From the Guidelines
For possible skin cancer, a thorough visual skin examination using the "ABCDE" rule and the "ugly duckling" sign, as well as dermoscopy, should be performed to assess suspicious lesions. The visual skin examination should include a survey of the body for skin lesions, looking for characteristics such as asymmetry, border irregularity, nonuniform color, diameter greater than 6 mm, and evolution over time 1. Dermoscopy can be used to further evaluate suspicious lesions, and a biopsy should be performed if there is uncertainty about the diagnosis. The "ABCDE" rule is a useful tool for assessing potential melanomas, and the "ugly duckling" sign can help identify pigmented lesions that look different from other moles on the patient 1.
When performing a physical examination, it is essential to examine the lesion's color, texture, and borders, and to palpate the lesion to assess its characteristic feel. Dermoscopy is crucial in evaluating suspicious lesions, and a biopsy should be performed if there is uncertainty about the diagnosis. A shave biopsy can be performed for histopathological confirmation, especially if the lesion shows concerning features like rapid growth, bleeding, or irregular borders.
In addition to the physical examination, a full skin examination is recommended because individuals with a skin cancer often have additional, concurrent precancers or cancers located at other, usually sun-exposed skin sites 1. Imaging studies should be performed when extensive disease is suspected, and MRI is preferred over CT scan if perineural disease is suspected 1.
It is also important to note that skin lesions in high-risk populations may be difficult to assess clinically, and a low threshold for performing skin biopsies in these patients is necessary 1. Multiple sudden-onset skin lesions may warrant further investigation for internal malignancy, and proper identification of skin cancers is crucial to prevent unnecessary treatments or missed diagnoses of more serious conditions.
The most recent and highest quality study, published in 2023, recommends a visual skin examination as the most commonly proposed method for skin cancer screening 1. This study emphasizes the importance of a thorough visual skin examination and dermoscopy in assessing suspicious lesions, and highlights the need for a biopsy if there is uncertainty about the diagnosis. A thorough visual skin examination using the "ABCDE" rule and dermoscopy, followed by a biopsy if necessary, is the most appropriate approach for possible skin cancer.
From the Research
Physical Exam Tests and Procedures for Possible Seborrheic Keratosis
To diagnose and manage seborrheic keratosis (SK), several physical exam tests and procedures can be employed:
- Dermatoscopy: a non-invasive diagnostic technique used to differentiate SK from other benign and malignant tumors 2
- Biopsy: may be necessary to rule out malignancy, especially if the lesion cannot be clearly differentiated from common skin malignancies 3
- Clinical examination: to assess the size, thickness, and pigmentation of the lesion, as well as its location on the body 4, 5
Procedures for Removing Seborrheic Keratosis Lesions
If removal of the lesion is deemed necessary, either for cosmetic reasons or to rule out malignancy, the following procedures can be used:
- Cryosurgery: a common removal method, but may cause post-procedure depigmentation, scarring, and recurrence 4, 6
- Shave excision: a method used to remove lesions, especially for cosmetic purposes 4, 6
- Electrodessication: a procedure used to remove lesions, but may cause post-procedure depigmentation, scarring, and recurrence 4, 6
- Curettage: a procedure used to remove lesions, especially under local anesthesia 6
- Laser therapy: a treatment option for removing SK lesions, with fewer side effects compared to other methods 5, 6
- Topical drug therapy: currently in development, with the goal of providing a non-invasive treatment option for SK lesions 5, 6