Skin Cancer Screening

Skin cancer is the most commonly diagnosed cancer in Canada. When detected at an early stage, treatment outcomes are significantly improved and the likelihood of cure is highest. Comprehensive skin cancer screening provides a systematic approach to identifying melanoma, basal cell carcinoma (BCC), and squamous cell carcinoma (SCC) before these conditions progress to advanced stages.

The Importance of Early Detection

Early detection remains the single most important factor in the successful treatment of skin cancer. Basal cell carcinoma, the most common form, rarely metastasizes but can cause significant local tissue destruction if left untreated. Squamous cell carcinoma carries a small but meaningful risk of metastasis, particularly when located on the lips, ears, or in immunosuppressed patients. Melanoma, while less common, is responsible for the majority of skin cancer deaths, and early-stage melanoma is associated with survival rates exceeding 95%.

Regular screening examinations allow suspicious lesions to be identified and biopsied at the earliest possible stage, reducing the need for extensive surgical intervention and improving long-term prognosis.

Who Should Be Screened

While skin cancer screening is beneficial for all adults, it is particularly recommended for individuals with elevated risk factors. Those with fair skin, a history of blistering sunburns, extensive cumulative sun exposure, or a family history of skin cancer should undergo regular screening. Individuals with a large number of moles (more than 50), a history of atypical or dysplastic nevi, immunosuppression, or a personal history of prior skin cancer are also considered to be at increased risk.

Screening frequency is determined on an individual basis, with higher-risk patients typically examined more frequently than those at average risk.

The Screening Examination

A comprehensive skin cancer screening involves a systematic, head-to-toe visual examination of the entire skin surface. The scalp, face, ears, neck, trunk, extremities, hands, feet, and nail beds are all carefully evaluated. Areas that are not typically exposed to the sun are also examined, as skin cancer can occasionally develop in sun-protected sites.

Dermoscopy is routinely used as an adjunctive tool during screening. This technique employs a handheld device with magnification and polarized light to visualize subsurface structures within the skin that are not visible to the naked eye. Dermoscopy significantly improves diagnostic accuracy, enabling the identification of suspicious features that may warrant further investigation through biopsy.

Risk Factors for Skin Cancer

Understanding individual risk factors is essential for determining appropriate screening intervals. The following factors are associated with an increased risk of developing skin cancer:

• Fair skin, light hair, and light eye colour
• History of blistering or severe sunburns, particularly during childhood
• Family history of melanoma or other skin cancers
• A large number of moles (greater than 50) or presence of atypical nevi
• Immunosuppression due to medications or medical conditions
• Personal history of prior skin cancer
• Chronic or cumulative ultraviolet radiation exposure, including tanning bed use

Self-Examination Between Screenings

Regular self-examination of the skin between clinical visits is strongly encouraged. Monthly self-checks help identify new or changing lesions that may require prompt evaluation. The ABCDE rule provides a useful framework for recognizing features that may be suggestive of melanoma:

• Asymmetry: one half of the lesion does not match the other
• Border irregularity: edges are ragged, notched, or blurred
• Colour variation: multiple shades of brown, black, red, white, or blue within a single lesion
• Diameter: larger than 6 millimetres, although melanomas can be smaller
• Evolution: any change in size, shape, colour, or symptoms such as itching or bleeding

Any lesion demonstrating one or more of these features should be brought to the attention of a dermatologist for further evaluation.

Next Steps After Screening

Following a screening examination, any lesions identified as suspicious are typically biopsied for histopathological analysis. If a skin cancer diagnosis is confirmed, a tailored treatment plan is developed based on the type, location, and stage of the cancer. For lesions that are clinically atypical but do not yet warrant biopsy, dermoscopic monitoring with sequential digital imaging may be recommended to track changes over time.

At the Centre for Medical and Surgical Dermatology, Dr. Maksym Breslavets provides thorough skin cancer screening examinations utilizing clinical assessment and dermoscopy. Patients at elevated risk are offered individualized screening schedules to ensure that any concerning changes are detected and addressed as early as possible.