Skin cancer is extremely common and, usually, very treatable, but the best treatments are performed in the earliest stages of this condition. When asked about why it’s important to check for skin cancer and get professionally screened for this condition at least once a year, Dr. Weilan Johnson of U.S. Dermatology Partners in Georgetown and Cedar Park, Texas, said, “At-home skin cancer screenings are so essential, especially for people who are at higher risk. These home screenings may be the difference between a simple treatment and total recovery or more advanced treatment and a long-term struggle with more severe forms of metastasized cancer. While most forms of skin cancer are slow-growing, melanoma can grow and spread very quickly, causing significant amounts of damage, so as soon as you see something on your skin that concerns you, call your dermatologist.” In this blog, Dr. Johnson reviews how to conduct an at-home skin cancer self-exam and exactly what you need to be looking for. If you have questions, don’t hesitate to ask during your next annual professional skin cancer exam in our office.
What is Skin Cancer?
Cancer in general is a disease that leads to the replication of damaged cells or an irregular replication of healthy cells. Skin cancer occurs when our skin cells are damaged, and these damaged cells begin to grow rapidly or accumulate in strange ways. According to Dr. Johnson, “While skin cancer can occur in the deeper layers of skin, we are usually talking about skin cancer that affects the epidermis, which is the top layer that you can see. Skin cancer causes changes to the appearance, texture, or sensations in this outer skin layer, and depending on the individual and the type of skin cancer, it can look a little different. However, the change or abnormality of the growth – areas that are different from how your other skin, moles, and spots look – is how most people can spot skin cancer in early stages, during self-exams.”
Below, we’ve described the pre-cancerous skin cells and the three most common forms of skin cancer that most people will notice:
- Actinic Keratoses (AK) – AKs are precancerous growths that develop due to years of cumulative damage from exposure to the sun’s damaging UVA/B rays. While AKs are not actually malignant forms of cancer, the presence of these precancerous growths is a warning sign you may be at greater risk for other forms of cancer.
- Basal Cell Carcinoma – In most cases, the names of different types of cancer refer to the cells that they’re found within, but in the case of basal cell carcinoma, the name actually refers to a type of cancer that causes epidermis skin cells to look like basal skin cells that are found in the deeper layers of skin. This common form of skin cancer (accounting for roughly 8 of 10 cases) evolves very slowly, and it’s extremely rare for basal cell carcinoma to impact surrounding cells or tissues. After removal, people are very unlikely to experience recurrence.
- Squamous Cell Carcinoma – This type of skin cancer is a little less common than basal cell carcinoma, but it is still relatively common. Like most forms of skin cancer, this type is named for the type of cells that it develops within, Squamous cell carcinoma forms within the skin’s squamous cells, leading to irregular development of these healthy cells. The damaged skin cells develop more quickly than basal cell cancers, but like basal cell carcinoma, squamous cell carcinoma rarely metastasizes (spreads to surrounding tissues). Even after removal, people may experience recurrence of squamous cell carcinoma.
- Melanoma – This is the deadliest form of skin cancer, and it often develops within existing moles, freckles, and age spots where there are a higher concentration of melanocyte (pigmented) cells. Melanoma spreads extremely quickly, and it is much more likely than other types of skin cancer to metastasize.
In addition to these four common forms of skin cancer, there are also several less common types of skin cancers and pre-cancers that may be diagnosed, including:
- Actinic Cheilitis (pre-cancerous cells that form around the mouth)
- Merkle Cell Carcinoma
- Kaposi Sarcoma (and other sarcomas)
- Cutaneous Lymphoma
- Skin Adnexal Tumors
What Causes Skin Cancer?
All forms of cancer are caused by damage to cellular DNA. This damage can occur for many reasons, but for those with skin cancer, the damage is most often caused by exposure to the sun’s ultraviolet (UVA/B) rays. In addition to sun exposure, individuals may also see the development of skin cancer caused by x-rays (very rarely), chemicals, toxins, burns, or injuries.
Who is at Risk for Skin Cancer?
