Early Detection

The first sign of melanoma is often a change in the size, shape, or color of an existing mole, or the appearance of a new mole. Since the vast majority of primary melanomas are visible on the skin, there is a good chance of detecting the disease in its early stages before it has had a chance to grow and spread.

This is important because when melanoma is found and treated early, the chances for long-term survival are excellent. As melanoma progresses, it becomes increasingly harder to treat and has a worse outcome. Five-year survival rates for patients with early stage are greater than 92% to 97%.1 Overall, 86% of all diagnosed patients enjoy long term survival after simple surgery.1

 

Methods of Early Detection

Melanoma can appear suddenly. Since the vast majority of primary melanomas are visible on the skin, there is a good chance of detecting the disease in its early stages.

To screen yourself, first you must know what the moles, blemishes, freckles, or other marks on your skin look like. That way, you can be aware of any changes in the future. It is recommend that you perform a complete self-skin examination once every month. It is also useful to see a physician for a complete skin exam before you begin self-exams so that a baseline of “normal” can be established.  From that point on, you can watch for changes.

A melanoma can develop anywhere on the skin, but it is important to be aware that it may occur in different places in men and women:

In men, melanoma is most often found between the shoulders and hips or the head and neck area.

In women, melanoma is most often found on the lower legs as well as between the shoulders and hips.

 

How to Do a Skin Self Exam

Melanomas can be distinguished from normal moles using the ABCDE rule:

  • A = Asymmetry
  • B = Border
  • C = Color
  • D = Diameter
  • E = Evolution

1. Examine your face, especially the nose, lips, mouth, and ears – front and back. Use one or both mirrors to get a clear view.

2. Thoroughly inspect your scalp, using a blow dryer and mirror to expose each section to view. Get a friend or family member to help if you can.

3. Check your hands carefully; palms and backs, between the fingers, and under fingernails. Continue up the wrists to examine both the front and backs of your forearms.

4. Standing in front of a full length mirror, begin at the elbows and scan all sides of your upper arms. Don’t forget the underarms.

5. Next focus on the neck, chest, and torso. Women should lift breasts to view the underside.

6. With your back to the full length mirror, use a handheld mirror to inspect the back of your neck, shoulders, upper back, and any part of the back of your arms you could not view in step 5.

7. Still using both mirrors, scan your lower back, buttocks, and the backs of both legs.

8. Sit down; prop each leg in turn on another stool or chair. Use the handheld mirror to examine the genitals and mucosal area. Check the front and sides of both legs, thigh to shin; ankles, tops of feet, between toes and under toenails. Examine soles of feet and heels.

 

How to Tell a Mole from Melanoma

 

These pictures show normal moles and melanomas

Most people have moles and they are almost always harmless. Although the first sign of a melanoma is often a change in a mole, it does not necessarily mean that all changes are melanomas.

 

ABCDEs of Melanoma

A = Asymmetry

Melanomas are frequently asymmetrical: the shape of one half does not match the other.

B = Border

Melanomas frequently have uneven or irregular borders (ragged or notched edges).

C = Color

Melanomas often contain multiple shades of brown or black but can sometimes be mixed with white, gray, blue, or red. Some melanomas will show a loss of color in a preexisting mole or in the area surrounding the mole.

D = Diameter

Melanomas are often larger than 6 mm (1/4 inch) in diameter. However, with increased awareness about early detection, about 30% of melanomas are found when they are less than 6 mm in diameter.

E = Evolution

Any change. Melanomas typically have shown some evidence of change in the months prior to diagnosis.

 

Concerned?

If you see any unusual spots, or changes to an existing skin lesion, contact your healthcare provider.

 

When to Contact Your Doctor

Tell your doctor about any changes you see. If you are concerned that a skin lesion may be melanoma, you should schedule an appointment with a doctor.

Important

If an appointment is not available even after explaining that you are concerned about melanoma, then seek another physician.

Contact your doctor promptly if you detect any of the following changes:

  • Increase in the size of a preexisting mole
  • Change in shape of a preexisting mole, particularly irregular borders
  • Change in color of a preexisting mole, including a darkening, loss of color, or the development of a red area
  • Any unusual oozing or bleeding from a preexisting mole
  • Halo formation around a preexisting mole
  • Itching, tenderness, or (less commonly) pain from a preexisting mole
  • Any unusual sore, lump, blemish, scaling, or marking
  • Appearance of a new mole in previously normal, unpigmented skin
  • Any new or suspicious lesion

Anxious About Skin Examinations?

Don’t get anxious about scheduling a skin examination with your healthcare provider. Learn what happens during one so you can prepare.

