Physical examination of the skin for skin cancer

Examination Overview

During a physical examination for a skin problem, your health professional will examine the skin over your whole body, looking for suspicious growths, moles, or lesions. The examination is performed using a bright light and occasionally a magnifying lens. The scalp is examined by parting the hair.

Why It Is Done

A skin examination is done if you have:

• Suspicious moles or skin lesions.
• Symptoms of early skin cancer.
• A history of previous skin cancer.
• 50 or more moles.
• Atypical moles (dysplastic nevi).
• A family history of skin cancer.

Results

Early signs of skin cancer are a change in the skin, such as a growth, an irritation or a sore that does not heal, or a change in a wart or a mole.

Signs of melanoma

The ABCDE rule of detection means watching for:¹

• Asymmetry. One half of the mole doesn't match the other half.
• Border irregularity. The edges are ragged, notched, or blurred.
• Colour. The pigmentation is not uniform. Shades of tan, brown, and black are present. Dashes of red, white, and blue add to the mottled appearance. Changes in colour distribution, especially the spread of colour from the edge of a mole into the surrounding skin, also are an early sign of melanoma.
• Diameter. The mole or skin growth is larger than 6 mm (0.2 in.), or about the size of a pencil eraser. Any growth of a mole should be of concern.
• Evolution. There is a change in the size, shape, symptoms (such as itching or tenderness), surface (especially bleeding), or colour.

Other signs of melanoma in a mole include changes in:

• Elevation, such as thickening or raising of a previously flat mole.
• Surface, such as scaling, erosion, oozing, bleeding, or crusting.
• Surrounding skin, such as redness, swelling, or small new patches of colour around a larger lesion (satellite pigmentations).
• Sensation, such as itching, tingling, or burning.
• Consistency, such as softening or small pieces that break off easily (friability).

Other signs of skin cancer

Signs of skin cancer include:

• A firm, transparent bump laced with tiny blood vessels in thin red lines (telangiectasias).
• A reddish or irritated patch of skin.
• A new, smooth skin bump (nodule) with a raised border and indented centre.
• A smooth, shiny, or pearly bump that may look like a mole or cyst.
• A shiny area of tight-looking skin, especially on the face, that looks like a scar and has poorly defined edges.
• An open sore that oozes, bleeds, or crusts and has not healed in 3 weeks.
• A persistent red bump on sun-exposed skin.
• A sore that does not heal or an area of thickened skin on the lower lip, especially if you smoke or use chewing tobacco, or your lips are exposed to the sun and wind.

What To Think About

Photographs may be used to document and detect changes in the skin, especially atypical moles. Some medical centres use computers to compare photographs taken at an earlier examination with new photographs of suspicious moles and lesions. This technique may more accurately determine whether a mole or lesion is changing.

There is not good evidence suggesting how often skin should be examined for signs of skin cancer.² Most experts think it's a good idea to check your own skin every month, and have your doctor check periodically. People who are at risk for skin cancer or those who are over 40 years old may want to have their doctor check their skin every year. If you have already had skin cancer, your doctor will recommend more frequent examinations.

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Author:	Shannon Erstad, MBA/MPH Carrie Henley	Last Updated: March 23, 2007
Medical Review:	Kathleen Romito, MD - Family Medicine Randall D. Burr, MD - Dermatology Andrew Swan, MD, CCFP, FCFP - Family Medicine
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