My teenage daughters are concerned about their skin ... but not for the typical teenage reasons

.
My daughters worry about their skin, but not for the typical reasons of most teenagers.  Yes - they have the typical teen concern for their complexions and they are hyper-sensitive about any pimples or break-outs, but they are also very vigilant about skin cancer, specifically malignant melanoma.

Unfortunately for them, they have inherited their high-risk for melanoma from me.

On Monday, at my regular 6 month check-up, this mole looked to have some slight
abnormality in the pigment layers and so my dermatologist removed it. 
We are ultra-cautious because of my past history with Malignant Melanoma. 
It is not uncommon for 2-3 moles to be removed at each semi-annual
appointment, just to be safe.

Although nobody else in my extended family (parents, siblings, cousins, grandparents, etc) has had skin cancer, I have had the dreaded (and scary) diagnosis three different times.  Three occurrences over the course of about 12 years, and according to my dermatologist, over that time span they were unrelated and were 3 individual, separate occurrences. 

My risk factors include my obvious light complexion with freckles, and my red hair.  The only other risk factor I can specifically point to is sunburns in childhood that caused blisters - a not so rare occurrence for anyone that is accidently too long in the sun.  Those blisters would usually occur on my shoulders or even my nose - and yet my melanoma showed up in areas that did not get sunburn exposure - my lower back, inside and outside of my thigh.

The only reason I mention this now is because of a recent conversation with my dermatologist.  For the most part, people are generally unaware that any new moles should be cause for concern and any existing moles that change should be cause for concern.  With melanoma (the most dangerous and deadly form of skin cancer) the earlier it is caught the better your chance of survival.  Early detection is critical.  C.R.I.T.I.C.A.L.

Malignant (which means spreading) melanoma forms in the pigment cells of the skin called the melanocytes.  Most times it spreads to the skin surface first and is detected as a mole.  It then spreads deeper into the skin layers and the blood stream - and then it can affect the lymph nodes and major organs; liver, lungs and brain.  This is why early detection is so important.  If a melanoma is detected early, it can be as simple as removing the mole, which removes the cancer cells.

My first bout with melanoma happened when I was 25 years old.  I had a small, dark mole on my lower back that seemed to change in size.  I was concerned enough to schedule an appointment with a dermatologist, who although he felt it did not look abnormal enough to be anything too serious, he removed it for my peace of mind.  THANKFULLY. 

A week later, he called me with the diagnosis of malignant melanoma and he already had an appointment scheduled for me with a surgeon.  The gravity of the situation did not sink in, and detecting this in my voice, he paused and said, "Karen, this is extremely serious and is a matter of life and death.  People die from melanoma.  If you make it 10 years without it spreading to your organs, you'll have a decent chance of survival."  That was enough to make the breath stop in my lungs and nausea well up in my stomach.  My mind reeled with his words .. death?!?! survival?!?!?  "I'm only 25 how can we even be having this conversation?!?!?"

Long story short ... the melanoma had not yet spread to any surrounding tissue, organs or lymph nodes and I had surgery to remove surrounding tissue below and around the site (in case there were any stray cancer cells), and emerged with a 6" long scar on my back and an intense fear of cancer.  For the next 10 years, I had full-body checks every 6 months to monitor moles (any changes in appearance) and chest x-rays to monitor my lungs for cancer (since that is a common area for it to spread). 

A few years later, we had our first daughter, and at that point, it really hit me as to how serious this brush with cancer was.  Now I had a daughter that I loved fiercely and protectively, someone counting on me, and my fear of cancer intensified.  Our precious second daughter arrived, and I was still getting check-ups every 6 months, and all was well.  At the 10 year mark, my doctor announced, "Congratulations, you are officially a cancer survivor and your prognosis is excellent!"  That was in  2003.

In 2004, a small dark mole appeared on my outer left thigh and I immediately scheduled an appointment.  A mole as small as this, usually is not cause for concern, but I asked my doctor to remove it anyway.  Melanoma - but no spreading to surrounding tissues.  I ended up with about a 1" scar.

In 2005, I noticed another small mole on my inner right thigh, this one about the size of the tip of a pencil lead.  But to me, the dark blackish/brown coloring was a tip-off.  Melanoma In-Situ.  Which means this one was caught so early that the cancer cells were only in the outermost layer of skin (the epidermis) and had not invaded any of the deeper skin cells.  I ended up with another small scar.

That was 6 years ago.  For 5 years after that last diagnosis, we stepped up my visits with the dermatologist to every 3 months and just this year, with no additional occurrences, we are back to every 6 months.

