Dr. Ben Wiese

🔍 MANY HARMLESS GROWTHS. ONE VERY DIFFERENT FINDING.

This patient’s face had numerous seborrheic keratoses—common, non-cancerous skin growths that often appear as we get older. These growths are harmless, but they can sometimes resemble skin cancer.

Nestled between them was a small melanoma.

During this patient’s assessment, FotoFinder’s ATBM full-body photography helped us identify the spot that needed closer attention.

📸 Full-body photography provides detailed images of the skin, helping us review lesions and compare images over time for new or changing spots. It supports a careful clinical examination—it does not replace one. And a photograph alone cannot confirm melanoma: that requires a biopsy and examination under a microscope.

The lesson? Don’t assume every spot has the same story.

A melanoma does not have to be large or dramatic-looking. It can be smaller than a pencil eraser. Pay attention to a spot that is new, changing, different from your others, itching or bleeding—and arrange a medical assessment rather than waiting for it to become more obvious.

You don’t need to diagnose your own skin. You just need to speak up when something changes or concerns you.

💾 Save this reminder and share it with someone who has plenty of skin spots. Not every spot is worrying—but each deserves to be considered on its own.

Melanoma does not only affect older adults. This educational case shows a 32-year-old with advanced invasive melanoma on the upper back—an area that can be difficult to see and easy to overlook. .official

A spot that looks **different** from the rest of your skin, is changing, bleeding, itching, or not healing deserves attention. Trust the “**ugly duckling**” sign: if one mark stands out, get it checked.

Melanoma can spread to other organs when it advances. Early detection matters.

Know your skin. Check hard-to-see areas. Ask someone you trust to help look at your back. And if something concerns you, make an appointment with a dermatologist or qualified healthcare professional promptly.

A melanoma hiding in plain sight. Ink should tell a story—not hide one. Save this post and share it with someone who has tattoos.

This melanoma was found within a large tattoo on the upper back of a 42-year-old man.

Does tattooing cause melanoma? At present, the evidence is mixed, and no causal link has been established. The more immediate clinical concern is that tattoo ink can camouflage a melanoma and make it harder to recognize early.

Clinically, dermatologists/skin cancer docs, look for evolution, asymmetry, irregular borders, multiple colors, and symptoms such as itching or bleeding. Under dermoscopy, dark pigment can also obscure important clues, including an atypical pigment network, irregular dots or globules, blue-white structures, regression features, and atypical vessels.

Before getting a new tattoo, consider a baseline skin examination and ask the artist to leave existing moles and other skin lesions uncovered. If you already have tattoos, include the inked skin in your regular self-checks—especially difficult-to-see areas such as the back. A new or changing spot deserves assessment, whether it is inside a tattoo or not.

Ink should tell a story—not hide one. Save this post and share it with someone who has tattoos.

“It didn’t hurt, so I wasn’t worried.”
This is one of the most common things patients tell us about basal cell carcinoma (BCC) — the most common form of skin cancer. In this case, a slow-growing BCC was left untreated long enough to erode through the earlobe of a 60-year-old woman. She didn’t seek care sooner because the spot never caused her any pain.
Here’s the truth about BCC: it’s usually painless, even as it grows. That’s exactly what makes it dangerous. BCC tends to grow slowly and quietly, often for months or years, without touching the nerves that would normally signal pain. Most people notice a sore that won’t heal, bleeds easily, or looks like a shiny bump or scaly patch — not something that hurts.
Because it doesn’t hurt, it’s easy to ignore. And the longer it’s ignored, the more it can grow — sometimes eating away at skin, cartilage, and even bone, like what happened to this earlobe.
The lesson: don’t wait for pain to take a skin spot seriously. Watch for:
A sore that bleeds, oozes, or won’t heal
A shiny, pearly bump
A flat, scaly, reddish patch
Any spot that’s changing, growing, or looks “different”

Pain is a late sign, not an early one. See a dermatologist for any suspicious or non-healing spot — the earlier it’s caught, the easier it is to treat, and the less tissue is lost.

