Skin mapping — or mole mapping — takes a lot of the guesswork out of skin-cancer worries
By Sarah Lemon
Former California “beach baby” Linda Savercool had her first brush with skin cancer at age 21.
The red spot on her chest was the common but rarely serious basal cell carcinoma. But removal of the pinhead-sized patch was just the first in a series of more than 50 atypical moles and cancerous or pre-cancerous lesions cut from Savercool’s skin by the time she was 40.
“When you’re 21 and young, you don’t listen,” she says.
Despite Savercool’s medical history and unusually large number of moles, not one of her physicians ordered a complete skin examination or “mole mapping” session before she became a patient of Medford dermatologist Dr. David Trask about four years ago. “He didn’t know where to begin,” Savercool says. “I have a lot of moles; they’re everywhere.”
Trask’s initial examination documented Savercool’s skin condition with digital photos and by plotting on paper the presence of lesions. The approach is intended to track changes in patients’ skin status and give dermatologists a way to verify their memories of particular moles.
“When a person has 100-some moles on their back, you can’t just look and go, ‘That’s new,’ ” Trask says. “The idea of taking photographs has taken root.”
The session didn’t stop there. Two or three of Savercool’s moles — deemed too suspicious to simply keep under surveillance — were removed then and there. Lab tests revealed characteristics of a pre-melanoma condition.
“If there’s even a chance a lesion is changing, we’re not going to sit on it,” Trask says.
Yet new moles seemed to pop up as quickly as others could be removed. Savercool’s subsequent dermatology appointments became a sad parody of “eenie, meenie, minie, moe.”
“It changes so fast,” Savercool says. “It can happen just overnight.”
For an entire year, Savercool, 52, endured the excision of five to eight moles every two weeks — nearly 100 moles in all. New surgery sessions practically coincided with removal of stitches from the prior visit, the Central Point resident recalls.
“It was pretty painful — my back was the worst,” she says.
“I have, you know, lots of scars,” she says, adding that the biggest on her arms and right leg are 2 to 3 inches long.
However, it’s the anticipation of biopsy results, Savercool says, that “kills” her, even since she started seeing Trask just once every three months.
“You’re waiting for the shoe to drop,” she says.
“I still don’t know what tomorrow could bring.”
While only 35 out of almost 100 moles have shown signs of basal cell carcinoma, pre-melanoma or other atypical features, Trask has assured Savercool, whose case is one of his most unusual, that a reprieve is unlikely.
“This is my life,” she says.
Savercool’s numerous scars have become a conversation starter at the Medford gym where she lifts weights three times per week. She’s aghast when friends tell her they’re going sunbathing or have an appointment at a tanning salon. Although Savercool’s olive-toned skin tanned easily, she still bubbled, blistered and peeled under a sheen of baby oil more times than she cares to remember.
“I just recommend people stay out of the sun — sunscreen or not,” Savercool says. “Nobody is safe. You don’t even have to have moles.”
Stacey Boals didn’t. But the 49-year-old Medford resident had developed an extremely rare and deadly form of skin cancer, noticed not a moment too soon.
Boals initially saw Trask for removal of a few “sun spots” that were later identified as basal cell carcinoma. A complete skin exam with photos wasn’t deemed necessary in her case.
Five years later, Boals was back in Trask’s office and offhandedly mentioned a raw patch on her thigh that she suspected was irritated when she shaved.
Biopsied, the spot proved a rare form of melanoma, completely lacking in pigment and requiring a surgeon’s expertise. A biopsy of Boals’ lymph nodes confirmed the cancer hadn’t spread. The 4-inch scar, which Boals has dubbed her “shark bite,” is a sobering caution against complacency.
“It was like a crater in my leg because they go deep,” Boals says. “I’d rather have that than the alternative.”
Boals’ and Savercool’s stories both illustrate Oregon’s status as a “hot spot” for skin cancer, Trask says. The trend, he and other dermatologists say, can be traced to a few factors: sun exposure through traditional occupations, such as logging, fishing and farming; an influx of former California residents who soaked up too much sun farther south; the state’s growing number of baby boomers, most of whom never wore sunscreen in their youth; and the state’s primarily Caucasian population, the group most affected by skin cancer.
“Skin cancer is pretty epidemic in this neck of the woods,” says Dr. Douglas Naversen, senior partner in Dermatology and Laser Associates of Medford.
“We get a lot of transplanted skin cancers in ex-beach boys and beach girls,” Naversen says.
“We have our hard-working farmers and ranchers ... The last thing they’re thinking about is putting on sunscreen.”
