Screening and surveying the skin for signs of skin cancer

Skin cancer screening is a comprehensive review of a patient’s skin for early detection of suspicious-looking lesions. Early diagnosis of skin cancer is imperative. In the case of melanoma, early detection may potentially save your life.

Skin surveillance is also a form of cancer screening for patients who previously had skin cancer. Surveillance is important for detection of new skin cancers and to check for any recurrence in scars due to previous skin cancer surgeries. Your dermatologist might ask you to return for regular follow-ups (e.g. every 3 or 6 months) to survey the skin for any new changes or developments.

The types of skin cancers that can be diagnosed by screening are basal cell carcinoma, squamous cell carcinoma, melanoma and other types of rare skin cancers:

  • Basal cell carcinoma, derived from basal cells of the epidermis, is the most common type of skin cancer. It is important that it is detected early to prevent local invasion and destruction of underlying tissue.
  • Squamous cell carcinoma has the potential of spreading to lymph nodes and other organs. For that reason, early detection is very important.
  • Cutaneous melanoma derived from melanocytes in the epidermis can be potentially fatal and the earlier the detection, the better the prognosis.

 

We also encourage patients to self-examine their skin and inform their dermatologist as soon as a new, worrisome lesion is detected or when they have noticed an old lesion that has changed its appearance.

How does your dermatologist perform skin cancer screening?

A full-body skin examination is usually done with the aid of a small handheld device called the dermatoscope.

Dermoscopy is the examination of the skin with a dermatoscope. This device helps your dermatologist to magnify and illuminate the skin to pick up certain worrisome patterns reflecting off the skin’s surface. Dermatologists are the only specialists trained in dermatoscopy.

The great thing is that the introduction of dermoscopy has led to a significant reduction in unnecessary biopsies. It has also improved diagnosis of early melanoma and other skin cancers. If a concerning pattern is detected, your dermatologist will perform a skin biopsy where a pathologist will examines the cells for any malignancy.

Some dermatoscopes may have cameras attached so that your dermatologist can reassess the pictures at a follow-up visit and see if the lesion has evolved or remained the same. This allows for consistent record keeping of your skin lesions and at times may avoid unnecessary surgical interventions.

Mole mapping

Mole mapping is a form of total body photography combined with dermoscopy. The photographs that are taken with a mole mapping machine are high definition and great quality images, which is then saved to document the appearance and location of moles on the body.

Your dermatologist reviews these pictures and may take dermoscopy pictures of concerning lesions for the purpose of documenting these and compare it later with follow-up pictures.

Mole mapping is a good technique to monitor patients with many pigmented lesions or atypical lesions but is not necessary for all patients. Your dermatologist will discuss whether you are a good candidate for mole mapping.

Who requires skin cancer screening?

  • Patients who have had a previous history of skin cancer.
  • Patients who have had a family history of skin cancer.
  • Patients who notice a new growth or a change in an existing lesion.
  • Patients who are immunosuppressed or undergoing immunosuppressant therapy or are immunocompromised due to HIV/Aids.
  • Patients with certain physical features, e.g. light skin, blonde or red hair, someone who has over 40 total moles or more than two atypical moles, many freckles, or sun damage.
  • Patients with a history of UV-radiation overexposure, e.g. previous sunburns, excess indoor tanning.

 

At the Dermatology and Skin Cancer Institute we use the most advanced technology available for skin cancer screening. Mole mapping in Stellenbosch and digital dermoscopy is preformed by Dr. Johann de Wet using the German-made FotoFinder System.

 

References:

  • Johnson MM,  Leachman SA, Aspinwall LG et al. Skin cancer screening: recommendations for data-driven screening guidelines and a review of the US Preventive Services Task Force controversy. Melanoma Manag. 2017 Mar; 4(1): 13–37.
  • Higgins HW, Lee KC, Leffell Point of care cutaneous imaging technology in melanoma screening and mole mapping. F1000Prime Rep. 2014; 6: 34.