Skin Lesions – A Closer Look

In the United States the American Academy of Dermatology estimates that there has been a significant increase in the morbidity and mortality of skin cancer in the past few decades.  Almost 138,000 new cases of melanoma were diagnosed in 2015 alone.  When you consider non-melanoma skin cancers including Basal cell cancer and/or squamous cell cancer more than 3.5 million new cases of skin cancer are diagnosed annually.  Skin cancers cause approximately 15,000 deaths per year of which 75% are due to melanoma.

The single most important risk factor for the development of skin cancer is exposure to natural and artificial ultraviolet radiation.

Avoiding natural and artificial ultraviolet light is the only risk factor that can be avoided.  Avoiding ultraviolet light can potentially prevent millions of new cases of skin cancer each year.  Other risk factors include:

  • A prior history of skin cancer.
  • A family history of skin cancer.
  • Fair skin.
  • Red or blonde hair.
  • A prosperity to burn easily.
  • Chronic exposure to toxic compounds.
  • A suppressed immune system.

In 1985, the American Academy of Dermatology studied melanoma and observed that there are several characteristic changes of skin lesions that correlate with melanoma.  Asymmetry (A); Border Irregularity (B); Color changes (C); and Diameter size greater than or equal to 6mm (D) were consistently observed with melanoma skin changes.  This led to the ABCD acronym that has been widely taught to physicians and patients around the world to determine the likelihood that a skin lesion is cancerous.

Additional criteria that are often used is the change in the size or appearance of the skin lesion with time.  Accordingly E for elevation and an F for evolving or fluxuating have been added to the A B C D criteria.

Changing “moles” are characteristic for patients presenting with a malignancy that will present as increasing in size or changing in appearance.

The Sollay Laser Center staff would like to review with all of our patients and remind all patients reviewing this website of the classic criteria of suspicious skin lesions:

  1. Asymmetric (irregular) on any side of the lesion.
  2. Ragid or blurred.
  3. Variegated with two or more colors including greys, browns, blues, whites, pinks.
  4. Greater than 6mm in size.
  5. Raised surface.
  6. Evolving/Changing appearance. Enlargement, changes in thickness or bleeding without cause.

The “ugly duckling sign” demonstrates the different appearance of the melanoma as it changes compared to other lesions that the patient may have.  All ugly duckling lesions need to be immediately examined by your family practice physician or dermatologist.


Prevention is aimed at reducing exposure to ultraviolet radiation.  The following measures can be protective:

  • Avoid the sun between 10:00 a.m. and 4:00 p.m.
  • Wear sun protective clothing when exposed to sunlight.
  • Wear sunscreen with a SPF (sun protection factor) of at least 30.
  • Avoid artificial sources of ultraviolet radiation. (tanning beds)
  • Be aware that fair skinned individuals are particularly at risk for the development of skin cancers.
  • Know your family history. If you have a significant family history of skin cancers then have your skin examined at least yearly during physical examinations by your family doctor.
  • History of benign or malignant cancer previously places you at particular risk for additional cancers. You should be examined and managed by your primary care physician on a regular individual basis.

You can make a difference in your outcome of skin cancers by regularly doing self inspection of your skin and by having your primary care physician examine your skin during routine examinations.  Bring to your practitioners all unusual skin lesions which are changing in appearance like the ugly ducking or have been bleeding or in any other way different than usual.  The life you save may be your own.

For a free consultation please call (410) 644-7655.  We will be happy to see you, examine your skin and talk to you about any other medical conditions that require management.

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