What you need to know about checking for and identifying melanoma

A lifelong sunscreen user, London, Ont., resident Maureen Meehan was always aware of the dangers of sun exposure and says she was diligent about protecting her skin — her fair complexion means she’s prone to burning easily.

“I’ve always worn a sunscreen or a sunblock. I stayed out of the sun during peak times. I never laid outside and worked on my tan,” she says. “So I think I always had a little bit of that consciousness in the back of my mind.”

When a mole on her right arm became raised and began to itch, she knew it wasn’t something to ignore.

“So I went to my GP and initially she wasn’t as concerned as I was. I went back to her a few weeks later and I said, ‘you know, I really am concerned about this mole.’ And she said okay and she referred me to a tissue specialist,” she says.

Two days after a punch biopsy, she received a call that she describes as “life-altering.”

“[He said] You have a malignant melanoma, it’s stage three, and you must get to the London Regional Cancer Program as soon as possible,” she recalls.

By the time she was seen by an oncologist and had further scans, the cancer had spread to two lymph nodes under her right arm.

“I went in for surgery. They did a wide excision on my right forearm, taking out all of the cells around the tumor and then they also removed the two lymph nodes,” she explains. “After the surgery, I had to have a number of follow-up scans, so I had regular ultrasounds and a couple of CAT scans.”

Meehan says she was able to avoid chemotherapy or radiation because the cancer cells were completely removed by surgery. She’s been in remission for five years but cautions that she was one of the lucky ones.

“When I was initially diagnosed [in 2018], 35 per cent of people with my kind of cancer didn’t survive after five years,” she says.

“You think it’s a mole, you’ll go to the doctor and they’ll just lop it off. It’s not — don’t discount the seriousness of it.”

Detecting and identifying melanoma

Dermatologist Dr. Maxwell Sauder says like Meehan, about two-thirds of all melanomas — caused by exposure to UV radiation from the sun — are identified by patients themselves or their loved ones. Early detection is key, so he suggests doing regular full body scans for yourself and family members.

“Do it systematically — start from the top and go down. So standing in front of a mirror, looking at the face, looking at the sides of the face, the neck, the chest, the arms, putting your arms up to look at the sides of the trunk, looking at the legs, looking at the feet, and then turning around,” he explains.

“If you have someone that can check your back [and scalp], that’s ideal. If you live alone, the use of a handheld mirror is ideal. So then you put your back to the full length mirror and then just use the handheld mirror to check your back and the scalp in areas that you can’t regularly check.”

Sauder says a thorough check once a month is enough and suggests picking the day you were born as one that’s easy to remember.

“If you’re checking more frequently than that, you will probably miss something that’s changing gradually over time. Doing it consistently in the same manner on the same day – that will allow you to identify things that look different,” he says.

Sauder says to pay attention to the ABDCEs of melanoma to determine whether a mole needs to be checked by a health-care provider:

• A – is for asymmetry, meaning if the mole was cut in half, it’s different on either side.
• B – is for irregular border. Look for any jagged edges or finger-like projections.
• C – is for colour. Check if the mole is uneven in colour with shades of brown and black and is three or more colours.
• D – is for diameter. Anything larger than the end of a pencil or a pen is of concern.
• E – is for evolution. Pay attention to any changes in size, shape, color or symptoms.

In addition, if you have over a hundred moles, it’s best to get assessed by a medical professional. Lighter skin and a family history of skin cancer are also risk factors to pay attention to.

Prevalence and protection

Sauder says while melanoma is not as prevalent or well known as other major cancers, it is one of the most common in younger individuals from age 15 to 50.

“It was estimated that in 2022, there were approximately 9,000 melanomas that were diagnosed in Canada and there was probably about 1,200 Canadians that died from melanoma,” he says.

“It’s a cancer that we can see and that we can see growing. So if someone is suspicious of something that’s changing on a regular basis, I would urge them to go see their doctor and get that checked out.”

Meehans echoes that sentiment and says people shouldn’t ignore their gut instincts when to comes to their health and should advocate for themselves.

“My own diligence and my insistence that I have that second visit with my GP saved my life because it was spreading and it was metastasizing,” she says.

Despite what she calls a traumatic journey, Meehan says she’s not suggesting people avoid the sun entirely.

“You can’t stay inside. You have to go outside and enjoy — but avoid those peak hours. Always wear a sunscreen, cover yourself up. Tanning is not a sport.”

Sauder adds that hats and sun protective clothing are also a good idea and staying in the shade during hot summer days is simple, but effective. He recommends using a broadband sunscreen with both UVA and UVB protection of SPF50 and reapplying regularly.

Like Meehan, he cautions against tanning.

“The idea is throughout the summer to be uniform in color — and not uniform tan in colour — but uniform in the sense that you’re really not getting that much darker right now,” he says.

“People with different shades of skin — some people just naturally tan — so it’s hard to say that for everyone. But the goal would be uniform in colour – no matter your skin tone.”