Dermatology Surveillance (Skin Cancer Monitoring)

Who benefits from skin surveillance

Routine skin cancer screening of the general population is not universally recommended because evidence of benefit is limited. Structured surveillance is aimed at people whose risk is clearly higher:

How often to have skin checks

Intervals are tailored by the dermatologist. Typical examples:

• After melanoma: every 3 to 6 months for the first 2 to 3 years, then every 6 to 12 months up to 5 years, then yearly. Intervals depend on stage.
• After basal or squamous cell carcinoma: every 6 to 12 months.
• Organ transplant recipients: every 3 to 12 months depending on history.
• Many or atypical moles without cancer: every 6 to 12 months.

What happens at a surveillance visit

1. History: new or changing spots, symptoms, sun exposure, medicines and family history.
2. Full-body skin exam: including the scalp, between the toes, soles, nails, genitals and inside the mouth.
3. Dermoscopy: a handheld magnifier with polarized light shows pigment patterns and blood vessels invisible to the naked eye, improving accuracy.
4. Lymph node check for people with a previous melanoma or squamous cell carcinoma.
5. Imaging: for people with many moles, total body photography and sequential digital dermoscopy (photos of individual moles compared over months) help detect subtle change.
6. Treatment or biopsy: suspicious spots are biopsied or removed. Precancers such as actinic keratoses are treated with freezing, creams or photodynamic therapy.

For melanoma survivors at higher stages, surveillance may also include scans and blood tests coordinated by an oncologist.

Monthly skin self-examination

Self-checks catch many melanomas between visits. Once a month, in good light, with a full-length mirror and a hand mirror:

1. Check your face, ears, lips and inside your mouth.
2. Part your hair to examine your scalp, or ask someone to help.
3. Look at your hands, palms, nails and between your fingers.
4. Check arms, underarms and the front of your body, including under breasts.
5. Use the hand mirror for your back, buttocks and the backs of your legs.
6. Sit to check your legs, soles, between your toes and toenails.
7. Check your genital area.

Use the ABCDE rule: Asymmetry, Border irregularity, Color variation, Diameter over 6 mm, and Evolving. Also watch for any spot that looks unlike your others, bleeds, itches persistently or does not heal. Taking photos of your skin on your phone makes changes easier to see.

Reducing your risk between visits

• Use broad-spectrum SPF 30 or higher sunscreen daily on exposed skin. See sun protection.
• Wear sun-protective clothing, a wide-brimmed hat and sunglasses.
• Avoid the midday sun and never use tanning beds.
• People with many skin cancers may be offered nicotinamide (vitamin B3), which reduced new non-melanoma skin cancers in a clinical trial. Ask your dermatologist whether it suits you.
• Transplant recipients may have their immune-suppressing medicines adjusted to lower skin cancer risk.

Benefits and limits

Surveillance in high-risk people finds melanomas at an earlier, thinner stage, when cure rates are highest, and keeps unnecessary surgery down by tracking moles rather than removing them all. It cannot prevent every cancer, and some benign lesions are removed to be safe. Good self-checks and sun protection make surveillance more effective.

Frequently asked questions

What is dermatology surveillance?

It is a schedule of regular skin examinations by a dermatologist for people at higher risk of skin cancer. Visits include a full-body skin check, dermoscopy, and sometimes photography, so new or changing spots can be found early and treated.

Who needs regular skin cancer checks?

People with a previous melanoma or other skin cancer, many or atypical moles, a family history of melanoma, organ transplants, large congenital moles, heavy sun damage or certain genetic syndromes benefit most. Your dermatologist will advise on frequency.

How often should I have a skin check after melanoma?

Typically every 3 to 6 months for the first 2 to 3 years, then every 6 to 12 months to year 5, then yearly for life. The exact schedule depends on the stage of melanoma and your other risk factors.

What is mole mapping?

Mole mapping uses total body photography and close-up dermoscopy images of individual moles, stored and compared at later visits. It helps detect subtle changes in people with many moles and avoids removing moles that are stable.

Can I check my own skin for cancer?

Yes. A monthly self-exam using mirrors and good light helps you spot new or changing spots. Use the ABCDE rule and look for spots that look different from your others. Report any change to your dermatologist rather than waiting for your next visit.