Now You See It, Now You Don't

Many people spend an inordinate amount of time on hair, nails, and even wardrobes. Not enough, however, spend time on their skin beyond choosing lotions or products to reduce the appearance of fine lines and wrinkles. Practicing sun safety and performing regular skin checks at home are our first line of defense against skin cancer. Coupled with visits to a dermatologist, suspicious spots and precancerous lesions can be detected and treated to prevent further damage.

The self-exam

The following steps for self examinations should be completed monthly. Choosing a specific date each month (the 1st or the 30th of each is ideal), you should perform the following steps to scan your body for new or changing moles, spots, or patches of dry skin.

• Take a close look at your face. Be especially careful to check your nose, around your lips, and both the fronts and backs of your ears.
• Though it is difficult, your scalp should be examined. Part your hair and check one section at a time using a mirror. If you find it too difficult, have a trusted friend or family member help you.
• Beginning with the tips of your fingers, check the backs and palms of your hands and work your way up your arm. Be very conscious of any changes in color beneath your fingernails, as well. An often forgotten area is the space between the fingers.
• A full-length mirror will be helpful in examining beneath your arms and all sides of your upper arms.
• Carefully check your neck, chest, and upper body. Don’t forget to lift each breast and note any spots there.
• You will want a hand mirror to help check the back of your neck, shoulders, and your back. If you feel you missed any part of your arms, use this time and the hand mirror to help check those areas.
• Slowly scan down and across your lower back, your buttocks, and the back of each leg.
• In a seated position and using the hand mirror, check your genitals, the front of each leg as well as the sides. Move from the top of the leg, down the shin to the ankle. Both the tops and soles of the feet should be checked. Again, be conscious of any changes in color beneath the toenails, and examine between the toes.

What are you looking for?

Checking your skin for changes can seem overwhelming, especially as we grow older. Every second spent in a once-monthly self-exam is worth the time and effort. Knowing what to watch for is essential to a successful self-check. There are many variations of lesions, moles, suspicious spots of which to be aware.

• Take note of any patch of skin that does not heal easily or continues to crust over and remains dry despite efforts to moisturize.
• Areas that mimic scars should be noted. They may be pale, yellow, and flat but firm
• Patches of red and itchy skin
• Pink areas with a dimpled center
• New spots similar to warts
• Rough patches of skin that tend to scale over and/or bleed easily

Any abnormality should be noted as basal cell and squamous cell carcinomas may manifest as very slight changes in the skin.

Some spots may be felt but not seen easily. Actinic keratoses are virtually impossible to see but can be felt. They feel like a grain of sand under the fingertips and may only be noticed during a shower when they break open and bleed lightly.

New moles

Any changes in an existing mole should be noted according to the ABCDEs of skin exams.
Note the following:

• Asymmetry (the halves of the mole do not match)
• Borders (anything but smooth and even edges should be noted)
• Color (inconsistencies in color)
• Diameter (sizes vary greatly, moles larger than a pencil eraser should be checked)
• Evolving (changes in size, colors, and shapes)

Keep detailed notes each month of the changes you see. Having had both melanoma and basal cell carcinoma, I find it helpful to keep a running record of my body checks in my Google docs. Having easy access to this file on my phone allows me to share my concerns much more readily when I am consulting with my dermatologist. Consistency is key. Whether you choose to map your areas of concern or take detailed notes, share your findings regularly with your dermatologist or family doctor.