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OHSU dermatologists set new record for finding smallest skin cancer

The team verified the melanoma measuring in at just 0.65 millimeters. OHSU leaders hope the recognition helps emphasize the importance of early cancer detection.

PORTLAND, Ore. — OHSU doctors are now in the book of Guinness Book of World Records. The team of dermatologists found the smallest skin cancer ever detected, thanks to a patient’s proactive prevention and some innovative new technology.

“We were able to get the smallest known skin cancer biopsied and removed without any consequence to that patient, other than a little tiny scar. So, amazing,” said Sancy Leachman, chair of the Department of Dermatology at OHSU and a member of the team that set the record.

Making it into the record books is an amazing feat, but the team at OHSU says they just hope their accomplishment encourages more people to do monthly skin checks.

“The record is a great thing, but that’s not really what we’re about. Really what we’re about is making sure that we catch things as early as we can so we can prevent people from dying from melanoma,” Leachman said.  

The importance of self-checking

May is National Skin Cancer and Melanoma Awareness Month and Thursday, May 18 is “Check Your Skin Day” in Oregon. The Steps Against Melanoma Walk is happening Sunday, May 21 in five different cities across Oregon, including Portland and Astoria. 

Leachman has good reason to be passionate about skin cancer prevention and awareness, because Melanoma is a particularly aggressive form of cancer in humans.

Catching it early is lifesaving, literally, lifesaving,” she said. “If you can catch it at that thin stage before it’s spread anywhere else, you’re going to be fine.” 

She and OHSU are spreading the word about getting proactive about skin health and empowering people to check their skin for warning signs of melanoma. It’s part of their War on Melanoma campaign.

“It’s the one cancer that you can really see yourself,” Leachman said. “I think we could cause the melanoma death rates to plummet, if all we did was look.” 

Setting a record

Leachman's team set a record by finding the smallest melanoma ever recorded, measuring just 0.65 millimeters. That’s 0.025 inches, about the size of a skin pore at the base of a hair follicle.

So, how did they catch a spot almost invisible to the naked eye?

The answer is a state-of-the-art non-invasive technology called In vivo confocal microscopy, which happens right in the dermatologist's office.

“Because it can see at the cellular level, we were able to tell — even though there were a very small number of cells — you can tell because you’re looking at the cells themselves that they look atypical,” Leachman said.

It’s a handheld or stationary microscope that’s placed on the top of the skin to visualize the cells underneath. It gives physicians the ability to see cells without having to cut into a patient’s skin.

“You can see at the cellular level and you can see, ‘Oh those cells look fine. That doesn’t need a biopsy.’ And especially if it’s something on your face, that’s a nice thing to hear,” she said.

If something is concerning, it can be biopsied. And if it's melanoma and it’s caught early enough, it can be removed.

“What’s great is that we’re getting better and better and better through technology at being able to identify the ones that are bad and the ones that aren’t bad so that we can make the right diagnosis earlier and sometimes now without having to cut. So, it’s pretty cool,” Leachman said.

Tools for home detection

But let’s go back a step, because there’s a way to take action about a concerning mole or growth even before you get into the doctor’s office. And it starts with your cell phone.

“Let’s say you find something that you’re worried about. Well now, all you have to do: you can take a picture of it and many, many places, you can send that digital image to a dermatologist,” Leachman said.

The doctor can often tell, from a simple cell phone photo, whether a mole needs more investigating or if it is nothing to be worried about.

There’s also a smartphone attachment that takes it a step further. It’s called Sklip Dermatoscope. 

“It’s a little dermatoscope that you can put on your phone and take another picture, but now, it’s a close-up picture with magnification – with special lighting that you can see deeper into the skin, and you can see more about whether that mole is concerning or not. That can then be sent by the phone for the dermatologist to look at,” Leachman said.

Virtual dermatology appointments allow access to convenient, effective, and safe care for skin concerns without leaving home – but technological issues such as poor image quality can limit a provider’s ability to make diagnoses.

OHSU offers the ability to borrow a Sklip® Dermatoscope for free for a two-week period to allow users to capture dermoscopic images of their concerning moles, to assist in receiving the best possible virtual care. You can also buy it online for between $99-$150.

It allows for busy, in-demand, dermatologists to screen out about half the people that you would normally have to see in person, according to Leachman.

What to look for during a skin check

“If you see a part of a mole that’s growing differently than the rest of the mole, that’s a huge red flag and you need to get in immediately,” Leachman said.

When examining skin, she said, it’s important to remember ABCDEs:

  • A is for asymmetry: One side is not like the other.
  • B is for border irregularly: The edges are irregular or ragged.
  • C is for color: It has color variations, such as shades of brown or black, sometimes with patches of pink, red, or white.
  • D is for diameter: It’s more than 6 millimeters across (the size of a pencil eraser), though it can be smaller.
  • E is for evolving: The mole may change in size, color, or shape.

“I think it’s probably the most important one because what it’s talking about is something that’s changing. Something that’s either new that you’ve never seen on your skin before that looks like a mole – it’s an unusual one or one that’s changing. A mole that’s already there or a spot that’s already there that is changing. That evolution is a big one,” Leachman said.

Don't forget about prevention

Leachmean also encourages people to get proactive about sun protection, including making sure they're setting themselves up to remember to apply sunscreen.

“A lot of times people ask me what type of sunscreen they should wear and the first, most important rule of thumb is: the one that you’ll actually wear,” Leachman said. “Because it’s not going to do anyone any good if you’re not wearing it, right?”

Other helpful reminders:

  • Use sunscreen with both UVA and UVB protection.
  • Reapply every two hours.
  • Reapply if you’re swimming or sweating a lot.
  • Use two tablespoons worth of sunscreen for an average-sized body.
  • Use protective clothing whenever possible.  

For more tips on how to do a proper skin check visit OHSU's startseeingmelanoma.com.

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