Skin Exams and Early Detection

Author: Alison Sims, MD

A common question asked during any routine office visit at our urgent care is “by the way, doctor, could you also look at this spot on my skin and tell me if it is something to worry about?” I am happy that so many people are checking their skin for unusual spots. Early detection of skin cancer increases survival rates for those patients who are diagnosed with melanoma. I encourage prevention with sunscreen and clothing, and promote early detection by educating my patients on regular skin self-examinations.
Melanoma is the most feared and deadliest of the skin cancers. The incidence of melanoma has been rising worldwide for the past two decades and now it is the sixth most common cancer in North America. Living in Southern California our sun exposure is much higher, and the risk of melanoma is higher in geographical areas with strong sun. Other risk factors include a history of sunburns in childhood and teenage years, a tendency to freckle, a high number of moles, phototypes with lighter skin, hair and eye color, and a personal or family history in first-degree relatives of melanoma.
Most melanomas are detected by patients themselves, and the more you know about what to look for, the better off you are at protecting you and your loved ones. In the last 10 years the two most common checklists used for identifying suspicious lesions that should be further evaluated have been revised. These simple criteria will help you to distinguish between an ordinary harmless mole, and a potentially cancerous skin lesion.
Read these checklists carefully and maybe even post them somewhere in your bathroom as a reminder to check yourself head to toe when you are undressed.
A = Asymmetry (if a lesion is bisected, one half is not identical to the other half)
B = Border irregularities
C  = Color variegation (a combination of brown, red, black, blue/gray, or white)
D  = Diameter greater than or equal to 6 mm (about the size of a pencil eraser)
E  = Evolving: a lesion that is changing in size, shape, color, or a brand new lesion
(Source JAMA. 2004;292(22):2771)
Glasgow Seven-Point Checklist
MAJOR FEATURES (indications for referral to dermatologist):  

  • Change in size/new lesion
  • Change in shape
  • Change in color

MINOR FEATURES (reinforces that a referral is needed):

  • Diameter greater than or equal to 7mm
  • Inflammation
  • Crusting or bleeding

(Source Br J Dermatology. 2010;163(2):238)
If you are middle-aged and have a light complexion then it is recommended that you have a baseline skin exam by a physician and annual rechecks. In addition, skin self-examinations at home should be monthly, and ideally with a friend or family member so that the back of the body is examined. Use a bright light source and a magnifying lens if necessary, and be sure to check areas that are not sun exposed as well. Your exam should include the entire head, neck and scalp, all surfaces of the arms, legs, hands, feet, webs of fingers and toes, palms and soles, nail beds, back, buttocks, and even private parts. You should also know that suspicious lesions may not be dark in color as there are some rare melanomas that are called “amelanotic” and can be nonpigmented. Happy hunting and spread the word, melanoma can be detected early!
The information provided is for general interest only and should not be misconstrued as a diagnosis, prognosis or treatment recommendation. This information does not in any way constitute the practice of medicine, or any other health care profession. Readers are directed to consult their health care provider regarding their specific health situation. Marque Medical is not liable for any action taken by a reader based upon this information.

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