Any dermatologist will agree that an annual trip to the dermatologist for a full-body skin check is a crucial part of the skin cancer–prevention process, but they’ll also agree that it’s not enough. “The time in between scheduled skin checks is when we really rely on patients to do a monthly self-exam at home,” says Denver dermatologist Joel L. Cohen, MD.
Examining the skin at home may sound cumbersome, but New York dermatologist and president of The Skin Cancer Foundation Deborah S. Sarnoff, MD says it’s well worth our time. “Unlike cancers that develop within the body, skin cancers are usually visible—that’s why skin exams, both at home and with a dermatologist, are especially vital.”
Another reason at-home self-exams are crucial: Early detection can save your life. According to the American Cancer Society, many of the 5-million-plus skin-cancer cases diagnosed each year could have been prevented with regular screenings and safe-sun habits. Dr. Sarnoff agrees, noting, “Skin cancers that are caught and treated early, before they’ve had a chance to spread, are highly curable.”
Scanning your body for potentially dangerous changes may not only sound difficult and time-consuming, but also out of your wheelhouse. If you don’t know where to start, you’re not alone. How often should we be scanning for changes and what exactly should we be checking for? We tapped leading doctors for answers.
How Often Should You Conduct At-Home Skin Cancer Screenings?
The Skin Cancer Foundation recommends a monthly full-body screening; Dr. Cohen and New York dermatologist Michelle Henry, MD are aligned. Dr. Henry explains that different types of skin cancers can grow at different paces, “and any step that we can do to make sure we find it earlier is going to improve a prognosis.”
Dr. Cohen agrees: “If something comes about a month after a patient’s scheduled skin check, and they’re not slated to come in for another five months, that five months can be really significant.”
What to Look for During At-Home Skin Cancer Screenings
There are three most common forms of skin cancer, and it’s important to understand them all.
Basal Cell Carcinoma (BCC): The most common form of skin cancer. According to The Skin Cancer Foundation, BCCs can look like open sores, red patches, shiny bumps, pink growths, scars or growths with slightly elevated, rolled edges and/or a central indentation. However, BCCs can look quite different from one person to another.
Squamous Cell Carcinoma (SCC): The second most common form of skin cancer, SCCs can appear as scaly red patches, open sores, rough, thickened or wart-like skin, or raised growths with a central depression, according to The Skin Cancer Foundation.
While these lesions are most commonly found in the sun-exposed areas of the body, Dr. Henry notes that SCCs can also occur in double-covered areas, including the genitals. “We often see squamous cell carcinomas in areas where we have a higher tendency to get HPV, so the groin, the fingertips, the mouth,” she explains.
Melanoma: The deadliest of these three forms due to its ability to spread, melanoma is typically pigmented, but as Dr. Cohen explains, about 10-percent of melanomas are not, also known as amelanotic melanoma.
In the case of pigmented melanoma, the ABCDE rule should be used. The rule includes:
A – Asymmetry: Growth is asymmetrical
B – Border: Border shows irregularity; rough or jagged edges
C – Color: Various shades of colors such as black, brown, tan, red, white or blue
D – Diameter: Larger than six millimeters (picture the tip of a pencil eraser)
E – Evolving: Has there been any evolution or change?
Dr. Cohen says the last point underscores the importance of self-exams, noting that screening for any type of change is absolutely necessary. “Patients know their own bodies best,” adds Dr. Henry. Keeping a close eye on any existing spots can make all the difference.
The bottom line: Dr. Cohen explains we should be checking every inch of our skin for anything that is “new, changing, bleeding, scabbing, getting larger, darker, crusted or just won’t heal after a couple of weeks.”
How to Conduct an At-Home Skin Cancer Screening
Experts agree that the most important part of an at-home screening is consistency—following the same rules, steps and order each time so that it eventually becomes routine.
“Most patients will start on the face, work their way down their arms, their chest, their legs, the tops of their feet, the soles of their feet,” explains Dr. Henry. “Then things get a little tricky when they’re looking at the back of them. I encourage them to either enlist a partner or to use a hand mirror,” she adds. A hand mirror can help when inspecting the back of your neck, shoulders, back and buttocks (be sure to reposition the mirror to make things easier on you!). Or, a partner or loved one can take photos of these areas for you, a step Dr. Henry highly recommends to all of her patients.
“I really, really like for my patients to utilize technology because they can zoom in on a lesion, they can really tell if those borders have changed. Your iPhone is not just for selfies. It can also be used to really save your life if you’re using it appropriately.”
Follow a Self-Screening Checklist
Face and neck: “About 80–90 percent of the skin cancers we find are on the head and neck,” says Dr. Henry. “It’s an area we’re getting constant sun exposure, so it’s really crucial that we are examining the face.” Don’t forget to also pay attention to the ears and eyelids.
Scalp: Dr. Henry instructs parting your hair in a grid-like fashion and taking photos of each section you can’t see in the mirror. “It’s going to be hard to take photos of every square inch, but really take the time to part your hair, go through it and take photos of those areas you can’t see. Again, enlist a partner if you have one.”
Arms and hands: Thoroughly scan the front and back of your hands and arms, including the underarms and in between each finger and beneath each nail. Dr. Cohen notes that cases of nail cancers are quite common and can be life-threatening. Remove any nail polish prior to the screening to ensure you’re seeing what’s beneath the nail clearly.
Mouth and lips: Dr. Henry says every one of her screenings includes a look inside the mouth. Always scan for abnormal lesions on and around the lips, as well.
Front of body: Closely examine the area from the chest to the pelvic area. Women should lift each breast to check underneath them, as well.
Back of body: Scan the areas from the shoulders to your buttocks.
Legs and feet: Ensure you get a good look at every inch of the front, back, outsides and insides of your legs, enlisting the help of a hand mirror or partner when needed. Next, move onto your feet, examining the tops and soles of each foot, along with each nail and in between each nail carefully.
Genitals: Sitting on the floor in front of the mirror may help get a closer look at these areas, which Dr. Cohen and Dr. Henry stress are just as important to check as the aforementioned. “Some skin cancers do occur in areas where the sun doesn’t typically shine,” stresses Dr. Cohen.
What to Do If You Find Something Suspicious
“If you see anything new, changing or unusual on your skin, get it checked out by a board-certified dermatologist as soon as possible,” urges Dr. Sarnoff. Depending on where your state currently stands on office openings, your doctor will make it a priority to schedule a consult, whether it’s a physical visit or via a virtual consult.
“While a full, comprehensive skin exam is not possible with telemedicine, spot checks can be performed,” says Dr. Sarnoff. However, Dr. Cohen notes that while there are benefits to telemedicine, there are also some limitations. “It is difficult to assess somebody [for skin cancer] over video when the video is moving, it’s not great image quality and you can’t really study it closely. But most importantly, you can’t use your dermatoscope tool, a hand-held instrument, which allows your dermatologist to polarize the light to analyze the lesion—to evaluate pigment networks, pigment consistency and borders.”
However, if your dermatologist is only seeing patients via telemedicine, Dr. Sarnoff offers up some helpful tips to help your physician virtually assess lesions as accurately as possible. Dr. Sarnoff recommends taking photos of the spots in question prior to the appointment. “Patients should make sure their images are in focus, well-lit and show some surrounding skin for context. Take multiple photos of the same spot from different angles and distances, with and without flash to help provide as much information as possible,” adds Dr. Sarnoff.
“The dermatologist can then look them over virtually and provide advice over the phone or during a video chat. If your doctor determines you have a suspicious lesion that is a bit more concerning, they may recommend you come into the office for an in-person visit.”
