McCOOK, Nebraska -- Donna P., (not her real name) thought she knew enough about skin cancer to get by.
"It was always about a bleeding mole, or a mole changing appearance," the 50-year old said. "But in everything I've read, they never said anything about freckles."
So when a tiny freckle on her upper thigh grew larger over the years, she wasn't too worried. What had started as small dot in her 20s had increased over the years to a light tan to black spot, with irregular edges, about the size of a Cocoa Puff, she said.
During a regular yearly examination, her doctor wanted to take a biopsy of the freckle. "I resisted, I thought it wasn't a big deal and I didn't want to waste my time on it," Donna recalled. But the doctor insisted so Donna relented. A small part of the freckle was removed that day and sent to the lab.
A sign that something is up is the 'Ugle Duckling" method of detecting melanoma, according to the Skin Cancer Foundation. This method is based on the concept that these melanomas look different -- they are "ugly ducklings" -- compared to surrounding moles. The premise is that the patient's "normal" moles resemble each other, like siblings, while the potential melanoma is an "outlier," a lesion that, at a given moment in time, looks or feels different than the patient's other moles, or that over time, changes differently than the patient's other moles.
A few weeks later, the doctor called with the results. "She said it was melanoma. I wasn't sure what that meant, but she insisted I had to make an appointment with a doctor right away, to get it removed," Donna said. "That's when I started doing research on the Internet, asked my doctor lots of questions and found out that melanoma can actually be fatal."
And increasing. Melanomoa is the most dangerous from of skin cancer, according to the Skin Cancer Foundation, with more people being diagnosed than ever. From 1970 to 2009, the incidence of melanoma increased by 800 percent among young women and 400 percent among young men.
Melanomas often resemble moles, said the Skin Cancer Foundation and some develop from moles. The majority of melanomas are black or brown, but they can also be skin-colored, pink, red, purple, blue or white. Melanoma is caused mainly by intense, occasional UV exposure (frequently leading to sunburn), especially in those who are genetically predisposed to the disease. As with all skin cancers, people with fairer skin (who often have lighter hair and eye color) as well) are at increased risk.
Donna, with blue eyes and brown hair, remembers getting very badly burned a few times when she was a teenager. "I got blisters pretty bad once or twice, but kept going to the pool," she said. "That's just what you did in the summer, hang out at the pool."
Donna was told if the freckle wasn't removed, the melanoma could spread to the nearest lymph node. After that, the cancer could then metastasize in one of the major organs, such as the liver or lungs, at which point the survival rate plumments.
The removal could be done in one day, she was told, taking about an hour with local anethestic. During the removal, the doctor would be able to tell how much the cancer had spread. If it had spread to the nearest lymph node, a treatment plan would be devised, depending on how aggressive the melanoma was.
If melanoma is recognized and treated early, it is almost always curable, but if it is not, the cancer can advance and spread to other parts of the body, where it becomes hard to treat and can be fatal. While it is not the most common of the skin cancers, it causes the most deaths. The American Cancer Society estimates that at present, about 120,000 new cases of melanoma in the US are diagnosed in a year. In 2010, about 68,130 of these were invasive melanomas, with about 38,870 in males and 29,260 in women.
Donna made an appointment with a plastic surgeon in Kearney who was experienced with skin cancer and she got in the following week. She remembers sitting in the waiting room with several teenage girls who were there to get permanent eyeliner.
"It was kinda surreal, the two extremes. They were reading 'People' magazine and being typical loud teenagers, and here I was, waiting to get a freckle removed and waiting to see how far the cancer had spread," Donna said.
They removal involved going down as far as possible to get all of the cancer, she said, estimating about a half inch deep. "It was hard to tell, the doctor just wanted to get it all," she said. Two weeks later, she learned that the cancer had not spread.
Now left with only a three-inch long scar, Donna said the experience left her a little shaken but not "scared straight."
"I wish I could say I wear sun block religiously now, but I don't," Donna said, confessing that she's even laid out at the lake and at a friend's pool a few times this summer. "But I did wear some sunblock and didn't get burned. Old habits die hard. But I am really grateful for my doctor in Cambridge, who insisted on checking this out."