According to Dr. Johnson, “Anyone can develop skin cancer no matter their skin tone, age, or other factors. But, certain characteristics make some people more likely to develop skin cancer. These individuals need to be especially vigilant in performing regular at-home skin cancer screenings.” Some of the factors that may increase the risk of developing skin cancer include:
- Light Skin Tone – Individuals with less melanin are more likely to develop skin cancer, especially if they have experienced one or more severe sunburns or prolonged exposure to the sun’s damaging rays.
- Climate & Weather – Living in warm, sunny places and areas at higher altitude means exposure to greater levels of UV radiation, which increases the risk developing of skin cancer.
- UVA/UVB Exposure – Repeated, prolonged exposure to UV radiation through sunlight or tanning beds, significantly increases the likelihood of cellular damage to skin cells.
- Naturally Occurring Moles & Spots – If the skin has numerous freckles, moles, and age spots naturally, the individual is much more likely to develop skin cancer, especially the deadliest form, melanoma.
- Radiation, Chemical & Toxin Exposure – Those who interact with radiation, chemicals, or toxins regularly for their professions and those who are treated with radiation therapy are at increased risk for skin cancer.
Why do I Need to Perform a Self-Exam?
According to Dr. Johnson, “Skin self-exams can save your life. Most forms of skin cancer progress slowly and are unlikely to metastasize, but melanoma can spread very quickly, putting individuals at significant health risk within just a few weeks or months of development. I recommend those at a higher risk perform skin self-exams once a month. Those at lower risk may be able to perform exams every two or three months, but the more frequently these exams are performed, the more likely you are to notice changes. Even if you perform self-exams regularly, you should still visit your dermatologist once a year for a comprehensive, full-body exam.”
What am I Looking for During a Skin Cancer Self-Exam?
Each type of cancer looks and presents a little differently, so you need to be looking for several different things during your self-exams. Below, we outline the most common characteristics of each form of cancer, but your dermatologist can help you to learn more about what to look for during your annual professional exam.
What Does Actinic Keratoses (Pre-Cancer) Look Like?
AKs are often called horns because they have bases that are larger in diameter with raised parts that may hook at the end. This can create an appearance similar to horns.
Other common characteristics include:
- Texture – thick and scaly
- Coloring – pink or red in color for most people, but they can also be white or silver
- Location – usually developing in sun-exposed areas like the hands, face, ears, nose, scalp, shoulders, and lips
What Does Basal Cell Carcinoma Look Like?
The appearance of basal cell carcinomas will vary depending on the individual’s natural skin tone and texture as well as the location where it develops, but in most cases, people will see the following characteristics:
- Texture – bumps on the skin that can feel scabby, scaly, or scar-like
- Coloring – usually pink colored and are often described as shiny or pearlescent with darker spots within them
- Location – most often developing on the head and neck, but they can form on any part of the body
What Does Squamous Cell Carcinoma Look Like?
This type of cancer can be the most difficult to spot because the appearance differs so dramatically from person to person, but the fast development and change (they can double in size in just a few days or weeks), compared with surrounding skin tissues, is often what alerts people there is something wrong.
Some of the most commonly reported characteristics include:
- Texture – domed bumps that can be ulcerous (open sores or wounds), scabbed, or scaly feeling that may bleed easily or be painful
- Coloring – pink or close to skin coloring or looking slightly inflamed
- Location – like basal cell carcinoma, squamous cell carcinoma most often appears in sun-exposed areas like the hands, head, and neck, but they can form on any part of the body
What Does Melanoma Look Like?
While rare, melanoma can be deadly without appropriate intervention in the early stages of development. Unfortunately, melanoma grows and spreads very quickly, so it’s important to pay attention and contact your dermatologist as soon as you notice changes. In many cases, melanoma either looks like or develops within existing moles, freckles, sun spots, and other darker-pigmented areas on the skin. In the early stages, melanoma may be pink, white, or flesh-toned, but will typically darken quickly as it develops. About the warning signs of melanoma, Dr. Johnson says, “We all learn our ABC’s in grade school, but when it comes to spotting melanoma, we need to learn our ABCDEs. Knowing these five characteristics of melanoma may just save your life.”
