Symptom and Medical History

You noticed an unusual mole or lesion on your skin and made an appointment with your doctor to have it checked. Before examining your skin, your doctor will ask questions about the lesion. Your doctor will also ask about your personal and family medical history.

The suspicious mole or lesion: details

“Evolution” is one of the typical features of melanoma. Evolution means that the size, shape, or color of the mole has changed. Skin self-examinations help you to spot skin changes. Information from your self-examinations will help you describe how a lesion has changed over time. If you have made a body mole map, bring it to your appointment.

Your doctor will probably ask questions such as:1

  • When did you first notice this mole or lesion?
  • How has it changed? Has it changed in size? Shape? Color?
  • Has it spread out?
  • Does the lesion itch?
  • Does it bleed?
  • Does it hurt?
  • Have you tried to treat it with anything? Did it help?

Your personal and family medical history: risk factors

A risk factor is something that affects the likelihood of developing a disease. Risk factors include age, skin color, personal medical history, family medical history, and sun exposure. Your doctor will ask questions to help her understand your risk of skin cancer.

Your doctor will ask if you have ever had skin cancer before. Having one skin cancer increases your risk of another one.2,3 If you have had skin cancer, your doctor will want to know:1

  • What type of skin cancer you had
  • Where it was located
  • When it was diagnosed
  • How it was treated

If you have had melanoma, additional information is helpful. Important details include how deep the tumor was and whether the lymph nodes were removed. In general, it is a good idea for cancer survivors to keep a copy of their medical records.3 If you have these documents, share them with your current doctor.

Tell your doctor if melanoma runs in the family. Having a close blood relative with melanoma also increases your own risk of melanoma.3 If you have two or more first-degree relatives with melanoma, your risk of skin cancer is considered very high.4

The most important modifiable risk factor for skin cancer is ultraviolet (UV) exposure. To assess your UV exposure, your doctor may ask questions such as:

  • Do you sunburn easily?
  • How regularly are you exposed to the sun?
  • What kind of work do you do?
  • What do you do in your free time?
  • Have you ever used an indoor tanning bed?
  • Did you spend a lot of time at the beach or pool as a child?
  • What type of skin products do you use?
  • How do you protect your skin from the sun?

Some medications, medical conditions, or treatments can increase your risk of skin cancer. Be sure to tell your doctor if you:

  • Take medications that weaken your immune system
  • Have had radiation therapy in the past
  • Have treated psoriasis with psoralens and UV light
  • Have HIV infection

Your genetic disposition to skin cancer

People of all skin tones are at risk of skin cancer, but the risk is greatest for people with fair skin. The Fitzpatrick Skin Phototype is a way of classifying skin into one of six types (Table).5-7 It is based on the color of unexposed skin, hair, and eyes, and your skin’s sensitivity to UV light.

In order to determine your Fitzpatrick skin type, your dermatologist may ask how your skin responds to sun. Mention if you typically burn, peel, or blister. Describe how well you tan; for example: tan a little, tan easily, tan gradually, or tan deeply.

Table. Fitzpatrick Skin Classification

Type
Complexion
Reaction to sun exposure
Skin Cancer Risk
I
Bright white skin, blue or green eyes, freckles
Always burns and peels; never tans
+++++
II
White skin, blue, hazel, or brown eyes, red, blonde, or brown hair
Burns easily, sometimes peels, rarely tans
++++ / +++
III
Fair, creamy white skin, brown eyes, dark hair
Sometimes burns, tans moderately and gradually
+++
IV
Olive/light brown skin, dark hair and eyes
Tans easily, burns minimally
++
V
Brown skin, dark hair and eyes
Tans easily, rarely burns
+
VI
Black skin, dark hair and eyes
Never burns, tans deeply
+

Sources: American Academy of Dermatology. Basal cell carcinoma: Basic dermatology curriculum. Accessed March 6, 2017 at: https://www.aad.org/File Library/Main navigation/Education/Basic Derm Curriculum/PDFs/Basal-Cell-Carcinoma.pdf; Skin Cancer Foundation. Where does your skin fit in? Quiz. Accessed March 6, 2017 at: http://www.skincancer.org/prevention/are-you-at-risk/fitzpatrick-skin-quiz; D’Orazio J, et al. Int J Mol Sci. 2013;14:12222-1248.

Written by: Sarah O'Brien | Last reviewed: May 2017.
View References