Whereas his practice 25 years ago treated approximately four cases of invasive melanoma per year, Dermatology and Laser Associates’ four physicians each see a case of melanoma about once every week, Naversen says. Although the cure rate for melanoma is 92 percent nationwide, an improvement over recent years, Naversen says, the total number of U.S. melanoma deaths continues to increase.
Statistically, Americans have a one in 70 chance of developing melanoma in their lifetimes, Trask says. In 1935, it was a one in 1,500 chance, he adds.
“Unfortunately, melanoma is one of the deadliest cancers known to mankind,” Trask says, adding that vaccines are experimental and chemotherapy often isn’t effective.
“Once it gets loose, it’s hard to stop it,” Trask says. “The earlier you catch it, the more likely you can be cured.”
Prevention, dermatologists say, is a matter of knowing the ABCs for melanoma and atypical moles: asymmetry, borders, color, diameter and evolution.
While instruments called dermatoscopes can be used to magnify moles and other lesions during an exam, Trask and Naversen primarily employ digital cameras capable of zooming in on a spot to take as many pictures as they believe necessary. Medical photography often is not covered by insurance.
Trask encourages everyone to self-examine their skin once a month, including the scalp. Anyone who’s had melanoma should see a dermatologist at least every six months, he adds. Diagnoses of other types of cancer, such as basal cell, should be followed by yearly visits to a dermatologist’s office.
Those who have never had a skin-cancer diagnosis should be aware that their risk for the disease increases if relatives like parents, siblings or grandparents have had skin cancer, Trask says. Instances of skin cancer pick up after age 20, he says, although his youngest melanoma patient was 11.
The presence of more than 50 moles on a person’s body also indicates an increased risk for skin cancer, he says, adding that the average number of moles is about 40. About 20 percent of melanoma arises from pre-existing moles, Trask says.
“The more moles you have, the more at risk you are.”
Trask dispels the notion that removing melanoma causes it to spread. In reality, melanoma spreads by penetrating deeper into the flesh, he says, requiring surgeons to err on the side of removing more tissue rather than less.
“The risk of not removing it could allow you to die,” Trask says.
Savercool has learned the shocking reality that the ratio of mole-to-scar sometimes doesn’t follow any logic. Excision of dime-sized, pre-melanoma lesions on her back healed to 1-inch scars while others the size of a pencil lead’s thicker end resulted in a 3-inch incision. The scars aren’t as frightening as the possibility that cancer could return to some of the same spots.
“Now I do not go in the sun,” Savercool says. “I wish I never would have done it.”
Frequently Asked Questions
Q: What does mole mapping mean?
A: Medical photographs are used by dermatologists to follow lesions over time. Often, patients have overview photos taken that can help detect new lesions. Mole mapping also includes close-up photography of atypical moles. Lesions are numbered on your body and a diagram, or “map,” is used so the photographed lesions can be compared on subsequent examinations. This allows your physician and you to follow individual lesions more closely to detect changes early.
Q: What happens during the visit?
A: First, a physician will see you in the dermatology clinic where you will have a full-body skin exam. Moles that appear unusual and would benefit from close-up photography would be identified and photos taken. A map is made of these moles to be used during subsequent exams.
Q: What should I wear?
A: Because you will be undressing, wear comfortable clothing and shoes that are easy to put on and take off. Remove jewelry and watches, and if you have long hair, bring something to pull it back into a ponytail. During the physician visit, you will be asked to completely undress and be given a gown. You will be draped appropriately during the exam. During the photography session, remove as much of your clothing as you are comfortable with, the more the better. If you are unable to undress completely, bring underwear that you will be comfortable wearing that covers the least amount of skin. Avoid “sports bras.”
Q: How long does this take?
A: Complete skin examinations could take 30 minutes to 2 hours, depending on a patient’s number of moles and the number of photos taken.
Q: Does insurance cover the visit?
A: Insurance will be billed for the physician portion of the visit similar to a routine doctor’s visit. The cost of medical photography is not routinely covered by insurance companies, although there may be exceptions. The cost depends on how many photographs are taken.
— Source: Oregon Health and Science University Department of Dermatology
ABCs of melanoma and atypical moles
Asymmetry — One half does not match the other in size, shape, color or thickness.
Border — A ragged, scalloped or poorly defined border that can fade imperceptibly into surrounding skin.
Colored — Pigmentation is not uniform. Shades of tan, brown, black are present. Dashes of red, white and blue add to the mottled appearance
Diameter — Melanomas are usually greater than 6 millimeters in diameter or approximately the size of a pencil eraser when diagnosed. They can, however, be smaller. Any mole this size or larger is considered atypical.
Evolution — If a mole is different from others, changes, itches or bleeds, see a dermatologist.
