I recommend every adult should have a full body skin exam yearly by a dermatologist or a primary care physician that is competent in doing a full body skin exam. The guidelines I use in evaluating pigmented skin lesions are the "ABCDE" rule. In general, if a patient meets any of these criteria, I refer them to a dermatologist. Patients can use the criteria to identify concerning lesions in between their checkups.
Evaluation is indicated for the following:
"A" stands for asymmetry. Imagine the lesion is cut in half. If the halves are not mirror images of one another, this could be concerning.
"B" is for irregular border, and "C" is for irregular color. Benign growths tend to grow in an orderly fashion, and therefore have regular borders and regular pigmentation. Melanomas can be variations of brown, black, red, and white. If a single color, melanomas tend to have areas that are lighter, and darker in pigment.
"D" is for diameter, specifically diameter greater than a pencil eraser.
"E" is evolving. Concern is raised when a lesion grows, changes in color, bleeds, becomes itchy, or painful.
Caveats:
1. Malignant melanoma can occur anywhere head to toe. As such, your socks should be off during your skin examination. Further, you should be asked to get up off the table, and turn around, so that the back of your legs, and buttocks can be inspected.
2. The most common type of malignant melanoma to afflict women, occurs primarily on the skin of the legs and buttocks. Since women are on their buttocks during the pelvic examination, women should either have their gynecologist inspect their buttocks, or make sure that their primary care physician does at the time of a physical examination.
3. Although rare, people of color can get melanoma. These tend to occur on the palms of the hands, soles of the feet, and underneath the finger and toe nails.
4. The key to curing malignant melanoma is the early detection, and excision of the lesion. Melanomas detected at advanced stages are highly lethal.
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