Skin Cancer Screening

What is a skin cancer screening?

A skin cancer screening checks your skin for signs of skin cancer before you have any symptoms. To do this, you or your health care provider will examine your skin for moles, birthmarks, or other areas that have an unusual color, size, shape, or texture. If an area of skin doesn't look normal, you may need tests to find out if it's cancer.

Skin cancer is the most common cancer in the United States. The most common types of this cancer are:

• Squamous cell carcinoma. This type forms in the upper parts of the epidermis (the topmost layer of the skin) and rarely spreads. It's most often found in sun-exposed parts of the body such as your face, arms, and hands.
• Basal cell carcinoma. This type forms in the basal cell layer (the lower parts) of the epidermis and also rarely spreads. It is the most common type of skin cancer and usually forms on the face, head, neck, and arms.
• Melanoma. This type forms in the cells that make your skin's pigment (or color). These cells also protect deeper layers of the skin from some of the sun's harmful effects. Melanoma is less common than the other two, but it's also much more serious. That's because it's more likely to spread.

The earlier your provider can detect these cancers, the more effective the treatments can be. This is especially true for melanoma.

Other names: skin exam

What is it used for?

Skin cancer screening, like other types of cancer screening, is used to find signs of cancer before you have symptoms. It's not used to diagnose cancer. If, during a screening test, your provider finds an unusual mole or other mark on your skin, you may need to have a test called a skin biopsy to find out whether you have cancer.

Your provider may also screen you for skin cancer more often if you have certain types of birthmarks or moles, or if you have a lot of moles on your body. If you notice any changes to these areas of skin, or if you develop any new moles, you should contact your provider.

Why do I need a skin cancer screening?

Some medical experts recommend checking your own skin regularly starting at age 18. That's because skin cancer is very common, and people of all skin colors can get it.

You may need a skin cancer screening with your provider or with a dermatologist (a doctor who specializes in skin disorders) if you:

• Have had skin cancer in the past. In this case, it's usually recommended to have a regular yearly skin cancer screening with your provider or a dermatologist.
• Have a higher-than-normal risk for getting skin cancer.
• Find a suspicious area of skin during a self-exam.

A suspicious area of skin can mean:

• Moles or spots of skin that have changed in size, shape, or color.
• Moles or other skin spots that ooze, bleed, or become scaly or crusty.
• Moles that are painful to the touch.
• Sores that haven't healed within two weeks.
• Shiny pink, red, pearly white, or clear-looking bumps.

You may have a higher risk of basal cell or squamous cell carcinoma if you have had:

• Actinic keratosis, a pre-cancerous condition caused by too much exposure to the sun. This condition causes patches of thick, scaly skin.
• Long-term inflammation or injuries such as severe burns.
• Radiation therapy for cancer.
• A weakened immune system.
• Exposure to arsenic.

Your risk for melanoma is higher if you have:

• Had many blistering sunburns, especially as a child or teenager.
• A personal and/or family health history of melanoma.
• A family health history of unusual moles, such as Gorlin syndrome or xeroderma pigmentosum.
• Several large or many small moles.

Your risk for all types of skin cancer is higher if you have:

• Had frequent exposure to natural sunlight or artificial sunlight, such as tanning beds.
• Pale skin that burns and freckles easily.
• Skin that tans a little or not at all.
• Blond or red hair.
• Light colored eyes, including blue or green.

Ask your provider how often to do a self-exam and whether you need to have regular skin cancer screenings from a provider.

What happens during a skin cancer screening?

For a self-exam to screen for skin cancer, you'll check your skin for any suspicious areas of skin. This can mean unusual moles or sores and any marks on your skin that have changed. As a good rule of thumb, follow the "ABCDEs" of melanoma. This stands for:

• Asymmetry: Does the mole or spot have an irregular shape with two parts that look very different?
• Border: Is the border of the mole ragged or irregular?
• Color: Is the color uneven?
• Diameter: Is the mole or spot bigger than the size of a pea or a pencil eraser?
• Evolving: Has the mole or spot changed during the past few weeks or months?

To do a head-to-toe self-exam:

• Choose a well-lit room with a full-length mirror. You'll also need a hand-held mirror.
• Check your scalp. Part your hair and look with a hand-held mirror for any unusual marks on your skin. It may also help to use a blow dryer to move your hair as you look. Check the back of your neck, too.
• Look at your face, ears, and front of your neck.
• Look at the front of your chest and belly. Lift your breasts to check the skin underneath.
• Raise your arms and check the skin on your left and right sides, including your underarms.
• Look at the front and back of your arms.
• Check your hands, including between your fingers and your fingernails (without nail polish).
• Check your back and buttocks with a hand-held mirror.
• Sit down to check the front and sides of your legs and use the hand-held mirror to check the backs of your legs and your genitals.
• Check your feet, including the bottoms, the spaces between your toes, and the nail of each toe (without nail polish).

For a skin cancer screening by a provider, you'll remove your clothing and put on a gown. Your provider will do a full exam that includes your scalp, behind your ears, fingers, buttocks, and feet. Your provider may use a special magnifying glass with a light to look more closely at certain moles or spots. The exam should take 10-15 minutes.

Will I need to do anything to prepare for the test?

You should not wear makeup or nail polish. You will need to have your hair loose so your scalp can be checked.

Are there any risks to the test?

Skin cancer screening isn't always helpful and can result in unnecessary treatments. For example, your provider could find a cancer that would never cause health problems and treat it with chemotherapy, radiation, or surgery. These procedures may not always be necessary and can cause side effects such as scarring from a skin biopsy and anxiety about having cancer

What do the results mean?

If you find a mole or other spot on your skin that concerns you, contact your provider. If you or your provider finds a sign of skin cancer, you'll probably have a skin biopsy to find out whether you have cancer.

A skin biopsy is a procedure that removes a small sample of skin for testing. The skin sample is checked under a microscope to look for cancer cells. Not all suspicious spots turn out to be skin cancer. If the biopsy shows that you do have skin cancer, your provider will talk with you about your treatment options.

In some cases, your screening test results may be misleading. For example, they could show that:

• You have skin cancer, but you really don't. This is called a "false positive." If you have a false positive, you may have other tests.
• You don't have skin cancer when you really do. This is called a "false negative." If your results are negative but you're still concerned about an unusual area of skin, talk to your provider about getting additional tests.

Learn more about laboratory tests, reference ranges, and understanding results.

Is there anything else I need to know about a skin cancer screening?

There are mobile phone apps that use the camera of your phone to check skin moles and spots to help find skin cancer. These apps need to be studied to see if they are accurate and useful for skin cancer screening. If you do use them to check skin moles and spots, always check in with your provider about the results the app gives you.