What Should I Look for When Examining My Skin for Signs of Melanoma?

By Shawn Allen, MD

Shawn Allen, MD, is the director and founder of Dermatology Specialists of Boulder, in CO. He is Assistant Clinical Professor in the Department of Dermatology at the University of Colorado School of Medicine.

A: Our skin is one of the few organs we can easily examine every day. This allows patients to look for blemishes, rashes, skin cancers, and other skin diseases and bring them to their dermatologist’s attention in a timely fashion. Patients and their significant others will often be the first to notice that something on the skin has changed; a thorough monthly skin self-examination and an annual visit to your dermatologist can be vital. Some specific guidelines can be helpful in identifying a potential melanoma, the deadliest form of skin cancer. We traditionally teach our patients the “ABCDEs” of melanoma. The “A” is for asymmetry of the mole. “B” stands for borders that are irregular, such as cloudshaped or scalloped borders, or lesions with poorly demarcated edges. “C” is for color — melanomas may have multiple colors such as light and dark brown, pink, red, gray or even blue. They will be differently colored and usually darker than the other moles in the area. The “D” stands for diameter, which in normal moles is usually no larger than 6mm, or the size of a pencil eraser tip. However, diameter is probably one of the least helpful signs, since melanomas can be smaller than 6mm and normal moles can be large. The “E” may be the most telling sign, and it stands for evolving. Look for moles that are changing in size, color, or shape or are drawing attention to themselves by bleeding or itching. As a rule, if the lesion is demanding the patient’s attention by changing signs or symptoms, it should be seen by a dermatologist promptly.

Q: “What is the best way to examine my skin?”

A: When examining the skin, stand in front of the mirror and look for a mole that stands out at first glance. This is now often referred to as “the ugly duckling” sign. The idea is that a mole that looks different from the others may be one of concern. When I first examine my patients, I similarly like to determine what the patient’s “typical” mole looks like, establishing a baseline to compare against. This is best determined during a total-body skin examination. Once this baseline is established, focusing on the moles that stand out or meet the criteria of any of the ABCDEs can be helpful in determining which moles, if any, need further evaluation. When looking for the ABCDEs or an “ugly duckling,” don’t neglect the scalp, nails, hands, and feet, since melanomas in these locations tend to be found at later stages, and can have a higher risk of spreading. Also be aware of the following signs of the more common nonmelanoma skin cancers: a skin growth that increases in size andappears pearly, translucent, tan, brown, black or multicolored; a spot that itches, hurts, crusts, scabs, erodes, or bleeds, or an open sore that does not heal within three weeks. Melanoma is one of the few cancers readily detectable with a simple, relatively quick and noninvasive skin examination. When caughtearly, melanomas are easily treatable and have very high cure rates. However, the longer a melanoma exists undetected, the deeper it grows, the more complex the surgery and the higher the risk of the cancer spreading. So regularly examine your skin for signs of melanoma and other skin cancers, and have a professional full-body skin screening annually.