The ABCDEs of melanoma are:
- A – Asymmetry – Looking at the spot, draw a line down the center vertically or horizontally. Is one part significantly different from the other?
- B – Border – Is the border jagged and irregular?
- C – Color – Is the color different from other moles and freckles? Does the spot have color variations throughout?
- D – Diameter – Compare the spot to a #2 pencil eraser. Is the spot as large or larger than the eraser?
- E – Evolving – Is the spot changing in size, color, or texture?
If you answered yes to any of these questions, the spot may be melanoma, and you should contact a dermatologist. Dr. Johnson also says, “In addition to the common ABCDEs of melanoma, you should also consider whether the spots are painful or itchy. If they bleed easily or you develop a sore that doesn’t seem to be healing on or around a mole, you may be dealing with melanoma.”
How to Perform a Skin Cancer Self-Exam
Now that you know what to look for, how do you perform a skin cancer self-exam? Dr. Johnson says, “Come up with a good, consistent self-exam process that works for you. Your dermatologist can help if you’re not sure what to do. The most important things to remember are, take your time and use good lighting. Without bright lighting, it may be difficult to see the differences on your skin’s surface that indicate developing cancer.” Below, Dr. Johnson has put together a simple step-by-step guide for skin cancer self-exams. You can also visit our page on annual skin cancer exams to find out more about preventive self-exams and download our mole tracking chart.
Step 0 – Preparation
To get started, you’ll need a well-lighted room with a full-length mirror. You should also have a hand mirror to look at your back and other hard to see areas. You can also use flashlights or other light sources to make it easier to see all parts of your body.
Step 1
Start at the top of your head. Part your hair and carefully examine your scalp visually. Use your hands to check for any lumps or bumps on the scalp that you may have missed. Examine your face and neck carefully. Look at your eyes for spots or irregularities, and check the eyelids, nostrils, and inside the mouth.
Step 2
Next, examine your shoulders, chest, back, and trunk carefully. Don’t forget to check your sides, and look carefully at your belly button and other areas where skin changes may be less apparent. Bend and twist, checking for areas that dimple or pucker.
Step 3
Check your arms and hands. Flex your arms, bend your fingers, and look under your arms. In the bends and creases, check for skin that puckers or dimples. Examine both the backs of the hands and the palms as well as the nail beds.
Step 4
Carefully look at your buttocks and genitalia. Use a hand mirror and extra lighting, if necessary, to clearly see the skin and note any irregularities.
Step 5
Examine your legs and feet. Like your arms, make sure to bend at the knee, twist the ankle, and wiggle your toes, looking for skin that puckers or dimples. Carefully examine the top and bottom of each foot and in the cuticle area around the nails.
Skin Cancer Prevention
Preventing skin cancer may not always be possible, but you can certainly do your utmost to avoid toxins, chemicals, and radiation. The most important way to prevent skin cancer is to protect yourself from the sun’s harmful UV rays. Keep the following tips in mind to reduce your risk for developing skin cancer due to sun damage:
- Wear sunscreen – Apply sunscreen with a 30+ sun protection factor (SPF) every day to the parts of your body that will be exposed to sunlight. If you’re worried about breakouts, there are many facial moisturizers with built-in sunscreen to minimize the number of products applied to your skin.
- Reapply Sunscreen – If you’re going to be in the outdoors for longer than a few minutes, you should reapply at least every two hours. If you’re going to spend time in the water or exercising, you may need to reapply more frequently.
- Take breaks – Seek shade or go indoors periodically if you’re going to be outdoors for an extended period, especially during the peak hours between 10 am and 4 pm.
- Cover up – Wear hats, gloves, long sleeves, and pants to cover your skin.
Visit U.S. Dermatology Partners for an Annual Skin Exam
When you’re ready for your annual comprehensive skin cancer exam, the U.S. Dermatology Partners team would love to hear from you. You can get started scheduling an appointment in one of our numerous office locations, using our simple request form online.
We are also happy to offer virtual consultation services online, using our teledermatology video platform. You can use our virtual visit request form to schedule an online teledermatology session. As soon as our team receives your appointment request form for an in-office or virtual visit, we’ll be in touch to finalize all the details.
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