Skin cancer can sneak up on the most savvy

By Louise Palmer

updated 8:25 a.m. ET May 12, 2008

Maybe you were sunburned as a kid, or haven't been diligent about wearing sunscreen, but you probably thought that, should a suspicious spot appear, your doctor would catch it and keep you healthy. Well, that isn't always the case.

More than 90 percent of dermatologic surgeons have seen at least one patient in the past year with skin cancer that was overlooked or misdiagnosed by a nondermatologist, finds a survey of 271 docs by the American Society for Dermatologic Surgery in Rolling Meadows, Ill.

Horrifying, especially as melanoma is the most common cancer among women ages 25 to 29, and skin cancer is the cancer most frequently diagnosed in women. Don't be the case that's missed. Read these stories, and take away a new sense of self-vigilance.

Iris Glass
"I was told the bump was simply a benign cyst."
— Diagnosed with basal cell carcinoma; South Salem, New York

For years, Iris Glass, 45, lived with a bump on the inside corner of her left eye. Even after a friend advised her to have a dermatologist check it, she brushed off the suggestion. "I was too busy to take time away from the office, so it wasn't until three years after my friend spoke up that I finally booked a checkup," Glass says. On the day of the appointment, though, the dermatologist didn't do the exam himself; he had a physician's assistant do it. When the PA never mentioned the bump, Glass inquired.

"She looked at it, poked it and said, 'It's nothing more than a cyst. An ophthalmologist can remove it for aesthetic purposes,'" Glass recalls. So she booked the procedure. But a few weeks after removing part of the bump (the odd location prevented a complete removal), the ophthalmologist phoned Glass with bad news. The removed tissue, sent to a lab for testing, was diagnosed as basal cell carcinoma. Although it is the least serious type of skin cancer, it can erode the skin if left untreated.

The skin tests that can save your life At the dermatologist's office: After asking about your history and sun habits, your doc will examine your skin from head to toe with the naked eye. If a spot looks suspicious, she'll use a dermascope (a magnifier) and possibly biopsy the lesion with a needle or a scraping tool. "If a patient has many moles, I'll send her to a dermatologic photographer for photos, which I can use for tracking purposes," says Macrene Alexiades-Armenakas, M.D., assistant clinical professor of dermatology at the Yale School of Medicine in New Haven, Connecticut. Pencil in an appointment once a year (every six months if melanoma runs in your family; every three if you've had previous skin cancer). Book free checks for you and a friend from May to July, courtesy of Olay and the American Society for Dermatologic Surgery. At home: "Cancers can grow rapidly — within weeks — and your doctor can't catch them all if she's seeing you only once a year or every few months," Dr. Alexiades-Armenakas says. So it's up to you to keep tabs monthly. Stand naked in front of a full-length mirror and look for new skin marks or changes in color, size, elevation, shape or state (bleeding, crusting, etc.) of existing ones. The best way to keep track: Start a body map, a generic front-and-back, head-to-toe image on which you plot your spots and their specifics. Find one — plus self-exam instructions — here. — Jolene Edgar, SELF

"I was shocked. I'm half-Colombian — not exactly fair-skinned — so didn't think I was the typical candidate for skin cancer," Glass says. She soon learned that Mohs surgery would be the best method for removing the remainder of the malignant tumor in the delicate area. A complex process, Mohs excises as little tissue as possible; a specially trained surgeon slices away thin layers of skin and analyzes each under a microscope until only cancer-free tissue remains. But because Glass's cancer had penetrated deeply, a plastic surgeon would also have to be available to patch up the area post-surgery.

After the carcinoma was thoroughly removed, the plastic surgeon performed a skin graft, replacing the thin skin near Glass's eye with tissue from behind her ear. The new tissue was lighter-skinned. Plus, it thickened during the healing process, creating a flap of skin, an irregularity Glass found embarrassing.

It took two more cosmetic surgeries for Glass to feel comfortable with her appearance. But the Mohs, which has a 99 percent success rate with basal cell carcinoma, has kept her cancer-free. And although she's still haunted by her missed diagnosis, she feels oddly grateful for her brush with cancer; it taught her the importance of finding the best doctor and paying attention to her body. "I'm so afraid of being misdiagnosed again," she says. "I'm now one of those people who goes to every doctor in town until I find the best one. Well, actually, the best two."

What you can learn from her
Make time for your health: Get an annual skin check, regardless of your skin tone. "The key to securing the near 100 percent cure rate is early detection and appropriate treatment," says Andrew J. Kaufman, M.D., a dermatological surgeon in Thousand Oaks, California. And choose your doctor wisely. "Anyone, even a doctor, can potentially miss a skin cancer. But studies show dermatologists are best at identifying them," Dr. Kaufman explains.

Jaime Regen Rea
"I'm telling Jaime's story so that one less mother has to bury her daughter due to skin cancer."
— Donna Regen, mother of Jaime Regen Rea, who died at age 29 after battling melanoma; Dallas

As a teen, Jaime Regen Rea was self-conscious about the large, dark mole she had had on her left shoulder blade since birth. At 14, she and her mother went to a dermatologist, who shaved it off, and that, they thought, was the end of that.

But six years after the procedure, the scar tissue left by the mole's removal started to itch and bleed. A new dermatologist diagnosed the condition as an infection and treated it with antibiotics. Then a few weeks later, during a routine physical, Rea's physician discovered a swollen lymph node in her neck and sent her to a surgeon. There, Rea inquired about the still-irritated skin on her back. Alarmed, the surgeon biopsied the tissue.

Despite Rea's fair skin, blue eyes and obsession with tanning (all things that increased her odds for skin cancer), neither she nor her mother was prepared for the test results: It was melanoma. The lesion had penetrated multiple layers of skin. (Soon determined to be stage II, the tumor had not yet spread to her lymph nodes; ironically, the swollen neck node was a harmless inflammation.) Rea required surgery to remove several layers of skin and tissue, leaving a 9-inch scar across her back.

"I had never heard of melanoma," remembers Donna Regen, Rea's mother, who immediately threw herself into researching her daughter's condition. Countless questions surfaced; among them: Was the mole cancerous when it was removed when Rea was 14? (There was no way to know, unfortunately; the doctor never did a biopsy.) Where did the original shaved-off tissue go? (She learned that the doctor had thrown it out, despite lab testing being standard procedure.) And why was the spot initially diagnosed as a simple infection — and not cancer?

For three years, doctors closely monitored Rea, doing blood tests every three months and yearly scans to watch for the cancer's recurrence. Rea graduated from college and began a fashion career. Then in March 2002, a month after getting married, she had her annual scan. Her oncologist soon discovered the melanoma had returned. This time it was stage IV cancer that had spread through her lymph nodes, causing a large tumor in her abdomen. It was removed, and Rea began immunotherapy.

But despite almost two years of treatment, another tumor appeared in her chest. After it was removed, Rea began a clinical trial for an experimental drug that required exhausting weekly travel from Texas to New Jersey. But nothing could stop the tumors that, over the next year, grew in several places, including her liver and brain. Rea died on March 16, 2007. "I'm telling her story to convince other women to be vigilant. Jaime wouldn't want this to happen to anyone else," Regen says.

What you can learn from her
Choose a doctor who is board-certified in dermatology; that assures the M.D. is receiving continual cutting-edge training. (Find one through the American Academy of Dermatology.) Ask how many skin checks and procedures she has done. "It should be in the thousands," says Michael Albom, M.D., clinical professor of dermatology at NYU Medical Center in New York City. And never be afraid to get a second opinion — it's your health and life.

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