Stories from the Road: A Melanoma Almost Missed

We all know the feeling of having a laundry list of appointments, errands and responsibilities that need attention. It’s easy to deal with only the most pressing matters and forget to schedule the preventive or maintenance checkups. Skin exams, unfortunately, often fall into the latter category. But a recent encounter during a free screening on our Destination Healthy Skin RV showed, once again, how imperative it is to check in with your skin regularly. It could very well save you time and money in the future, and may even save your life.

A Suspicious Spot

On a rainy day in New York City, Julie Karen, MD, was standing in the RV, staring at what was almost certainly a melanoma. A dermatologist and active member of The Skin Cancer Foundation, no part of this was new. She had volunteered for the Destination Healthy Skin program before and had diagnosed plenty of skin cancers in her practice. But this melanoma was unusual.

“He walked into the room and I saw a probable melanoma literally on the center of his face,” says Dr. Karen. “Melanoma is less common on the face than elsewhere on the body. And it was one of those rare melanomas that actually had all the features of the ABCDEs.”

Dr. Karen knew that the man was visiting the RV that day at the behest of his wife, who had visited the day before. He had never been to a dermatologist before — he was having trouble finding a dermatologist within his insurance network. Dr. Karen knew he was concerned about one spot in particular, and asked if the spot on his face was the one. The man confirmed that it was. “He said he had had it for a few years. It started like a pimple, and it had been growing,” she says.

In other words, if some spots on the skin wave a red flag, this lesion was waving several. For Dr. Karen, it was an example of how far we still have to go in terms of skin cancer awareness.

“I think it shows that there’s a deficit in public education,” she says. “The Skin Cancer Foundation has made tremendous strides in getting the message out there, and we dermatologists try to give out pamphlets and spread the word, but there’s still this subset of the population that isn’t informed enough. He was living with this spot for a couple of years and didn’t realize the potential severity of it.”

Dr. Karen gave the man an overview of the different types of skin cancer, focusing specifically on melanoma. Then she asked if she could perform a full body skin examination. “We know that patients who have one melanoma are at an increased risk for another.” He agreed to a full skin exam, and Dr. Karen was glad he did.

“He had multiple moles, but there were two lesions in particular that concerned me,” she says. “One I was almost certain was an early melanoma.” The second spot appeared to be a very atypical mole (a potential precursor to melanoma).

“Here’s the thing,” she says: “He knew he should probably get the one on his face checked out.” He hadn’t, however, been concerned about the additional two lesions. “This is why Destination Healthy Skin is so critical, because it brings in people like this to get evaluated, and will hopefully enable him to get treatment while it’s still in the early stage.”

No Backing Down

Dr. Karen says she was “thrilled” the man came in for an exam. But that was only half the battle. The next step for the patient would be getting the suspicious lesions biopsied. On the RV, volunteer dermatologists identify potential skin cancer but do not administer treatment on board. With a very busy practice of her own, Dr. Karen knew getting a timely appointment can often be a challenge. But she made it very clear to the man that this was not the time to back down.

“I told him if he needed my help contacting a doctor who took his insurance, I’d be happy to help,” she explains. “But I said, if they can’t get you in within two weeks, don’t take no for an answer. You cannot take no for an answer.”

Several weeks later, Dr. Karen followed up with the patient, who confirmed that the two spots had both been diagnosed as melanomas. He said he would be meeting with a surgical oncologist for treatment.

Dr. Karen had been in this situation before: She met one of her current patients at another free skin cancer screening event several years ago. “She had a suspicious spot on her leg that turned out to be a stage 1A melanoma,” Dr. Karen says. “Then, a year later, I found another melanoma. Now I see her every four to five months. She told me that if the screening event had not come to her office, she would never have gotten a skin check.”

It’s part of the reason why she makes time to participate in volunteer events like Destination: Healthy Skin. “I firmly believe in the mission of The Skin Cancer Foundation, and I take my job and skin cancer very seriously,” she says. “I care so much about eradicating this condition — or at least diagnosing it early and at a curable stage. That’s why I make myself available for things like this. It’s so important not only to give back, but to spread the message. So it’s easy to find a way to say yes.”

Destination Healthy Skin, the Skin Cancer Foundation’s mobile skin cancer education program, runs seasonally each year. If you’re concerned about a spot on your skin, or just haven’t had a professional skin exam this year, find out if we’re coming to a community near you.

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This year, our Destination Healthy Skin RV is traveling around the country to provide free full-body skin cancer screenings along with educational materials and sun protection giveaways. Your support can help keep this lifesaving program on the road.