Self Skin Check.

The Do’s and Dont’s of self-checking

Traditional self skin check

Traditionally, you can perform a head to toe skin check using a Mirror or your partner.

However, spotting subtle changes is impossible without a photograph. How will you know where the lesion is a year later? The rules themselves are flawed … and so on.


Use of a smartphone for skin cancer self checks

The smartphone is a great way to enhance your surveillance. Apps make tracking skin lesions easy. Smartphones with attached dermoscopy is now available for the consumer. All this makes it doubly-important that you seek advice.

It should be emphasised that the apps are not designed to diagnose skin cancer. Both the manufacturers of these apps and independent cancer experts such Terry Slevin, director of education and research at the Cancer Council of Western Australia, emphasise that they do not replace a visit to a doctor for a skin check.

What the apps and/or smartphone adapters can do is to flag up a lesion for further review by an expert.

The apps will typically allow you to do the following on your smartphone:

  • Take a photo of a lesion.
  • Map the lesion to body via a body diagram.
  • Allow you to track the lesion over time.
  • Provide a simple analysis of the lesion – absolutely not to be relied upon.

Adapters are coming onto the market that allow you to:

  • Attach a dermoscopy lens to the smartphone.
  •  Take acceptable quality dermoscopy photographs of skin lesions.
  • Forward the photographs to a doctor for analysis.

There are currently two main contenders for the combined smartphone dermoscopy with the app.

MoleScope is a smartphone adapter that is used with the MoleScope app.

Dermlite HUD is another system that provides similar functionalities.

How Can you tell if a mole is a melanoma?

Traditional self skin checks involve applying some simple rules to any concerning lesions that you see.

The ABCDE or SCAN rules are the best known.

These rules have quite significant shortcomings because they do not involve dermoscopy. However, they are better than nothing.

SCAN

This acronym focuses on fewer characteristics of moles and is better at picking up non-melanomas. It is also a bit easier to remember.

Sore – Does the spot itch or is it sore?  Has it taken more than 6 weeks to heal?

Changing – This is like “evolution” and the question is has it changed in size, color, or appearance?

Abnormal – Does the mole appear to be different from other moles you have?  Just like the ugly duckling in the childhood story stood out from the rest of the flock, check for any growths that are not consistent with others in the area.

New – Did it just appear? While melanomas may evolve, they frequently appear as a new growth.

Other Warning Signs.  Redness, pain, swelling, tenderness, bleeding, oozing or a scaly appearance can all be signs of skin cancer.

ABCDE

This acronym is to remind you what to look for when performing a skin cancer check.  Each letter represents a certain characteristic you should use to evaluate each mole, growth, or freckle on your body.  As you perform your check, ask these questions.

Asymmetry – Do both sides of the growth appear to be symmetrical?  If one side does not look like the other, it may be cancer.  Melanomas do not grow in a symmetrical fashion.

Border – Are the edges (border) irregular, notched or ragged in appearance? These are all warning signs of skin cancer.

Color – Is the color uniform or does it appear to have several colors?  Does it have a mottled appearance?  A harmless growth may be any of several different colors, but no matter the color, it is usually only one color.

Diameter – Is it greater than 6mm (1/4 of an inch)?  Harmless growths are usually smaller than a pencil eraser.

Evolution – Has the mole or growth grown or changed in any manner since you last looked?  If you see changes to color, size, symmetry or the edges, you need to immediately seek the services of a medical professional.

Other Appearances

SCAN & ABCDE are designed mainly to screen for melanoma on the skin. Other changes to look for:

  • A Brown or Black streak under the nail – particularly when this spreads to the nailfold can be a sign of nail melanoma
  • A scar that appears waxy may be a rare type of BCC called a morpheaform BCC
  • Look carefully at the edge of the lesion for any elevation. The elevation is called a “rolled edge” when part of a BCC. With a superficial BCC (A flat one), the rolled edge is subtle and best seen looking at an oblique angle.
  • Look carefully at the reflectivity of a pink or red lesion. A BCC tends to be a little transparent or pearly/shiny whereas an IEC tends to be duller.

