Do I Need an Annual Skin Check? And Should I be Doing Skin Checks at Home?

Skin cancer is the most common cancer in the US and worldwide. More people are diagnosed with skin cancer each year in the US than all other cancers combined. One of five Americans will develop skin cancer by the age of 70, and more than 2 people will die of skin cancer in the US every hour.  The good news: when detected early, the 5-year survival for the most dangerous skin cancer, melanoma, is 99%.  Routine skin cancer screenings can truly mean the difference between life and death. 

Two other types of skin cancer, basal cell carcinoma and squamous cell carcinoma, cause far fewer deaths, but can cause significant local damage, requiring large, wide excisions if they are progressed.  Early detection can prevent this.  Early forms of pre- squamous cell cancer, called actinic keratoses (identified as small, rough red spots in sun-exposed areas) can be burned off with little to no scarring before a biopsy or excision is ever needed.

We recommend a skin screening with a medical professional at least once a year, as well as monthly self-checks at home.  Reasons to have a skin screening more frequently than once a year include a family history of melanoma, personal history of sunburns (having had 5 or more sunburns doubles your risk of melanoma), tanning bed use, fair skin, or having more than 50 moles.

In general, you should start getting screened for skin cancer in your 20s or 30s.  For a full skin exam, you’ll typically plan on coming in make-up free, without polish on your nails or toes, and wearing clothing that you can easily get on and off.  You’ll slip into a gown and then your doctor will examine your skin closely – from head to toe and front to back- including some of the more sneaky spots including the tops of the ears, between your toes, under the nails, and on your scalp.  Approximately one-third of all new melanoma cases are diagnosed on the head and neck.

In the event that something does look suspicious, a dermatologist will decide to either watch the spot, scheduling you for follow-up in a few months, or biopsy it.  The biopsy can be a scraping of the skin or a small cut, both of which are done with local numbing.  Highly visible areas can be biopsied by a dermatologist trained in aesthetics or a plastic surgeon.  

For monthly self-checks at home, take a look at this Health article for more information. Briefly summarizing: Each self-check should take no more than 5 minutes.  Find an area with good light just before or after your shower, where you can carefully examine your body, front and back, in a mirror.  You can use the acronym ABCDE to help you pick out suspicious moles.  Look for: Asymmetry (mole halves don’t match), Borders that are uneven, Color that isn’t uniform, Diameter larger than the size of a pencil eraser (4mm), or Evolution of the mole (growth, inflammation, itching, bleeding). Check each side with your arms raised above you. Bend your elbows to look carefully at forearms, underarms and palms. Your palms as well as bottoms of feet and nail beds are the places where you’re more likely to get acral lentiginous melanoma (ALM) —a type of melanoma that hits women of color more than any other group.  Check the backs of your legs and feet, the spaces between your toes, and the soles of your feet. Examine your fingernails and toenails for any new or unusual pigmented bands – if you spot a vertical line in any shade of brown extending from cuticle to the tip of your fingernail, make sure to check in with your doctor.  For harder-to-see places, including the back of your neck, scalp and buttock, use a hand mirror or get a friend or partner to help you.  Although less than 6% of melanomas pop up on the scalp, they can be more dangerous because they’re often found at later stages.  Be sure to part your hair, using your fingers or a blow dryer, to see the skin throughout your scalp.

Jennifer Abrams, MD, May 13, 2021