April 16, 1997

Media Contacts: Sarah Goodwin, 404/727-3366 -
Kathi Ovnic, 404/727-9371 -

Be Alert For Melanoma Signs, Sun or No Sun

Although exposure to the sun is one of the major risk factors for melanoma, it's not the only one, cautions Barbara Rock, MD, director of the Melanoma and Pigmented Lesion Center at Emory's Winship Cancer Center. People often do not examine their skin for abnormal moles in sun-protected areas. In fact, says Dr. Rock, melanoma can occur on any area of the skin, including the nails, genitals or buttocks. "Melanoma occurs in blacks at a rate equal to that of whites in sun-protected areas," she says. "Sometimes black people have melanoma lesions on the bottoms of their feet or around their nails and do nothing about it because they do not think they can have skin cancer. People need to examine all their skin, not just the areas exposed to the sun."

A Three-Pronged Plan for Protection

Avoiding sun exposure is important especially for fair-skinned people, says Dr. Rock. Her plan for fair-skinned people who want to modify their sun-worshipping behavior is three-fold: (1) avoid the time of day when the sun is brightest (10am to 4pm); (2) cover as much of your skin as possible with clothing and a hat; and (3) use sunscreen containing titanium oxide or zinc oxide (ingredients that protect against both ultraviolet A and B rays) and that rate SPF 15 or higher. Apply at least 15 to 30 minutes before going outside, and reapply frequently and liberally at least every two hours and after swimming or perspiring heavily. Do not forget to use sunscreen on the ears, nose, neck, and bald spots and even on the lips. People who have previously had skin cancer should wear sunscreen everyday, even in winter. "I like to use the analogy of cigarette smoking and lung cancer," says Dr. Rock. "People get lung cancer who have never puffed on a cigarette and people get skin cancer who have never had a lot of sun exposure. But it is a risk factor that is important to know about. We avoid smoking because we know it is a risk factor, and we should avoid the sun as well."

Studies Prove Dangers of Childhood Sun Exposure

At least two studies have shown conclusively that early exposure to sunlight in children increases the number of nevi (moles), mostly in fair-skinned people. A high number of nevi is a known risk factor for melanoma, even if the moles are not atypical. Studies done in Australia have shown that adult melanoma can be reduced by protecting the skin in childhood.

Be Forewarned About Melanoma Danger Signs

Some pigmented areas of the skin are more dangerous than others. Freckles are simply darkenings of the top layer of skin, with no potential for malignancy. Moles, however, are composed of nevus cells that have migrated into the skin and are pigmented. Many of these moles are harmless, but moles with certain characteristics may be premalignant or malignant and should be examined by a physician.

A normal mole is brown, tan, or black. It is evenly colored, and may be flat or raised, and round or oval with sharply defined borders. Moles usually stay the same size, shape, and color, although they may fade in older persons. A physician should check any sudden or progressive change in a mole's appearance. Use the American Cancer Society's ABCD rule to check for warning signs of melanoma:

A (asymmetry): the two halves do not match
B (border irregularity): ragged, notched or blurred edges
C (color): pigmentation that is not uniform
D (diameter): greater than 6 millimeters

Other warning signs in a mole include:

  • a sudden or continuous enlargement
  • a change in the surface (scaling, eroding, oozing, crusting, ulcerating or bleeding)
  • a change in the surrounding skin (redness, swelling or satellite pigment)
  • a change in sensation (itching, tenderness, pain)
  • a large brown or black area that begins to lose pigment
  • a mole that appears after age 30

Risk Factors for Malignant Melanoma:

  • a family or personal history of melanoma
  • a light complexion, blue or green eyes
  • tendency to freckle
  • a large number of moles, including abnormal moles
  • a history of blistering sunburns during childhood or adolescence
  • very large moles that were present at birth

The Melanoma and Pigmented Lesion Center

The Melanoma and Pigmented Lesion Center in Emory University's Winship Cancer Center provides multidisciplinary treatment and followup for melanoma patients as well as education for prevention and early detection. Individuals who have been diagnosed with melanoma or who have had melanoma in the past are encouraged to call the center for treatment and regular followup. Family members of patients also are encouraged to have moles or other suspicious areas checked regularly. Clinical and basic science research are important components of the Melanoma and Pigmented Lesion Center. Multicenter clinical trials for melanoma are currently under way and new protocols continue to be developed.

For an appointment in the Melanoma and Pigmented Lesion Center, please call (404) 778-4797.

For more general information on The Robert W. Woodruff Health Sciences Center, call Health Sciences News and Information at 404-727-5686, or send e-mail to

Copyright ©Emory University, 1997. All Rights Reserved.
Send comments to