A new lesion that hasn’t healed within 6 weeks is an important sign that you need to get it checked out.

The Risks and Benefits of a Skin Cancer Self-Check.

What are the Benefits of a Skin Cancer Self-Check?

Avoiding disfiguration and death are the goals of early detection. The deeper a skin cancer, the longer it has been growing, the more difficult it is to treat and the greater likelihood it has spread. By giving all parts of your body a regular check you may be able to detect the early signs of skin cancer and increase the likelihood of successful treatment.

But there are also more subtle benefits to regular self-screening for skin cancer. The self check process takes time. By devoting the necessary time to the process you stay aware of the dangers of skin cancer.  As a result, you will be more likely to apply and re-apply sunscreens as appropriate, avoid the use of tanning beds, and take other steps to protect your skin from solar exposure.  You benefit from preventing skin cancer before it can get started.

In terms of evidence, there is some evidence for the benefit of a skin cancer self-check & it is recommended in Australian guidelines though not guidelines from The USA.

There’s a degree of common sense involved in looking at the evidence for a self-examination of the skin. It would seem self-evident that regular self examinations will pick up melanoma earlier than people who do not self examine their skin.

But let’s look at the evidence of benefit. An Italian study¹ looked at 1240 people with newly diagnosed melanoma. All were taught to self-examine their skin after the diagnosis. Over the follow up period, 47 had a recurrent melanoma. So here are the stats: The average thickness of the original melanoma was 1.31mm (that’s a significant melanoma), but the average thickness of the 2nd melanoma was 0.66mm – that’s an impressive reduction.

What are The Risks of a Skin Cancer Self-Examination?

Most skin cancers are not pigmented (dark) and it requires dermoscopy to diagnose an early BCC or SCC.

It’s well known that Melanoma can kill. There were 1544 deaths from melanoma in Australia in 2011² and 9128 that same year in The USA³. Melanoma needs to be diagnosed early yet signs of an early melanoma are subtle & require dermoscopy. In addition, Uncommon forms of melanoma such as amelanotic and desmoplastic types do not adhere to the usual ABCDE signs of melanoma and would probably be missed in a self-exam. Melanoma detected at a routine skin check is thinner compared with those detected by other means. Finally, most skin cancers are not melanoma and SCC in particular kills more people than melanoma.

Let’s not forget non-melanoma skin cancer. In 2013 in Australia, there were 592 deaths from non-melanoma skin cancers (Cancer Council Australia). The signs of non-melanoma skin cancer are not straightforward though people who have a tendency to recurrent BCCs are often able to pick out another BCC. However, SCC is the more dangerous type of skin cancer & tends to grow rapidly – probably the first symptom will be an uncomfortable lump that has just appeared.

One of the risks of relying exclusively on self-checks for skin cancer screening is that you can’t identify it if you can’t see it.  Our bodies have many bits that are difficult to see without a mirror.  This includes not only your back, but the back of your neck, the top of your head, behind your ears, etc.  Cancers that arise in these areas may go undetected because you can’t easily see them when you inspect yourself.

Be mindful of the risk that self-checks can encourage people to take a wait-and-see approach that gives the cancer more time to spread.

Now let’s look at the evidence. A focused review of routine self skin-examination (SSE) in the diagnosis of melanoma was published in the international journal of dermatology in 2010². Of the studies examined between 1987 and 2007, the sensitivity of SEE for detecting melanoma ranged from 25% to 93%, whilst the specificity was 83% to 97%. This can be translated as follows: Take 100 people who have a melanoma but are unaware. The Self-check will pick up between 25% and 93% of these – let’s say around 50% to 60%.

So yes do your own skin checks on a regular basis, but this should not replace a regular skin clinic examination.

Author: Dr Richard Beatty

Last Modified:   12/1/2017

First published: 8/06/2015