My dermatologist specializes in melanoma, and he carefully examines each mole with a special lighted scope that he holds against my skin and views each mole under magnification to see the structure of the pigment cells.  Any tiny abnormality that he detects, we automatically remove the mole, which involes a shot to numb the area, a quick circular cut with a scalpel about 1/8" deep, and 2-3 stitches.  A sharp pinch of the shot when he numbs the area, otherwise it's painless and I remove the stitches myself after 10 days.  Yes - it leaves a small 1/4", nearly invisible scar, but I count those scars as insurance against a future skin cancer.

A few years ago, it occurred to me that whenever I had a regular doctor appointment, they always asked me about any family history of melanoma because it can be an inherited predisposition, so I decided to bring my daughters in for a full body check.  Both of my daughters have now had 4 or 5 moles removed, and each of them have had 1 mole diagnosed as atypical or dysplastic - which means that there was some slight abnormality in the cells which made it likely to have developed into skin cancer in the future.  All 3 of us are extra vigilant about watching for any changes in our moles and at the slightest concern, we schedule an appointment with our dermatologist.

Emme had a small mole removed from her upper back about a month ago.
Although the mole looked suspicious, the pathology report came back clear. 

The scar on Emme's upper chest (see blue arrows) is from the removal of a mole
that was atypical and was at risk for skin cancer.

Don't forget to check the scalp by drawing small sections
of hair back to methodically look for moles.  Maea's atypical mole was on her scalp.

My entire reason for explaining this is to bring your awareness to it - for you, your kids and your family.  My dermatologist mentioned that most people don't notice the early changes (because they are not monitoring or looking for changes) and with melanoma, by the time they seek medical care, it may be too late.  My first diagnosis was in 1993 (18 years ago).  My second diagnosis came 11 years later and my 3rd diagnosis came 1 year after that.  For the last 6 years, I have had several moles removed but none have been melanoma.

Moms - check your kids, check yourself, check your spouse and your loved ones.  If you notice anything that causes concern, make an appointment with your doctor or dermatologist.  It's better to be safe than sorry, and have it removed (and always make sure it is sent to pathology for examination).

Establish a baseline so you are familiar with your moles and can recognize any changes.  For me, the first thing I noticed 18 years ago was the darkness of the mole compared to all my other freckles, and that the size seemed to have changed.  For my 2 most recent occurrences, it was simply the dark color that made it noticeable to me.

Here's what to look for (excerpt from the PubMed Health website):

The primary symptom of any skin cancer is usually a mole, sore, lump, or growth on the skin. Any change in appearance of a pigmented skin sore over time is a warning sign. Also, watch for any bleeding from a skin growth.

The ABCD system may help you remember features that might be symptoms of melanoma:

• Asymmetry: One half of the mole or lesion is different from the other half.
• Borders: Irregular edges.
• Color: Color changes from one area to another, with shades of tan, brown, or black (sometimes white, red, or blue). A mixture of colors may appear within one mole or lesion.
• Diameter: The trouble spot is usually (but not always) larger than 6 mm in diameter -- about the size of a pencil eraser.

The key to treating melanoma is recognizing symptoms early. You might not notice a small spot of concern if you don't look carefully, so perform thorough self-examinations monthly, and schedule a formal skin exam with a dermatologist yearly.

Melanoma can spread very rapidly. Although it is less common than other types of skin cancer, the rate of melanoma is steadily increasing. It is the leading cause of death from skin disease.  The risk of developing melanoma increases with age. However, the disease also frequently affects young, otherwise healthy people.

The development of melanoma is related to sun exposure or ultraviolet radiation, particularly among people with fair skin, blue or green eyes, and red or blond hair.
Risks for melanoma include the following:

• Living in sunny climates or at high altitudes
• Long-term exposure to high levels of strong sunlight, because of a job or other activities
• One or more blistering sunburns during childhood
• Use of tanning devices

Other risk factors include:

• Close relatives with a history of melanoma
• Exposure to chemicals that can cause cancer, such as arsenic, coal tar, and creosote
• Presence of certain types of moles (atypical dysplastic) or multiple birthmarks
• Weakened immune system due to AIDS, some leukemias, organ transplant, medications used to treat illnesses such as rheumatoid arthritis

I don't live in constant fear about skin cancer anymore - but it has become a regular habit for me to monitor my skin for any changes - as well as my daughters.  Early detection is critical and if you notice anything that causes concern, schedule an appointment with your doctor and have it checked.  And feel free to spread the word to your friends and family by forwarding this post.