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Skin Exams

During a physical exam for a skin problem, your doctor will examine the skin over your whole body, looking for suspicious growths, moles, or lesions. The exam is performed using a bright light and occasionally a magnifying lens. The scalp is examined by parting the hair. A skin exam 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); or a family history of skin cancer. 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:

  • Asymmetry . One half of the mole doesn’t match the other half.
  • Border irregularity . The edges are ragged, notched, or blurred.
  • Color . 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 color distribution, especially the spread of color 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 color.

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 color 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

  • 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 center.
  • 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 centers use computers to compare photographs taken at an earlier exam with new photographs of suspicious moles and lesions. This technique may more accurately determine whether a mole or lesion is changing.

Doctors don’t have to do a biopsy to see if a lesion is benign (noncancerous). They may use a dermatoscope to see spots on the skin. This tool’s special magnifying lens and light source help the doctor see the skin more clearly. Also, with a method called confocal laser scanning microscopy (CLSM), doctors can look even more closely at changes in the cells and tissue of the skin.

Some 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 exams.

Written by Patrick Bitter Jr, MD

Patrick Bitter, Jr., M.D., is a board-certified dermatologist specializing in non-surgical treatments to improve skin health and delay aging and anti-aging medicine. He is the founder of Advanced Aesthetic Dermatology and maintains medical practices in Los Gatos, CA and Beverly Hills, CA. He graduated from the University of California with highest honors in Biology. He received his medical degree from Stanford University School of Medicine. He completed his dermatology residency at Stanford University School of Medicine in 1986. Dr. Bitter is regarded as the pioneer in the use of pulsed light technology for skin rejuvenation. He is the developer of the acclaimed FotoFacial procedure using pulsed light to rejuvenate aged skin. He has authored several ground-breaking scientific papers on the use of pulsed light for skin rejuvenation. He is a sought after lecturer and teacher and has taught over four thousand physicians world-wide in the use of pulsed light. Dr. Bitter has been featured as a celebrity dermatologist on ABC's Extreme Makeover. He is a member of several professional societies including Fellowship in the American Academy of Dermatology and the American Academy of Anti-Aging Medicine. Dr. Bitter has been a consultant to the medical laser device industry and to nutritional and anti-aging companies. Dr. Bitter is dermatologist for the San Jose Sharks National Hockey League Team. He is a former USA Triathlon National Champion and two-time Hawaiin Ironman Triathlon finisher.