Should You Be Screened for Skin Cancer?

Skin cancer is the most common form of cancer in the United States, and some people are more prone to it than others. You should see a dermatologist if a change in your skin concerns you, but how do you know whether you require regular skin cancer screening?

We talked to UNC Medical Center dermatologist Puneet Singh Jolly, MD, PhD, to learn more.

Types of Skin Cancer

First, it’s important to understand that most skin cancers fall into two categories, nonmelanoma and melanoma. The two most common types of nonmelanoma cancers are basal cell carcinoma and squamous cell carcinoma. About 5.4 million basal and squamous cell skin cancers are diagnosed each year in the U.S.

Melanoma accounts for about 1-2 percent of skin cancers diagnosed in the United States but causes the majority of skin cancer deaths.  Fortunately, if melanoma is detected before it spreads, it has a high cure rate. The five-year survival rate for people whose melanoma is detected and treated before it spreads to the lymph nodes is 99 percent.

Detecting Melanoma

Almost everyone has moles on their skin, and usually they are harmless. However, if you have a mole that changes in appearance or looks different from the rest of your moles, tell your doctor, because these can be early signs of melanoma.

When checking a mole, use the “ABCDE” rule as a guide to detecting potentially abnormal changes:

  • A is for Asymmetry: One-half of a mole or birthmark does not match the other.
  • B is for Border irregularity: The edges are jagged, scalloped (like flower petals) or blurred.
  • C is for Color: The mole has differing shades of brown, black or other colors such as blue, red or white within it.
  • D is for Diameter: The mole is more than 6 millimeters across or is growing in size.
  • E is for Evolving: A mole that is changing in size, shape or color.

See a dermatologist if you experience the appearance of new moles or changes to your existing moles. Additionally, if you have any of the following risk factors for melanoma, Dr. Jolly says you may require regular visits to a dermatologist:

  • A family history of melanoma
  • More than 50 moles
  • Lots of freckles
  • Red hair
  • A tendency to get a sunburn

“If you are a redhead or strawberry blonde, have a family history of melanoma and have lots of moles, even if you don’t have melanoma, your surveillance is going to be more strict rather than somebody who doesn’t have a lot of moles and doesn’t have a family history of melanoma,” Dr. Jolly says.

Dr. Jolly says a genetic condition called dysplastic nevus syndrome can make you more prone to melanoma, and if you have this condition, you should see a dermatologist for yearly skin checks.

Signs of Basal Cell and Squamous Cell Carcinomas

Basal cell cancers and squamous cell cancers can often appear as a sore that is red and does not heal or as a lesion that bleeds for no reason. These skin cancers can also feel tender, Dr. Jolly says.

“If you notice a sore on your body that persists for more than a month and cannot recall suffering any trauma to cause that sore, you should have your dermatologist examine the area since that can be what basal cell (cancer) and squamous cell cancer look like. Sometimes skin cancers arise as a new tender growth that can look like a wart,” Dr. Jolly says.

If it turns out to be one of these nonmelanomas or you have a family history of basal cell or squamous cell cancer, you should see a dermatologist for regular skin cancer checks, he says.

When to See a Dermatologist Regularly for Skin Checks

Go to a dermatologist for a baseline skin check, which is a visual inspection of your skin by a medical professional, if you:

  • Have any risk factors for skin cancer outlined above
  • Have a history of blistering sunburns
  • Are fair-skinned and have lots of moles

“At that point, your dermatologist may determine you are low risk and do not need regular visits, or he or she may say you should come back sooner because you have a lot of skin damage,” Dr. Jolly says.

Some populations require regular skin checks because their health history puts them at higher risk of skin cancer, including people who have received organ transplants.

“What happens is somebody receives a solid organ transplant, and then they have to now be on medicines that suppress their immune system so that they don’t reject their organ, but the risk of skin cancer (all types) after organ transplant and being on those medicines can be 200-fold higher than prior to transplant. A properly functioning immune system is necessary to help your body combat factors that put you at risk for skin cancer,” Dr. Jolly says.

A dermatologist should see organ transplant patients at least once before their transplant and again periodically after their transplant. “A significant number of those patients will stay with a dermatologist for regular surveillance,” Dr. Jolly says.

Other immunosuppressed patients such as those with leukemia and HIV also should see a dermatologist regularly for skin cancer checks because they, too, are at a higher risk for getting skin cancers than those whose immune systems are working at full strength.

Talk to your doctor if you are concerned about skin cancer. If you need a doctor, find one near you.