Skin Cancer, Self-Exams, and Dermatoscopic Skin Surveillance

Discovering melanomas can be quite challenging with the naked eye for many patients. Throughout various skin cancer educational campaigns, some patients and their relatives have gained greater knowledge about possible skin cancer development and have become able to detect suspicious lesions. As a result, more cases have been reported to dermatologists, and treatment, if needed, has begun at early stages before the disease could progress further. However, in many cases, patients are unaware that some of their lesions are diagnosed as melanoma and become surprised when dermatologists reveal the presence of skin cancer during a regular examination. The Canadian Dermatology Association highly encourages individuals to report any changing and concerning lesions to their dermatologists for further assessment and clinical diagnosis. Moreover, any changes in asymptomatic (atypical) moles and the appearance of any new lesions on the skin in individuals 35 years of age and older are considered warning signs that cannot be ignored.

Studies have shown that an average person may have difficulty accurately assessing the skin for the presence of any changes, especially if the change has lasted for a prolonged period of time or if it is located at a site that cannot be easily seen, such as the back.

In comparison with other more prevalent carcinomas, melanoma's anatomical distribution is very unpredictable because it does not only appear on areas of skin exposed to UV rays. However, due to the popularity of UV tanning beds and full-body tanning sessions during summer, almost the entire body becomes exposed to UV rays, which increases the risk of developing melanoma skin cancer, especially in western societies.

Seventy-one percent of nevus-associated melanomas appear as new lesions on the skin rather than in already existing moles. It is important to keep in mind that new lesions are also critical and, in many cases, go unnoticed during self-skin examinations.

Dermatoscopic Skin Surveillance refers to a specialised procedure of skin screening via dermatoscopy in order to assess moles and the presence of any high-risk malignant melanomas. The procedure is composed of a clinical full-body skin examination and assessment of concerning lesions. The purpose of the assessment is to detect any new and changing lesions.

Dermatoscopy refers to skin examination via skin surface microscopy. The device contains a high-quality magnifying lens and a powerful lighting system. It enables the examination of different skin structures and patterns. Hand-held devices with varying weights and battery capacities are available on the current market.

The following characteristics of skin lesions are assessed with the help of a dermatoscope: symmetry or asymmetry, distribution of pigment (such as brown dots, lines, clods, and areas with undefined structures), homogeneity or heterogeneity of structure, skin surface keratin (small white fissures, crypts, and cysts), border of lesion (radical, sharply cut off, or fading streaks), presence of ulceration (full-thickness loss of epidermis), and vascular morphology (regular or irregular). Dermatoscopy is essential for assessing various lesions including melanoma, atypical naevi, basal cell carcinoma, moles (benign melanocytic naevus), and seborrhoeic keratosis.

Dermatoscopic Skin Surveillance is useful for individuals who have many moles (more than 50 to 100), moles on the back, or dysplastic and atypical naevi (large moles that appear in an unusual shape and colour). Individuals who already have a personal history of melanoma or a family history of melanoma are highly encouraged to undergo regular skin examinations. Individuals who have fair skin that has experienced severe or repeated sunburns are also advised to arrange a skin examination.

Dermatoscopic Skin Surveillance is extremely advantageous because melanoma and other pre-cancerous lesions can be detected at very early stages. New lesions and already existing ones can be identified with great accuracy. If a dermatologist determines a concerning or pre-cancerous lesion, it can be removed at the earliest stage possible, which greatly decreases the risk of developing melanoma.