How to Do a Skin Self-Exam

You’re drying off after a shower and catch a dark spot on your shoulder in the mirror. You can’t tell if it’s new. You touch it, forget it, and three weeks later you can’t remember what it looked like. You don’t have a photo, and you don’t have a baseline.

The five steps

The AAD’s¹ five steps, which use a full-length mirror and a hand mirror:

1. Full-length mirror. Examine your body front and back, then look at the right and left sides with your arms raised.
2. Arms and hands. Bend your elbows and look carefully at your forearms, underarms, fingernails and palms.
3. Legs and feet. Check the backs of your legs and feet, the spaces between your toes, your toenails and the soles of your feet.
4. Neck and scalp. Use a hand mirror to see the back of your neck and scalp, and part your hair to look closely.
5. Back and buttocks. Use a hand mirror.

The AAD¹ offers a body mole map to document what you find.

What to look for

The AAD’s² ABCDEs of melanoma:

• A, asymmetry. One half of the spot is unlike the other half.
• B, border. An irregular, scalloped or poorly defined border.
• C, color. Varying colors from one area to the next, such as tan, brown or black, or areas of white, red or blue.
• D, diameter. Melanomas are usually greater than 6 millimeters, about the size of a pencil eraser, when diagnosed, but they can be smaller.
• E, evolving. The spot looks different from the rest or is changing in size, shape or color.

The AAD² says if you notice a new spot, a spot that differs from others, or one that’s itching or bleeding, make an appointment with a board-certified dermatologist. See age spots for the harmless kind, and skin tags for another common bump.

Why it matters

The CDC³ says too much exposure to ultraviolet rays from the sun or tanning beds causes most skin cancers, and that to lower your risk you should protect your skin from the sun and avoid tanning. It lists squamous cell carcinoma, basal cell carcinoma and melanoma, and says melanoma causes more deaths than the other types because it often spreads to other parts of the body.

The National Cancer Institute (NCI)⁴ says risk rises with fair skin, sun exposure and certain pigmented lesions, and that people with dysplastic nevi have a twofold to threefold increased risk. It says more than 90% of melanomas are recognizable to the naked eye.

A word on phone apps

The NCI⁴ says mobile phone applications that evaluate skin lesions have been problematic because of a lack of evidence for their diagnostic accuracy. A photo is useful for tracking a spot over time. A dermatologist is the one to judge it.

The NCI⁴ also notes there’s insufficient evidence that population-wide screening reduces skin cancer deaths, so ask your own clinician how often a professional exam makes sense for you.

The play

Try this: a first baseline

In good light, with a full-length mirror and a hand mirror, work through the five steps once.

Take a photo of any spot you aren’t sure about, next to a ruler or coin, and put the date in your phone notes.

Look again in a month, or sooner if something changes. Bring photos to a dermatologist if a spot looks different.

Ask someone you trust to check your scalp and back, since those are hard to see.

When to get checked

The AAD² says to see a board-certified dermatologist for any new spot, a spot that looks different from others or is changing, itching or bleeding.

Book an appointment if any of these fit:

• A spot is new, or differs from your other spots
• A spot has an irregular border, more than one color or has grown
• A spot itches or bleeds
• You’ve had serious sunburns or used tanning beds and have never had a skin check
• You have fair skin, or know you have dysplastic nevi, and haven’t had a professional check
• You can’t tell whether a spot has changed

A skin check is quick, and boring is the result you want.