Skin Cancer Screening

Why screening matters

Skin cancer is the most common cancer in the US. Most skin cancers are basal cell and squamous cell carcinomas, which rarely spread but can cause local damage. Melanoma is less common but causes most skin cancer deaths. When melanoma is found early, before it has spread, the 5-year survival rate is over 99%. Survival falls substantially once it spreads to lymph nodes or other organs.

Who should be screened

The USPSTF (2023) concluded there is not enough evidence to recommend for or against routine skin cancer screening by clinicians for all adolescents and adults without symptoms. However, many experts and the American Academy of Dermatology recommend regular professional checks for higher-risk people:

• personal history of melanoma or other skin cancer
• family history of melanoma (parent, sibling or child)
• more than 50 moles, or atypical (dysplastic) moles. See dysplastic nevus
• fair skin, red or blond hair, light eyes, freckles, and skin that burns easily
• history of blistering sunburns, especially in childhood
• tanning bed use
• weakened immune system, such as organ transplant recipients
• older age with significant sun damage or actinic keratoses
• certain genetic syndromes

What happens during a skin check

1. You undress and wear a gown. You can ask for a chaperone.
2. The clinician examines your skin from scalp to soles, including between toes, the nails, ears, and, with your consent, the buttocks and genitals.
3. A dermatoscope, a handheld magnifying light, is used to look at pigment patterns in moles.
4. Some clinics take photographs or use total body photography to track changes over time.
5. Suspicious spots are biopsied under local anesthetic, by shaving or punching out a small sample, or removed entirely.

Remove nail polish and makeup beforehand, and point out any spots that concern you.

Warning signs

ABCDEs of melanoma

• Asymmetry: the two halves do not match
• Border: irregular, ragged or blurred edges
• Color: several shades of brown, black, red, white or blue
• Diameter: larger than 6 mm (about a pencil eraser), though some melanomas are smaller
• Evolving: changing in size, shape, color, height or symptoms

The ugly duckling sign

A mole that looks different from all your other moles deserves a check.

Other skin cancers

How to do a skin self-exam

Once a month, in a well-lit room with a full-length mirror and a hand mirror:

1. look at your face, ears, neck, chest and belly. Women should check under the breasts
2. check your underarms, arms, palms, backs of hands, fingernails
3. sit and check your legs, the tops and soles of your feet, between toes and toenails
4. use the hand mirror to check the back of your neck, back, buttocks and genitals
5. part your hair to check your scalp, or ask someone to help

Take photos of moles to compare over time. Apps can help track changes but should not replace a clinician's assessment.

Reducing your risk

• use broad-spectrum sunscreen SPF 30 or higher daily, reapplying every 2 hours outdoors
• wear protective clothing, a wide-brimmed hat and sunglasses
• seek shade between 10 a.m. and 4 p.m.
• avoid tanning beds
• protect children from sunburn

See sun protection for more.

Frequently asked questions

Who should get a skin cancer screening?

Professional skin checks are most useful for people at higher risk: those with a personal or family history of melanoma, many or atypical moles, fair skin that burns easily, heavy sun exposure, tanning bed use or a weakened immune system. Everyone should do monthly self-checks.

How often should you get a skin check?

People at high risk often see a dermatologist every 6 to 12 months. Those at average risk may not need routine professional screening but should report new or changing spots. Your dermatologist will suggest a schedule based on your risk.

What happens at a full-body skin exam?

You change into a gown, and a clinician examines all of your skin, from scalp to feet, often using a dermatoscope to look closely at moles. Any suspicious spots may be photographed or biopsied. The exam takes about 10 to 15 minutes.

Does skin cancer screening include a biopsy?

Only if a suspicious spot is found. A biopsy removes a small piece or the whole spot under local anesthetic to examine under a microscope. Most biopsied spots turn out to be harmless.

What does skin cancer look like in its early stages?

Early melanoma may look like a new or changing mole with an irregular shape or uneven color. Early basal cell carcinoma often appears as a pearly bump or a sore that does not heal. Early squamous cell carcinoma may be a rough, scaly red patch.