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Skin Cancer
Skin Examination
Skin examination should be preceded by inquiry for patient concern, e.g. of newly grown lesions or change in appearance of any lesions in the past few months. Examination should assess asymmetry, border, colour, diameter and elevation (ABCDE). Lesions which are asymmetric, have an irregular border, variation in colour or have a red halo, are >6 mm or elevated are possibly melanomas.
Early detection of cancers - Full body skin examination has been shown in general practice to take on average 2-3 minutes.
Self examination - Photography may aid in monitoring skin lesions over time Patients should be advised on the specific changes that suggest melanoma, and encouraged to perform self examination especially of naevi. Those at high risk can benefit from use of total body photography.
Clinical Considerations
- Benefits from screening are unproven, even in high risk patients. Clinicians should be aware that fair skinned men and women aged >65, patients with atypical moles, and those with >50 moles constitute known groups at substantially increased risk for melanoma.
- Clinicians should remain alert for skin lesions with malignant features noted in the context of physical examinations performed for other purposes. Asymmetry, Border irregularity, Color variability, Diameter >6 mm (“A,” “B,” “C,” “D”), or rapidly changing lesions are features associated with an increased risk of malignancy. Suspicious lesions should be biopsied.
- The U.S. Preventive Services Task Force (USPSTF) concludes that the evidence is insufficient to recommend for or against routine screening for skin cancer using a total-body skin examination for the early detection of cutaneous melanoma, basal cell cancer or squamous cell skin cancer.
- Intermittent or intense sun exposure is a greater risk factor for melanoma than chronic exposure. The observational studies support the hypothesis that preventing sunburn, especially in childhood, may reduce the lifetime risk for melanoma.
- Measures for preventing skin cancer include avoiding direct exposure to midday sun (between the hours of 10:00 AM and 4:00 PM) to reduce exposure to ultraviolet (UV) rays and covering skin exposed to the sun (by wearing protective clothing such as broad-brimmed hats, long-sleeved shirts, long pants, and sunglasses).
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