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Skin Cancer: Symptoms and Diagnosis

Jessica Evert, MD, edited by Benjamin McDonald, MD

list with boxes checkedSkin cancer is very curable when it is found early. While only your doctor can determine whether or not you have skin cancer, you can take an active role in checking for symptoms and warning signs.

A monthly skin check self-examination is a good practice to cultivate. You should become familiar with the pattern of moles and other markings on your skin so that you will recognize if and when any changes occur. Self-examinations should be performed in a well-lit area in front of a large mirror. Check yourself all over for blemishes or marks on the skin that are unfamiliar to you or which have changed in size, shape, texture or color. The "ABCDE" rules can also help you discriminate between potentially cancerous and noncancerous skin:

Asymmetry. Skin cancers are often irregularly shaped rather than symmetrical.

Border. Skin cancers often have irregular (jagged) borders.

Color. Skin cancers often show a color variation rather than being evenly toned.

Diameter. Skin cancers are often larger than noncancerous skin features and may be observed to grow over time.

Elevation. Skin cancers are commonly raised off the surface of the skin.

Any one of these changes may be an early indication of skin cancer and should be checked as soon as possible by your primary care physician or by a dermatologist.

Diagnosis

In diagnosing skin cancer, your doctor will examine your skin for suspicious looking moles, blotches and growths. You can expect to be asked questions about when particular marks first appeared, and if they have changed since you have known about them, whether you have previously had skin cancer, and the extent to which you have been exposed to UV radiation.

If your doctor finds marks which may potentially be cancerous, he or she will probably schedule you for a biopsy, a procedure in which the doctor will take samples of skin from suspect areas so that they can be investigated under a microscope. There are a few ways in which a biopsy for skin cancer can be performed:

Shave Biopsy. During a shave biopsy the doctor will use a surgical knife to remove the uppermost layer of skin. The patient is given local anesthetic and should not feel any pain. Shave biopsies are not commonly used if melanoma is suspected because a shave biopsy does not offer access to deeper tissues.

Punch Biopsy. During a punch biopsy the doctor uses a special instrument which resembles a cookie cutter to remove all of the layers of skin over the trouble area. Local anesthetic is used and the patient should not feel any pain. Punch biopsies are not the preferred method for determining if the patient has melanoma.

Incisional and Excisional Biopsies. During an incisional biopsy the doctor uses a surgical knife to remove a portion of the skin tumor. During an excisional biopsy the doctor will use a surgical knife to remove the entire skin tumor. Local anesthetic is given and the patient should feel no pain. These methods are generally regarded as the best way for determining if a particular tumor is melanoma.

All of these methods of taking a skin tumor biopsy are very quick and require no hospital stay, but can result in scaring.

There are other tests doctors may order if they believe that skin cancer may have spread beyond the skin tissue:

Lymph Node Biopsy involves the surgical removal of a lymph node that is believed to be cancerous. The lymph node is then sent to a lab where it is checked for cancer. The incision involved in this procedure is small and only a localized anesthetic is necessary.

Fine Needle Aspiration (FNA) Biopsy. During an FNA biopsy a thin needle is inserted into tissues believed to contain a tumor so as to remove a small tissue sample from that area. There are advantages to FNA in that no anesthetic is necessary (the procedure feels no worse than a conventional shot) and no scaring risk is incurred.

Chest X-Ray. Doctors may order an x-ray picture be taken of your chest area if they believe that skin cancer may have spread to your lungs.

Computed Tomography (CT) Scan. Doctors may order a CT scan of body areas suspected to have been compromised by metastasizing skin cancers. A CT scan is basically a computer-assembled highly detailed series of x-ray images that can reveal if anything out of the ordinary (like a tumor) is growing in scanned tissues.