Skin cancer assessment

Skin cancer assessments are integral to managing solar damage and skin cancer. This topic provides advice on performing a skin cancer assessment in general practice. A long consultation is usually required.

Good lighting and a source of magnification are essential basic equipment. A dermatoscope can increase diagnostic accuracy. A camera is useful for taking baseline photographs.

Before examining the patient, take a thorough history, including:

  • changing, new or symptomatic lesions
  • risk factors for skin cancer, such as
    • past history of skin cancer and its type
    • marked sun exposure (eg during work and leisure time)
    • solarium use
    • marked solar skin damage
    • blistering sunburns as a child or adolescent
    • family history of skin cancer
    • multiple common melanocytic naevi
    • dysplastic or atypical naevus syndrome
    • immunodeficiency
  • previous skin lesions requiring treatment
  • factors that may influence management, such as drugs (eg anticoagulants, immunosuppressants) or medical conditions (eg chronic lymphocytic leukaemia, other immunosuppressed states [eg after organ transplant]).

Ask the patient to undress, leaving on their underwear.

Systematically and completely examine all skin surfaces, including the scalp, palms, soles, nails and mucosae. Take photographs for future reference. Malignant lesions are commonly missed in the nasolabial folds, behind the ears, and in the inner corners of the eyes. For warning signs that a lesion may be a melanoma, see Melanoma warning signs.

Ask the patient if they are concerned about lesions in areas covered by their underwear, and offer to examine them.

If the patient has had skin lesions treated in the past, examine the sites for recurrence. If the patient has had a previous invasive melanoma, palpate lymph nodes on the whole body (including the abdomen). If the patient has had a squamous cell carcinoma (SCC), particularly on the head or neck, palpate local lymph nodes.

Skin cancer assessments are a good opportunity to educate the patient about skin health. Discuss the importance of sun protection (see Preventing solar damage), and the warning signs of malignancy (eg a lesion that is new and growing, bleeding, painful or changing). Educate the patient on the ABCDEFG rule for melanoma diagnosis.

In addition to formal skin cancer assessments by a clinician, recommend regular self-examination of the skin (eg every 3 months). Effective self-examination requires the patient to be aware of the location and appearance of current naevi and lesions. For lesions they are not able to see easily (eg on the back), they should ask a friend or family member to provide assistance. Personal photography (noting the date) can be helpful.

For a patient who has had treatment for a skin cancer, follow-up is recommended to identify new or recurrent lesions, or metastases. The frequency and duration of follow-up varies according to the patient’s level of risk for skin cancer. Patients assessed as low risk still need to self-examine their skin regularly. For advice on follow-up frequency following skin cancers, see individual sections on melanoma, squamous cell carcinoma, and basal cell carcinoma.

Advise all patients to seek assessment for new or changing skin lesions of concern.

Note: Advise all patients to seek assessment for new or changing skin lesions of concern.