John Baltzegar has spent his entire life outdoors. He mostly enjoyed offshore fishing from “Miss Caroline,” a boat named for his wife of 25 years. His skin, he said, is admittedly on the darker side, and he’s never had to worry about the impact of the sun’s rays.
But at Caroline’s insistence, he scheduled a checkup last fall. He hadn’t seen a dermatologist for several years, since before the beginning of the COVID pandemic. Baltzegar, who turns 77 this summer, sold his boat and in September made the two-hour trek to see Dr. Manuel Valdebran at the Medical University of South Carolina in Charleston.
“I’ve never had any indication I had anything wrong,” said Baltzegar, owner of StoneWorks, a marble and granite fabricator in the Hilton Head area. “Caroline just wanted me to have a head-to-toe checkup.”
Dr. Valdebran performed a thorough examination and found a questionable growth on the back of Baltzegar’s shoulder. A biopsy confirmed that the growth was malignant. In early October, a surgeon removed the mole and took a lymph node for examination. Thankfully, the cancer had been confined to the small growth. At his follow-up visit in April, Dr. Valdebran found a pre-cancerous mole on Baltzegar’s temple, which he froze.
“My wife’s right – you need checkups,” he said.
With his dark complexion, Baltzegar rarely saw any discolorations on his skin. But others with fairer skin, like Caroline, are more prone to sunburn and the dangers of sun exposure. They also may have freckles, which usually appear on the skin of individuals with red hair.
There are two types of freckles, or tan spots, according to Dr. Valdebran. Ephelides are small, pigmented spots that are generally 1 to 2 millimeters in size, light brown in color and more common in people with red hair, who have a genetic predisposition to freckles. They first appear around the age of 2 or 3 and increase during adolescence, Dr. Valdebran explained. They are most often found on the face, arms, neck and chest and become more pigmented during the summer, and they partially disappear with age.
Ephelides are associated with a sensitivity to the sun, which activates melanocytes, cells that provide pigment to the skin. Studies have shown that individuals with a multitude of freckles may be more prone to developing melanoma or skin cancer with excessive sun exposure.
Lentigines are larger than ephelides, ranging in size from millimeters to centimeters in diameter, and their color can be a darker brown. Also referred to as a sun spot or liver spot, they are more commonly found in people over the age of 50 on chronic sun-exposed skin, mostly on the face, the dorsum or top of the hand or either side of the forearm, Dr. Valdebran added. These spots are generally benign and are confined to the top of the skin.
“Freckles themselves are absolutely harmless,” said Dr. Valdebran. “What should be alarming is any new mole that is different from a freckle in people over the age of 40.”
A mole is a skin growth that can be flat or raised and is darker in pigment than a freckle. Moles that change in color, size or symmetry over a period of one to three months or appear after the age of 40 should be concerning, said Dr. Valdebran.
“Any mole that is rapidly changing should be taken care of immediately because they may represent a melanoma, which is one of the deadliest cancers that we have,” he added.
A dermatologist will use a dermoscope, a magnifier that enables the physician to view the structure of the pigmented lesion and distinguish the difference between a freckle and a mole. Those that affect the basal or innermost layer of the skin are sometimes determined to be cancerous, and, when they are caught early, there is a nearly 100% cure rate.
Dr. Valdebran stressed the importance of seeing a dermatologist as soon as you realize that a growth is changing in size, shape or pigment.
“If you know that it is a mole and not a freckle and it is looking irregular, then it should be very concerning and you have to be seen as soon as possible,” he explained.
According to the American Academy of Dermatology, 1 in 5 Americans will develop skin cancer in their lifetime, but, when it is caught early, it is highly treatable. Conducting a regular self-check once a month can help you find areas of concern while they are small. Look for new spots on your skin that are different from others, changing, itching or bleeding.
Be mindful of the ABCDEs of Melanoma
A: Asymmetry – half of the spot is unlike the other half.
B: Border – the spot has an irregular, scalloped or poorly defined border.
C: Color – the spot has varying colors from one area to the next, such as a shade of tan, brown or black or areas that are white, red or blue.
D: Diameter – melanomas are usually greater than 6 millimeters but they can be smaller.
E: Evolving – a mole or spot on the skin that is different from the rest that is changing in size, shape or color.
Follow these steps for a self-check
• Using a full-length mirror, examine your body front and back, then look at the right and left sides with your arms raised.
• Bend your elbows and look carefully at your forearms, underarms and palms.
• Look at the backs of your legs and feet, the spaces between your toes and the soles of your feet.
- Using a hand-held mirror, examine the back of your neck and scalp. Part your hair for a closer look at your scalp. Finally, check your back and buttocks.
If you notice a spot that is different from others or that changes, itches or bleeds, make an appointment to see a dermatologist.
-American Academy of Dermatology
By Linda L. Esterson