of the time with questions regarding spots that are changing or causing symptoms. The lesion may have been present for several years but recently it has begun to change, prompting patient concern.
“The other scenario is that there is a new spot that comes out of the blue that either the patient or a family member may notice.”
Benign lesions: Bland colors, change little over time
Differences in color are often what make lesions stand out on the skin. The color of a lesion is an important determinant of the likely diagnosis of a lesion. Benign lesions usually have particular color features, and malignant lesions often have different color features.
“Benign lesions tend to be bland in color and usually match other lesions on the patient’s skin,” says Dr. Syed. “Oftentimes, patients with a few dark moles will have lesions that tend to all look relatively similar in appearance. Benign moles often have two or less shades of brown or pink, and are one of many lesions. “
The colors tend not to be darker than the patient’s own natural hair or eye color. Similarly, there are many yellow to pink non-cancerous keratosis that are age dependent or genetic in nature, that will often have similar bland non-varying color shades.,
Over short- and long-term frames, benign lesions seldom change.
“There will be the occasional irritated mole, cyst or growth that will get tender in a short period of time, but then it will tend to calm down again and revert to its original size. Other benign lesions will usually grow slowly and stop growing once they have reached their final size.”
Malignant lesions: Differing colors, exhibit progressive change over time
Lesions that are cancerous oftentimes have multiple or differing colors within them. “If a patient has a melanoma,” says Dr. Syed, “the lesion will often have three or more darker shades of brown, or have blue or black tones within it. Other types of common skin cancer, such as basal cell carcinoma or squamous cell carcinoma, will be more red or crusted white compared to normal skin lesions.”
Blandly colored lesions however, can sometimes be cancerous.
“There are small instances where a melanoma has no color at all. Basal cell carcinomas can also often blend into their surrounding skin and grow unnoticed. It is important to have any lesions with color changes evaluated.”
One critical feature of cancerous lesions is they are almost always progressively changed with time. Slow growing skin cancers can include basal cell carcinomas, which will slowly get larger and bleed over time. These lesions may heal temporarily but will almost always bleed and scab and progressively change. Melanomas will slowly get darker and larger over time, and once they are progressive they may thicken and develop more colors within them.
Faster growing skin cancers can also occur, such as rapidly growing squamous cell carcinomas and Merkel cell carcinomas which can be particularly deadly. Any rapidly growing lesion that is tender or bleeding needs prompt evaluation by a physician.
Watch for these changes
It is always a good idea to have your primary physician or dermatologist evaluate any new lesions that are not going away within 4 weeks. Changes such as bleeding, scabbing and tenderness of the underlying skin or local structures are also very important.
Use the change in seasons to look at your own skin and your family’s skin to see if there are any new suspicious spots. And remember that sunblock isn’t just for summer — it can be used on any sun-exposed areas throughout the year.