What is the recommended procedure for a skin check?

Skin Check Procedure

The US Preventive Services Task Force (USPSTF) does not recommend routine skin cancer screening for asymptomatic adults due to insufficient evidence of mortality benefit, but clinicians should use their clinical judgment to perform visual skin examinations, particularly in higher-risk patients. 1

For Asymptomatic Average-Risk Patients

No routine screening is recommended by the USPSTF for the general asymptomatic population, as there is no proven reduction in melanoma mortality despite increased detection of early-stage lesions. 1

Key Considerations:

• The decision to perform a visual skin examination should be based on clinical judgment rather than routine protocol. 1
• No professional organizations in the US currently recommend routine clinical visual examination for skin cancer screening in average-risk individuals. 1
• Screening may lead to false-positive results requiring unnecessary biopsies and potential overtreatment of lesions with minimal malignant potential. 1

When Skin Examination IS Indicated

High-Risk Patients Requiring Examination:

• Personal or family history of melanoma (especially first-degree relatives or familial melanoma syndrome) - refer to dermatology for monitoring. 1
• History of skin cancer - these patients should receive regular full-body skin examinations. 2
• Multiple atypical/dysplastic nevi or high nevus count. 1
• Increased sun exposure (recreational or occupational). 1
• Fair skin or sun sensitivity. 1
• Clinical evidence of precursor lesions. 1

Symptomatic Patients:

• Any patient presenting with a concerning skin lesion as their chief complaint requires thorough examination. 1
• New or changing skin lesions warrant evaluation. 3

How to Perform a Complete Skin Examination

Examination Technique:

A complete full-body skin examination should assess all skin surfaces, as 45% of melanomas are detected incidentally during routine examination rather than as the presenting complaint. 4

Areas to Examine:

• All body regions including non-sun-exposed areas, as melanomas can occur anywhere, particularly in people with darker skin who are often diagnosed at later stages. 3
• Most health care providers fail to routinely examine the areas where melanomas commonly arise. 5
• Complete examination detects significantly thinner melanomas compared to examining only the presenting lesion. 4

Assessment Criteria - ABCDE Method:

• Asymmetry: Irregular shapes or halves that don't match. 3
• Border irregularity: Jagged, notched, or blurred edges. 3
• Color variation: Multiple colors or uneven distribution. 3
• Diameter: Lesions larger than 6mm. 3
• Evolution: Changes in size, shape, color, or symptoms over time. 3

Additional Assessment Tool:

• Apply the "ugly duckling" sign to identify moles that look different from surrounding moles. 3

Surveillance for Diagnosed Melanoma Patients

Stage 0 (Melanoma in Situ):

• Every 6-12 months for 1-2 years, then annually thereafter. 1
• Physical examination with emphasis on local recurrence (particularly lentigo maligna subtype) and full skin check for new primary melanomas. 1
• No radiologic imaging required. 1

Stage IA-IIA:

• Every 6-12 months for 2-5 years, then at least annually thereafter. 1
• Comprehensive history and physical examination focusing on skin and regional lymph nodes. 1
• No routine imaging. 1

Stage IIB and Higher:

• Every 3-6 months for first 2 years (highest risk period for relapse). 1
• At least every 6 months for years 3-5, then at least annually thereafter. 1
• Comprehensive history and physical examination. 1
• Imaging may be performed for up to 3-5 years (chest radiography, CT chest/abdomen/pelvis, brain MRI, or PET-CT depending on recurrence risk). 1

Common Pitfalls

• Incomplete examination: Examining only the presenting lesion misses 3.3% of basal cell carcinomas and 0.6% of potentially lethal melanomas. 6
• Patient barriers: Patients often don't receive recommended skin exams due to scheduling conflicts, provider availability, and lack of awareness that examination is recommended. 7
• Assuming breast cancer survivors need special screening: Breast cancer itself does not increase skin cancer risk beyond general population recommendations. 3
• Overlooking darker skin: Melanomas in people with darker skin often occur in non-sun-exposed areas and are diagnosed at later stages. 3

Patient Education

• Self-examination is uncommon: Only 9% of the general public performs thorough skin self-examination regularly. 5
• Patient acceptance is high: 87% of patients want their provider to perform regular full-body skin examinations, with only 8% reporting embarrassment. 2
• Reminder systems help: Text/email/phone call reminders increase likelihood of patients receiving recommended skin exams. 7