Health Matters R.D. O’Bryan Skin abnormalities
by R.D. O'Bryan for the Patterson Irrigator
Jan 11, 2012 | 1802 views | 0 0 comments | 7 7 recommendations | email to a friend | print

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Taking a break from the recent chain of columns that are centered around medicines, today I will discuss moles, skin changes, the use of the word “lesion” and the dreadful medical “C-word,” cancer.

First, let’s be clear about the meaning of a word you will hear clinicians use and you might see on laboratory reports. That word is “lesion.”

A lesion is simply an abnormal skin growth. It is used to identify an area of concern. It does not mean cancer in and of itself, although a lesion can very well turn out to be made of cancerous cells. But it can just as easily be made out of harmless, noncancerous cells. Either way, it is an abnormal area of concern, usually to both the patient and the health care provider.

As a basic rule of thumb, most family-practice and primary-care offices use a very simple guideline when evaluating skin changes.

Most doctors and other health care providers use the ABCDE’s of dermatology — a fantastic and easy-to-understand series of diagrams that can be found on the American Academy of Dermatology’s website, Essentially, the ABCDE’s are an easy set of five guidelines used to keep an eye on lesions and help decide whether to have the lesions evaluated by a health provider and have part of the lesion cut off (a biopsy) and sent to a pathologist (a doctor who specializes in analyzing tissue samples).

When a skin lesion meets one or more of the guidelines, it raises the level of suspicion in the mind of the doctor and usually prompts a physician to advise the patient to have a biopsy performed or to be evaluated by a dermatologist

• A stands for asymmetry, when one half or one part of the lesion is unlike the other.

• B stands for border: An irregular, poorly defined border or margin may be worth a checkup.

• C stands for color, as an irregularly colored lesion is also a reason for suspicion.

• D stands for diameter, as certain cancerous lesions, such as melanomas, are usually greater than 6 mm.

• Finally, E stands for evolving, as a lesion that looks different or is growing or changing in size, shape or color is reason for suspicion.

Dermatology as a whole can be very challenging. Some skin disorders “jump right out” and are relatively easy to diagnose by looking at them and obtaining a brief history from the patient. However, many skin disorders manifest in ways that make them virtually indistinguishable from any number of other infections or abnormal growths.

There are many types of skin cancers. Some are slow evolving and are not likely to spread; these can be controlled and contained by simply removing a small amount of tissue. Other skin cancers are simply deadly, aggressive and quite prone to spread (metastasize).

Fortunately, doctors have a wide range of resources and guidelines to support them in their investigations, the most valuable probably being the skin biopsy. This really is the only way to know 100 percent what you are dealing with when it comes to a questionable lesion that may meet one of the concerns summarized in the ABCDE’s.

As in the case of all other aspects of medicine, written resources, picture books and the Internet are fantastic in providing information, but these resources are completely incapable of giving you advice that is unique to your case. That is what your primary doctor, dermatologist or other health care provider is for. If you have a concern about the health of your skin or a lesion that concerns you, please talk to your personal health care provider.

• Richard O’Bryan, a volunteer columnist for the Irrigator, is a nationally board-certified and licensed physician assistant and former Patterson paramedic who practices at the Patterson First Care clinic. Information in this column is not intended to replace advice from your own health care professional. For any medical concern, consult your own doctor. Readers can email questions and suggestions to

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