As healthcare professionals, we are expected to do a thorough review of systems, assess your medication, evaluate your past medical and family history, equip you with health maintenance and, of course, conduct a physical exam. Examining the skin is the focus in dermatology, but this kind of exam should be part of any internal medicine visit.
Often people ask me, how do you do an effective skin exam and identify a mole that is suspicious?
When I examine a patient’s skin, I am very methodical, often starting at the head and working my way down a person’s body. Additionally, I am always looking out for the “ugly duckling”–the mole that stands out and looks different from the rest.
Don’t forget the ABCDE’s:
Asymmetry–is there a lack of symmetry in the color or shape of the lesion?
Border–is the edge irregular or jagged?
Color–what color is the lesion? Is it brown, black, gray, blue, red or a mixture?
Diameter–is the lesion larger than the size of a pencil eraser (> 6mm) or changing in size?
Evolving–is the lesion new, growing, spreading or changing? Can you affirm for its changelessness?
Most moles on an individual have a pattern, a “look”. The patterns or arrangement of moles on an individual’s skin are good; they serve as an example or point of reference when examining a patient’s skin. When a mole doesn’t fit the pattern, it deserves further investigation (e.g., biopsy, etc.).
When a patient says that a lesion is changing, I believe them, even if I am not alarmed by the way it looks. After all, you see your body every day. If you notice something is different, if some aspect about the mole seems to be evolving, say something. Get it checked.
And always question an inflamed lesion, with or without pigment.
My rule of thumb is one month. If something you notice does not resolve within a month, if the mole looks different and those changes last one month, get yourself to a dermatologist for a full skin check-up and have the lesion examined.
If you live in an area where access to a dermatologist is restricted, get to your primary care giver or internist, who may be able to do a biopsy or refer you to a surgeon who can. As part of health maintenance (this goes for everyone), you should have a full skin exam by a dermatologic practitioner yearly. If you have more than 50 moles, have had skin cancer or pre-cancerous/suspicious moles or growths, have a family history of atypical moles or melanoma, you should have a skin exam performed more frequently.