🚨 SIZE DOESN’T ALWAYS MEAN SAFE 🚨
Did you know melanoma — the most dangerous form of skin cancer — can spread even when it’s tiny?
🔬 Unlike many other cancers, melanoma can start moving to lymph nodes and other organs while still very thin, sometimes less than 1 millimeter (about the thickness of a credit card).
✨ Why? Melanoma cells are especially good at:
Hiding from the immune system
Building new blood vessels to spread
Traveling early, before a mole even looks “big” or alarming

📏 That’s why doctors don’t just look at size — they look at the ABCDEs:
A - Asymmetry
B - Border irregularity
C - Color variation
D - Diameter (but don’t rely on this alone!)
E - Evolving (changing over time)
💡 Bottom line: A small spot can still be serious. Early detection saves lives.
👩‍⚕️ See a skin cancer doctor for annual skin checks, and sooner if you notice any changing mole or new growth.

This is a good example of why prevention is better than cure!

“My wife keeps nagging me to wear sunscreen… she doesn’t know what she’s talking about.”

That was the first thing this gentleman told me when he walked into the clinic.

Then we looked at his forearms.

Years of unprotected sun exposure had led to extensive actinic keratoses (AKs)—rough, scaly patches caused by cumulative UV damage.

Here’s why that matters:

☀️ Actinic keratoses are not just “sun spots.” They are precancerous lesions. While many remain stable, some can progress to squamous cell carcinoma, a common form of skin cancer that can become invasive if left untreated.

Your skin remembers every sunburn.
Every day on the golf course.
Every afternoon gardening.
Every fishing trip.
Every drive with your arm resting in the window.

The damage adds up.

🧴 Here’s what I recommend:
• Wear a broad-spectrum SPF 30 or higher every day on your face, ears, and neck.
• Protect your forearms with lightweight UPF sun sleeves or long sleeves whenever possible.
• Reapply sunscreen every 2 hours if you’re outdoors.
• Have persistent rough, scaly spots checked by a healthcare professional.

And one more thing…

❤️ If your partner keeps reminding you to protect your skin, they’re probably doing it because they want you around for many more years.

Sometimes the best medical advice starts at home.

Protect your skin today—your future self will thank you.

⚠️ This video is shared with the patient’s permission for educational purposes. Individual circumstances vary. If you notice a new, changing, or non-healing lesion, seek assessment by your healthcare provider.

🧊 THE MISTAKE
A 71-year-old man had a lesion on his lower back. It looked benign. It was treated with liquid nitrogen — no biopsy, no dermoscopy.
Freeze and forget, right?
Wrong. It didn’t go away. When it was finally biopsied…
It was melanoma. A thick one.

🔬 THE PATHOLOGY
🔹 Breslow thickness: 5.2 mm 😳
🔹 Clark Level V — invasion into subcutaneous fat
🔹 Neurotropism: Present (nerve invasion ⚠️)
🔹 Stage: pT4a — at least Stage IIB
Cryotherapy may have delayed the diagnosis, destroyed surface features that could have aided earlier detection, and wasted valuable time.

📊 THE PROGNOSIS
It’s serious — but it’s NOT hopeless.
✅ Stage IIB (T4a, node-negative): ~87% five-year survival
✅ No ulceration — a favorable sign
✅ Clear surgical margins
⚠️ But 1 in 3 patients with T4 melanoma will have positive lymph nodes — which would upstage this to Stage IIIC and significantly change the outlook.
Sentinel lymph node biopsy is the most important next step.

💡 THE LESSON
❌ Cryotherapy is NOT a biopsy
❌ Not every rough or dark lesion is a seb K
❌ You cannot rule out melanoma by appearance alone
✅ When in doubt — BIOPSY FIRST
✅ Dermoscopy can help differentiate seb K from melanoma
✅ If a treated lesion doesn’t resolve — get tissue. Always.

🎯 BOTTOM LINE
The most dangerous thing about melanoma is assuming it’s something else.
A simple punch biopsy could have caught this earlier — thinner, earlier stage, better prognosis.
Biopsy before you freeze. Always. 🔬🖤 This pt gave consent for the photos to be used for educational purposes.

🔍 Hidden in plain sight: Melanoma in Situ within a pre-existing nevus!

This compelling case highlights a 53-year-old male who was completely unaware of a subtle lesion on his scalp. What initially appeared as an ordinary pigmented macule revealed a more complex story under dermoscopy.

Key findings:

• Clinical View: A subtle, pigmented macule on the scalp, easily missed amidst the hair.
• Dermoscopic View: Features consistent with melanoma, including an atypical pigment network and irregular pigmentation.
• Diagnosis: Melanoma in Situ arising within a pre-existing nevus.

This case underscores the critical importance of thorough skin examinations, especially in areas like the scalp that are difficult for individuals to self-monitor. Early detection is paramount in improving outcomes for melanoma.