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| IS IT SKIN CANCER?: Recognizing Suspicious Lesions |
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by Risha Bellomo, MPAS, PA-C - May 11, 2011
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Dermatology is a field that every specialty of medicine will encounter at some point throughout a typical day. No matter if you are performing a physical exam or applying electrodes for a routine EKG you will definitely be visualizing the skin. It is crucial to the health of your patients that if you recognize a suspicious lesion to refer them to a dermatologist for a biopsy and a full skin examination. It is recommended that all patients at all ages receive an annual skin exam performed by a dermatology provider.
By understanding a few simple rules can help you tremendously in recognizing a basal cell carcinoma, squamous cell carcinoma or a melanoma. This could save your patient's life. It is also important to recognize pre-cancerous lesions, such as dysplastic nevi and actinic keratoses. Early recognition and education is key to keeping our patients from having unnecessary surgical procedures.
A Basal Cell Carcinoma (BCC) is the most common skin cancer in the United States affecting more than 1 million patients a year. BCCs are typically found in sun exposed areas and can look like pearly pink papules, which can appear to patients like a pimple that just does not go away. BCCs can be also mistaken for angiomas, fibrous papules and sebaceous hyperplasias. BCCs may bleed, itch or be tender. They may have an ulcerated center or ectasias.
Squamous Cell Carcinoma (SCC) is the second most common skin cancer and if gone unrecognized and left untreated an SCC may become invasive and potentially metastasize. Actinic Keratoses (AKs) are the precursors to squamous cell carcinoma and should be treated aggressively in order to prevent an SCC from developing. But even without the signs of a hypertrophic AK, an SCC may develop and they can develop rapidly. A Keratocanthoma is a type of SCC, which typically develops rapidly and can grow to double its size within weeks. Squamous Cell Carcinomas can also look like a psoriasis plaque or nummular eczema and I have seen cases where an SCC has been treated with topical steroids for more than ten years. Some good advice to take is that if a lesion looks like a rash and is not responding to a topical steroid then it is probably something else and should be biopsied. SCCs can also present as nodules that are painful and may bleed. So be on the lookout.
Melanoma is the skin cancer everyone is most fearful of. It affects the melanocyte, the melanin producing cell which is the cell that constitutes the benign melanocytic nevus. These can be silent killers. The reason is they do not always present in sun exposed areas and may appear only slightly darker with minimal blurry borders that a patient may never notice. Many patients believe if a mole is elevated then it is abnormal, but the majority of dysplastic nevi and melanoma I have found have been macular. Melanoma can also present as nodules, acral, superficial spreading, lentigo maligna, and ulcerated. A good start to assessing patients with malignant melanoma is understanding the ABCDs of Melanoma.
A is for Asymmetry: one side is unlike the other.
B is for Border: irregular borders; blurry, notched, scalloped or poorly defined.
C is for Color: a variety of hues within the same lesion, or a very black mole that stands out from the rest.
D is for Diameter: a new appearing mole that is bigger than 6 mm or bigger than a pencil eraser.
E is for Evolving: any mole that is changing, bleeding , tender or itching.
It is also important that you question the patient about the history of the mole. Such as, how long has it been there, did it develop after the age of 21 or have they had it there their whole life. And always ask about any physical changes in the mole and if the mole is symptomatic. Another important question to ask is about the patient's family history, since we know that melanoma in particular can have a genetic link. Other history taking tips:
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Has the patient had or is currently using any type of immunosuppressant agents.
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History of severe sunburns, accidental burns or chemical burns.
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History of Radiation.
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More than 50 moles.
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History of Dysplastic or Atypical Nevi.
Understanding the differences in lesions is important in order to save patient's lives. So if during your daily routine you come upon a lesion that looks suspicious then consider a biopsy or refer to your local dermatologist.
Learn more about Suspicious Lesions, Bites and Infestations and The Art and Science of Botox at my upcoming presentation in Orlando, Florida on September 7th, 2011 during Skin, Bones, Hearts and Private Parts.
 Risha Bellomo, P.A.-C. has over 18 years of healthcare experience. Risha specializes in Medical and Cosmetic Dermatology, with a background in Primary Care and Emergency Medicine. She earned her Bachelor's Degree in Microbiology with a Minor in Chemistry at the University of Florida, and went on to earn a Masters Degree as a Physician Assistant through the College of Medicine at the University of Florida. Risha currently is employed with Advanced Dermatology in Orlando, FL where she has worked alongside Dr. Matt Leavitt for the last 9 years. Risha specializes in the treatment of all skin, hair and nail disorders, performs surgery along with a variety of cosmetic procedures. Her sub-specialties include Pediatric Dermatology, Psoriasis, Acne, advanced Botox techniques, dermal fillers, laser treatment and sclerotherapy. A National Trainer for Botox and dermal fillers, Risha has also been featured in Central Florida Bride as the key Dermatologist for Extreme Bridal Makeover. Risha is the Central Florida Representative and Co-founder of the Florida Society of Dermatology Physician Assistants. She is a national speaker for Galderma, Coria, Amgen, Warner Chilcott, Allergan, and Centocor . She is the cosmetic columnist for the Journal of Dermatology Physician Assistants and the PA columnist for Skin & Aging. Ms. Bellomo is a faculty preceptor for Nova Southeastern University and University of Florida where she takes pride in giving back to her profession. She is also the co-founder of the Florida Society of Dermatology Physician Assistants.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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