Two patterns catch most of it. ABCDE flags a mole that is Asymmetric, has a ragged Border, more than one Colour, a Diameter over about six millimetres, or is Evolving in any way. Applied whole, it flags a feature in eight or nine of ten melanomas, and Evolving does the most work 1. The ugly duckling is simpler: your moles rhyme with each other, so the one that looks unlike the rest is the suspect 2.
People who examined their own skin had roughly a two-thirds lower risk of dying from melanoma, a gap that held seventeen years on 3, and they caught their own tumours thinner 4.
Strip down in good light. You need a full-length mirror, a hand mirror, and a phone. Anchor it to a fixed monthly date so it survives.
Where you look depends on you. Fair skin, easy burns, red or blonde hair puts lifetime melanoma risk near one in thirty-three 5; men's tend to land on the back and trunk, women's on the legs. On darker skin melanoma is far rarer but shows up where the sun map ignores: soles, palms, between the toes, and the nail beds, where a new dark lengthwise band is the signal. If you have a hundred-plus moles, several odd ones, or a family history, add annual dermatology and ask about a one-time full-body photo baseline.
The fine print โ when to skip it, and what people get wrong
ABCDE misses two. Nodular melanoma is often round, uniform, small; learn EFG instead โ Elevated, Firm, Growing 1. Amelanotic melanoma has no colour: a pink papule that grows and won't heal.
Most skin cancers don't hurt. Waiting for pain or itch lets it grow. And sunscreen is prevention, not screening.
Two failure modes. Geography: the scalp, back, and soles get skipped, which is exactly where the dangerous ones hide; a hand mirror and a partner fix it. Memory: you can't recall a mole from six months back, so photograph and compare.
Also, don't over-react. Diagnoses have quintupled since 1975 while deaths barely moved, mostly thin harmless lesions 6. Book the appointment for something new, growing, or persistently changing past a month, not every spot you own.
- 1Tsao et al. (2015). Early detection of melanoma: reviewing the ABCDEs. Journal of the American Academy of Dermatology. link
- 2Grob JJ, Bonerandi JJ (1998). The "ugly duckling" sign: identification of the common characteristics of nevi in an individual as a basis for melanoma screening. Archives of Dermatology. link
- 3Berwick M, Begg CB, Fine JA, Roush GC, Barnhill RL (1996). Screening for cutaneous melanoma by skin self-examination. Journal of the National Cancer Institute. link
- 4Pollitt et al. (2009). Efficacy of skin self-examination practices for early melanoma detection. Cancer Epidemiology, Biomarkers & Prevention. link
- 5SEER (2024). SEER cancer stat facts: melanoma of the skin. link
- 6Adamson et al. (2024). Ecological study estimating melanoma overdiagnosis in the USA using the lifetime risk method. BMJ Evidence-Based Medicine. link
Skin Self-Examination
Five to ten minutes a month with a mirror, a hand mirror, and your phone โ the habit you have to remember more than the habit you have to grind out.
A landmark case-control study found two-thirds lower mortality among self-examiners; the biology of catching skin cancer thin is tight; no randomised mortality trial yet exists.
A melanoma caught at a millimetre is a thin scar; the same melanoma caught a few years later is a different disease. Six minutes a month buys you the catch.