Nick Napalo never gave his sun exposure much thought. In fact, as a coal miner living in Rachel, W.Va., he had spent part of his life underground.

	Matt Freed, Post-Gazette photo illustration Click photo for larger image. Related articles Outing honors melanoma victim Skin cancer cases on the rise

But when he was laid off for 19 years, he supplemented his income by mowing lawns. In his earlier years, there were summers of baseball and basketball, with teams identified as shirts and skins. "I did spend a lot of time in the sun.''

In July 2002, Napalo's wife noticed some blood on the back of his white T-shirt. A mole that had thickened and had changed colors was bleeding. He went to a dermatologist in Morgantown, W.Va., who referred him to University of Pittsburgh Cancer Institute after a biopsy was taken.

The diagnosis was melanoma, the deadliest type of skin cancer, but it was caught early before it had spread.

Because he was at high risk for possibly more melanoma diagnoses, Pitt doctors suggested Napalo, now 47, undergo body mapping, a process in which 36 digital photos are taken of the whole body as a baseline to track changes on the skin.

Just last week, he was back at the cancer institute to have a new mole examined on his back. The photos confirmed the suspicious spot hadn't been there on his first visit in the spring. A biopsy will be taken.

"I thought it was well worth it,'' Napalo said about the photographs. "It's a lot simpler way to keep track of everything.''

More and more, specialists are using an extensive array of digital photos as an additional tool to help detect and prevent melanoma.

The American Cancer Society Web site, other respected Internet sites and most consumer medical books still focus on the A,B,C,Ds of identifying potentially cancerous moles.

The guides suggest examining your moles for Asymmetry, meaning one half of the mole doesn't match the other; Border irregularity; Color (two-toned or more colors) and Diameter (being more than ¹/₄ inch wide).

But an additional letter "E" that stands for Evolution may be the most important indicator of them all, said Dr. John Kirkwood, director of the Melanoma Program of UPMC Cancer Centers and a renowned melanoma researcher.

"Change is far and away the most important factor as an indication of potential worry," he said.

	More info Patients at high risk for developing melanoma should talk with their primary care physician or dermatologist about whether they might be candidates for the body mapping system. University of Pittsburgh Medical Center offers the service at an affordable rate, said Dr. Larisa Geskin, director of the Cutaneous Oncology Center and an assistant professor for Pitt's Department of Dermatology. Cost for the service is about $75, which includes a small fee for a CD that the patient can take home for self-monitoring and comparison. The service is not covered by insurance, but Geskin said other centers charge $250 or more. A referral is generally needed for body mapping as the patient would come under care of physicians at the center. For an appointment, call the University of Pittsburgh Physicians Department of Dermatology at 412-648-3263 and ask for the pigmented lesion clinic at the Hillman Cancer Center. To read more about melanoma, check: www.melanomacenter .org www.upmccancer centers.com/melanoma/

Recognizing melanoma early is key to curing it, specialists say. The cancer that originates in the pigment-producing cells of the skin is now diagnosed in one out of 55 men and one out of 82 women. While it makes up only 4 percent of skin cancers, it accounts for 79 percent of skin cancer deaths. Those with a family history of melanoma, those who have received a lot of sunburns, are fair-skinned, have blond or red hair or have a lot of moles are at highest risk.

Watching for new lesions

Monitoring existing moles is important, of course. But two-thirds of melanoma develop on skin that previously had no pigmented lesion, Kirkwood said. Melanoma also can appear on skin that has never been exposed to the sun.

Some dermatologists routinely photograph trouble spots on their patients, but the practice isn't universal.

Dr. Judith Small, director of Allegheny General Hospital's Division of Dermatology, said her office for years has taken close-up photographs of people's skin with a 35 mm camera. Where they're taken, and how many are taken, depend on the patient's risk and medical history. Sometimes the whole body is photographed.

"It's easy. I hold the picture right up to the patient's moles,'' she said. "It's the same concept. I've never seen how the digital ones work, but everybody does it differently.''

Companies across the country, such as DigitalDerm out of Columbia, S.C., are creating specialized full-body digital photography programs, sometimes called mole mapping.

Pitt has developed its own version for patients at high risk.

"We have detected a tremendous amount of melanomas using this system,'' said Dr. Larisa Geskin, director of Cutaneous Oncology at the cancer institute.

Thirty-six high-resolution digital photos are taken of the patient to cover all areas of skin. These are kept in a secure database at the institute, and a set is given to the patient to use in self-monitoring at home. The imaging system also allows Web access for physicians to aid in consults all over the world.

"A person might be a little embarrassed, but it didn't bother me,'' said Napalo, the West Virginia patient. "The photographer was real professional.''

At regular checkups, or if the patient detects a suspicious change, doctors consult the photos.

"We can put the digital photo on the computer screen,'' Geskin said. "We can pull the screen up next to the patient to give a side-by-side comparison.''

Magnifying and zooming in on the photo images can improve detection. In addition to the pictures, Geskin uses a hand-held dermatoscope, which allows her to see the pattern of the pigment under the skin.

This comprehensive inspection also allows doctors to be more selective in their diagnosis and to determine which moles should be biopsied. Not all changes in moles signal cancer and not all new moles that appear in adulthood pose a risk. Gaining weight can make one's moles appear larger and hormonal changes in adolescence and pregnancy can cause changes.

Doctors in a lot of private practices look at a person with many moles, and biopsy ones that "look ugly" or stand out, Geskin said.

It's not unusual for her to see more than 30 scars after the mole biopsies on a patient, which can be disfiguring. Still making the correct assessments are challenging and involves a lot of training for doctors.

"Without a biopsy, right now, we still sometimes make an educated guess," she said. That is why in some cases we still need a biopsy to confirm.''

Body mapping is a helpful tool being used to reduce the number of biopsies that need to be done to rule out melanoma until better diagnostic equipment is available. Other imaging devices are being developed to improve diagnosis. For example, the confocal microscope allows researchers and physicians to see through a person's skin as if it is under a microscope.

"This is unbelievable technology. It is the way of the future,'' Geskin said. She hopes it will be available for clinical use in the next few years.