Skin Cancer Screening

Screening looks for any spot that does not match the rest of your skin. The ABCDE rule is the starting point for pigmented lesions: Asymmetry, Border irregularity, Color variation, Diameter greater than six millimeters, and Evolution or change. The ugly duckling sign, a mole that looks different from your other moles, is just as important.

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Non-pigmented warning signs include a sore that bleeds, scabs, and refuses to heal after three to four weeks, a pearly or shiny bump with visible blood vessels, a rough scaly patch that is not responding to moisturizer, a wart-like growth that suddenly enlarges, and any new dark streak under a fingernail or toenail. Tell your dermatologist about any spot that itches, hurts, or has changed, even if it looks unimpressive.

Anyone can develop skin cancer, but certain factors raise your risk and your screening frequency should match. Risk goes up with fair skin, light eyes, blond or red hair, freckling, a personal history of any skin cancer, a family history of melanoma, more than 50 moles, atypical moles, significant lifetime sun exposure, a history of blistering sunburns or tanning bed use, immunosuppression after organ transplant, and certain inherited conditions such as xeroderma pigmentosum.

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Skin cancer can occur in skin of color too, often in less sun-exposed areas such as the palms, soles, and nail beds, and is more likely to be diagnosed at a later stage. Regular screening matters regardless of skin tone.

The screening exam itself is non-invasive. You change into a gown so the entire skin surface can be examined, and the dermatologist works systematically from the scalp to the soles, including the scalp, behind the ears, between the toes, the palms, the nails, and other areas patients commonly miss on self-exam. We use a dermatoscope, a handheld magnifying device, to look at the pigment and vascular structures of any lesion that catches our eye.

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If a lesion is suspicious, we biopsy it during the same visit when possible. A biopsy is a quick in-office procedure under local anesthesia, usually a shave or punch technique, with results back in five to seven business days. Most biopsied lesions turn out to be benign, but the small fraction that are precancerous or cancerous are then treated with the appropriate option, ranging from cryotherapy to surgical excision to Mohs surgery, depending on diagnosis.

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For patients with many moles or atypical moles, total-body photography and serial dermoscopic monitoring create a baseline so we can track subtle changes over time rather than relying on memory.

A typical screening exam takes 15 to 30 minutes. Come without makeup, nail polish, or self-tanner, and pin long hair up so the scalp can be seen clearly. You will change into a gown and the dermatologist will guide you through positions to examine each area. The exam is professional and respectful, and you can ask for a chaperone at any time.

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Bring a list of any spots you are concerned about so they can be addressed first. We point out the lesions we want to follow, photograph anything that needs monitoring, and explain whether biopsy is recommended. If everything looks reassuring, you leave with a recommended timeline for your next exam.

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Most patients are surprised at how quick and straightforward the visit is, and how often we catch spots they had not noticed at all.

Schedule a screening sooner rather than later if you notice any new or changing spot, a sore that will not heal, a mole that looks different from your others, a dark streak under a nail, or a rapidly growing pink bump. Get a baseline exam if you have not had one as an adult, particularly if you have any of the risk factors above.

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Anyone with a personal history of skin cancer needs ongoing surveillance, typically every six to twelve months for life. Family members of patients with melanoma should also be evaluated, since melanoma can run in families.

The best partner to professional screening is monthly self-examination. Pick a day each month, stand in good light with a full-length mirror, and use a hand mirror for the back, neck, and scalp. Get to know your own moles. Photograph anything you are watching so you can compare objectively in future months. The new and the changing are the spots to flag.

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Daily broad-spectrum SPF 30 or higher, hats, sun shirts, and shade between 10 a.m. and 4 p.m. lower your lifetime risk. Avoid tanning beds entirely. If you have already had a skin cancer, sun protection is not optional, because second skin cancers are common and largely preventable.