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If I Had - A Changing Mole - Dr. Nanette Liegeois, MD, Ph.D
If I Had - A Changing Mole - Dr. Nanette Liegeois, MD, Ph.D

(November 22, 2007 - Insidermedicine) Welcome to Insidermedicine's If I Had, where we get a chance to ask an expert what they would do if they had a medical condition.

This week, we have the opportunity to talk to Dr. Nanette Liégeois, MD, Ph.D, an Assistant Professor of Dermatology at Johns Hopkins University.

Dr. Liégeois is also the Director of Dermatological Surgery at Johns Hopkins, and is interested in both Dermatologic Surgery and Cutaneous Oncology.

We asked Dr. Liégeois what she would do if she had a mole that concerned her.

I'd like to thank Dr. Liégeois for lending her insight to Insidermedicine's If I Had.

Dr. Liegeois: What I tell people is, if you have a mole and it changes, have it evaluated. Sometimes people can have it evaluated by their primary care physician. A dermatologist would be an excellent source. In some geographic areas, dermatologists are not as accessible. But, certainly have it evaluated, and any changing mole deserves a biopsy. That’s going to be the gold standard for evaluating; do not wait for something to bleed.

How can a mole change?

Dr. Liegeois: A mole can change in any way. We call it the A-B-C-Ds: A is for asymmetry, so if one side is different than the other, B are the borders, if the borders become jagged or start looking like the Chesapeake Bay or the coast of Maine, C is the color, it could be multi-colored or the color could be unusual. We’ve seen moles become gray, red, black. Any strange color, or multi-colored. And D is the diameter – if something is getting bigger and evolving, get it looked at.

What should you expect in the doctor’s office?

Dr. Liegeois: Things that I want to know when I evaluate something on the skin; I want to know “What is this person’s personal history?” Has this person ever had a skin cancer of any type? The second thing I want to know is “What is their family history?” Do they have a family history of skin cancer? The third thing, specifically, is “What is their own health situation?” Is this somebody who is a transplant patient, or are they on all sorts of medications that are going to change how I think about this particular skin thing? The actual visit of looking at skin needs to be systematic, it needs to be complete. Sometimes patients are surprised when we want them to take off their socks and they have to take off their underwear. But, truly, you cannot look at skin unless you completely undress.

What are some primary risk factors for skin cancer?

Dr. Liegeois: Primary risk factors for skin cancer… Number one is outdoor exposure, excess of sunlight, and sunburns. People who spent an enormous amount of time outdoors are at very high risk. The second risk factor is fair skin, blue eyes, red hair. The third risk factor is actually if you’ve had another skin cancer before. The writing is on the wall - chances are you’ll have another skin cancer.

How is skin cancer treated?

Dr. Liegeois: So, for non-melanoma skin cancer there are many options, and one is to simply do a surgical excision, and that has the advantage of being relatively quick. Generally, an excision is performed in a half-hour to 45 minutes. At the end of the day the patient leaves with stitches, and then the pathologist tells you under the microscope if the tumor is removed. The advantage of Mohs micrographic surgery is that it’s cosmetically sparing, and so in areas such as the face, or in places where tissue really needs to be sparing or else it’s rather mutilating. Mohs offers the advantage of having a really high cure rate and it’s cosmetically sparing because we don’t do the stitching until we know it’s all removed.