 

Regular Skin Examinations by Your Doctor

A skin examination by your doctor involves a thorough and systematic examination of all areas of the skin to see if any moles or lesions are suspicious for melanoma. You will also be checked for other spots and moles that may be related to skin cancer.

To help you and your doctor stay alert to any changes in your moles or lesions, your doctor may also take photographs or measurements of selected areas of the body or of the total body. This photograph or measurement is then used as a reference for follow-up examinations. This approach is particularly useful if you have numerous pigmented moles or lesions. At many medical centers, you can have pictures taken of your entire body.

The American Cancer Society recommends regular cancer-related checkups, including a skin exam every 3 years if you’re 20 to 40 years of age and every year for people 40 and older.

What Happens at a Skin Cancer Examination

  • When contacting your doctor to arrange a total body skin examination, you should request an appropriate amount of time for the appointment with the scheduler.
  • At the time of arrival, when placed in the room, and when first greeting the doctor, you should make your desire for a total body skin examination known, including a request for a gown if one is not provided.
  • During a skin cancer checkup or “screening,” your doctor will probably discuss your medical history and inspect your skin from head to toe-even areas that don’t get any sun. If your doctor performs only a waist-up exam, inform him/her that you would like a complete skin exam.
  • Your doctor will record the location, size, and color of any moles.
  • If a mole looks unusual, he/she may arrange for a biopsy.

 

Mole Mapping

The term mole mapping usually refers to a surveillance program for those at high risk of malignant melanoma. It may include a clinical skin examination and dermoscopy to identify and evaluate lesions of concern.

Mole mapping is intended to diagnose melanoma at the earliest possible stage, by identifying new moles or changes in preexisting moles. These features may be suspicious of melanoma if the lesion also has a disordered structure clinically or on dermoscopy.

 

Advantages and Disadvantages of Mole Mapping

Advantages Disadvantages
The previous record can be used to determine whether a lesion of concern is new or has changed. There may be a melanoma in a hidden site that has not been imaged, such as the scalp or genitals.
If the doctor determines that a lesion has the criteria for removal, this can be done at the earliest possible stage, reducing the risk of melanoma and minimizing surgery. Early melanoma may look like a normal mole or other benign skin lesion and might be missed (false negative).
If a lesion is new or has changed, but does not reach the threshold for removal, it can be reimaged and watched carefully. A harmless lesion may be misdiagnosed as melanoma, resulting in unnecessary surgery and alarm (false positive).
Lesions that do have not structural disorder and have not changed are very unlikely to be melanoma and so may not need to be removed, reducing the potential cost, risks, and complications of surgery. Melanoma may grow rapidly, particularly nodular melanoma; it may reach a dangerous size before the next planned visit for mole mapping.
Reassurance to patients and their health practitioner(s). The procedure may be embarrassing.

 

What Mole Mapping Usually Involves

You will be asked to remove at least outer clothing. Let the staff know if you feel uncomfortable, especially if there are lesions of concern hidden by your underwear. Makeup, nail polish, and jewelry should be completely removed prior to the procedure. Long hair should be tied up.

You are likely to undergo the following steps:

Risk evaluation (ie, medical and family history, skin typing, sun exposure)

Patient education regarding sun protection, moles, and melanoma

Skin examination by a health professional (usually a doctor or specially trained nurse). This may involve:

  • Simply marking spots on a cartoon drawing of you to indicate the position of skin lesions of concern, particularly moles and freckles
  • Photographs or digital images of the whole body’s skin surface. These can be reviewed at a later date to see if there are any new skin lesions or whether preexisting skin lesions have grown or changed color or shape.

Evaluation of the images by an expert in skin cancer, usually a dermatologist

A report to you and/or your referring health practitioner including suspected diagnoses and recommendations for treatment of lesions of concern

Follow-up:

  • 3 to 6 months for lesions of concern that are not removed
  • 1 to 2 years or as recommended by your doctor for all routine follow-up

Copies of the images for you or doctor to aid in skin self-examination

 

Suitability for Mole Mapping

Mole mapping is particularly useful for individuals who have:

  • Many moles (more than 50 to 100)
  • Atypical or dysplastic nevi – moles that are large or of unusual color(s) or shapes
  • Moles on the back, which may be difficult to keep an eye on
  • Previous history of melanoma
  • Strong family history of melanoma
  • Moles and fair skin that has been severely sunburned
  • Concerns about individual moles or freckles, eg, because of their appearance or recent change

If you are considering undergoing mole mapping, discuss the procedure with your own doctor.