On one of the first dates that I was on with a girl a few years back, she noticed a big thick textbook in my car as I escorted her towards the passenger door. She asked me why I had a Dermatology textbook in my car. The response exited my mouth, I believe, quicker than my brain even processed the question. I said, “Because most of my patients have skin.” I feel that sometimes my smartass remarks are funny but in that instance I wasn’t so sure. Of course, you never know on those first few dates when trying to feel each other out. Well, she must have thought it somewhat comical because she eventually married me. Now when I say something to that affect I can see her head shake and her eyes roll.

That is the topic for the month. The integumentary system, or skin to most. Skin is the largest organ of the human body. It does many extraordinary things which I’m certain you’ve heard or read especially when it comes to absorbing sunlight and producing vitamin D.

In addition to all those wonderful things that you’ve learned, it can also be home to some of the most destructive things known to us all. And that, my dear readers, is Cancer. I’m guessing you didn’t expect me to ever hit on this topic. Because, what does skin, cancer and feet have to do with one another? I am sorry to say that they have a lot to do with one another.

Ever hear doctors or read articles about cancer being most common on sun-exposed surfaces of the body? Most of us think of the head, face, arms, neck and shoulders. Ever sit on the beach and put suntan lotion on pretty much everything else but the tops or bottoms of the feet? Not typically done because you think that you’ll bury your feet in the sand if sitting. Or, if lying face down the tops are buried. But what about the soles of your feet? What, they can’t get burned or end up with cancerous lesions? Think again, it’s skin. Cancerous lesions have been found on every square inch of skin-palms, soles, between the toes, ears, knees you name the area it’s been found there.

Okay, so what does skin cancer look like? Well, let me tell you a story. Last week I was at a conference in Atlantic City and attended more than a few lectures on skin conditions including benign and malignant lesions. All 3 lecturers had shown slides which they would flip back and forth between, challenging the audience to choose which freckle was benign and which was malignant. It would’ve been easier to pick a Triple Crown winner.

Skin cancer can look like any other freckle or spot that’s on your body. It can be something that’s been there forever, or may have changed shape or color or began bleeding. It can also be a regular plain old wart that’s been around since you don’t know when. So-called benign lesions can and have transformed into malignant ones.

I suggest, and usually quite strongly, to every patient that when I see a dark spot or freckle which has a particular appearance to have a biopsy of it to make certain it is nothing to worry about. Better safe than sorry. Some opt for it and have it checked right then and there. Others will state that “It’s been there as long as I can remember and hasn’t changed a bit.” Those are the patients that scare me. Trust me, I’m not suggesting to have it done because it benefits me. I’m suggesting it so that you can avoid the possibility of it being pre-malignant or malignant down the road.

I have already found a cancerous lesion that was a lot further along the course than it should’ve been. The patient declined, actually refused, to have it biopsied for about 18 months until it really began bothering the patient. After I had sent out the sample to a pathology lab it traveled down the east coast and ended up at Johns Hopkins University.

The ABCD’s of evaluating skin lesions
A - asymmetry or irregularly shaped lesions
B - border-a well-defined margin
C - color is uniform throughout
D - diameter larger than 6mm’s

A few years ago a lesion would be suspect if all 4 applied. Now, it has been stressed that a lesion which falls into any one of the ABCD categories should be enough cause for alarm. Please, for your own good and everyone around you that loves you, get your feet checked. If you can’t see the bottoms of your feet, see a podiatrist who will be more than happy to check tops, bottoms and in between all your toes.