Melanoma screening: the skin exam at the clinic

May is Skin Cancer Awareness Month in Canada. It's an opportunity to revisit a topic many people put off: the full body skin check. Melanoma is one of the cancers that responds best to treatment when detected early. The question isn't *if* you should see a doctor, but rather understanding what to look for, what to expect, and which signs warrant prompt evaluation.

What is melanoma?

Melanoma is a cancer that originates in melanocytes, the cells responsible for skin pigmentation. These cells produce melanin, the pigment that gives color to the skin, hair, and eyes. When their DNA deteriorates, often due to UV rays, some cells can multiply uncontrollably and form a tumor.

What distinguishes melanoma from other skin cancers is its ability to spread to other parts of the body, including lymph nodes, lungs, or liver. It accounts for a minority of skin cancers diagnosed each year, but it is responsible for the vast majority of deaths related to these cancers. It is this disproportion that justifies the attention it receives.

It can appear on an existing mole that changes in appearance, or form directly on normal-looking skin. In some cases, it develops on areas that are rarely or never exposed to the sun, which complicates self-monitoring.

Why screening matters

Melanoma detected at an early stage, when the lesion is still superficial and localized, is generally treated with surgical excision. The prognosis is then significantly better than at an advanced stage. This is documented medical reality. The depth of the tumor at the time of diagnosis, known as the Breslow index, is directly linked to the outcomes.

The problem is that melanoma doesn't hurt. It doesn't cause obvious symptoms at first. Many people discover a suspicious lesion by chance, or because a loved one noticed it on their back. Regular skin checks, whether done at home or in a clinic, aim to shorten this detection time.

The Canadian Cancer Society recommends paying attention to any unexplained skin changes and discussing them with your doctor. The Canadian Dermatology Association agrees. Regular vigilance remains the best detection tool available to date.

Risk factors to be aware of

Certain factors increase the likelihood of developing melanoma. Knowing them is not meant to cause alarm, but rather to calibrate your vigilance.

UV radiation exposure is the most well-documented factor. This includes the sun, of course, but also tanning beds, the use of which before age 35 is associated with an increased risk according to several studies. Severe sunburns, especially during childhood, also play a role.

The skin phototype is taken into account. People with fair skin, red or blonde hair, and light eyes naturally have less protective melanin. They burn more quickly and are more exposed to UV damage.

The number and type of moles are also relevant. Having more than fifty moles, or having large, irregularly shaped ones, increases the risk. Atypical moles warrant special monitoring.

Personal or family history of melanoma is a significant risk factor. If a first-degree relative has had melanoma, the risk is higher. A person who has already had melanoma also has an increased risk of developing a second one.

Finally, a weakened immune system, whether due to illness or medical treatment, reduces the body's ability to eliminate abnormal cells.

What does a skin exam involve?

A comprehensive skin examination in a clinic begins with a questionnaire. The doctor will inquire about your medical history, sun exposure habits, and any history of melanoma in your family. This conversation helps guide the examination and target areas that warrant particular attention.

The visual examination itself covers the entire body, including the scalp, spaces between the toes, nails, and mucous membranes. The doctor often uses a dermatoscope, a magnifying optical instrument with built-in illumination, which allows for viewing the internal structures of a lesion and identifying characteristics invisible to the naked eye.

To evaluate each lesion, doctors rely on the ABCDE rule:

• A, Asymmetry. The two halves of a normal mole look alike. An asymmetrical lesion warrants attention.
• B, Borders. Irregular, jagged, or poorly defined edges are a sign to note.
• C, Color. A uniform mole is reassuring. Several shades (brown, black, red, white, blue) in the same lesion are concerning.
• D, Diameter. Most melanomas are larger than 6 mm at the time of diagnosis, about the size of an eraser. Smaller lesions can still be suspicious.
• E, Evolution. Any recent change, whether to size, shape, color, or bleeding, warrants evaluation.

If a lesion appears suspicious, the doctor may recommend a skin biopsy. A small tissue sample is taken and sent to the lab for analysis. This is the only way to confirm or rule out melanoma.

Monthly breast self-exam at home

The annual clinical examination alone is not enough. Between visits, a monthly self-examination allows for monitoring changes in your skin and detecting any alterations quickly.

Choose good lighting and use a large mirror. For hard-to-see areas, a hand-held mirror or the help of a loved one is useful. Examine methodically: face, scalp (a comb can help clear areas), neck, chest, abdomen, arms, hands (including under the nails), back, buttocks, legs, and feet.

What matters is the comparison over time. Photographing a lesion to note its evolution from one month to the next is a simple and effective practice. The goal isn't to self-diagnose, but to spot what's changing. A mole that has remained the same for years is generally not a cause for concern. It's the one that evolves that warrants a consultation.

When to consult?

Certain signs warrant an immediate consultation, without waiting for the next scheduled annual exam:

• A mole that bleeds, oozes, or crusts over for no apparent reason
• A lesion that rapidly changes in size, shape, or color over a few weeks
• A new dark spot appearing under a nail, on the sole of the foot, or on a mucous membrane
• An itchy mole that persists
• Any skin lesion that worries you, even if you can't pinpoint why

Instinct has its place in medicine. If something feels off, talking to your doctor is always the right decision.

The role of the family doctor in Quebec

In Quebec, the family doctor is often the first point of contact for a skin examination. As part of a routine consultation or a health check-up, they may include a skin examination and, depending on what they observe, refer you to a dermatologist for a more in-depth evaluation.

Dermatologists often have long waiting lists in Quebec's public healthcare system. A medical referral from a family doctor is generally required to get an appointment with a specialist. In this context, not waiting until you have an obvious symptom to talk to your doctor is a winning strategy.

The Canadian Dermatology Association also recommends that general practitioners include skin examination in the annual physical examination of at-risk patients. This is a developing practice in Quebec, varying from one doctor and one establishment to another.

Sun protection and prevention

Prevention starts with sun protection, and it's more nuanced than just applying sunscreen once when you head to the beach.

Health Canada recommends a broad-spectrum (UVA and UVB) sunscreen with an SPF of at least 30, applied generously to all exposed areas and reapplied every two hours or after swimming. Most people apply about half the amount needed to achieve the SPF indicated on the packaging.

Clothing also provides effective protection. Tightly woven fabric, dark colors, and a wide-brimmed hat offer better protection than any sunscreen. Several brands now offer clothing with certified UV protection (UPF) ratings.

Avoiding the sun between 11 AM and 3 PM, when UV rays are most intense, is a simple recommendation to integrate. This time window doesn't mean staying indoors all day, but rather choosing shade, covered patios, and outdoor activities outside of these hours.

As for tanning beds, their use is discouraged by the World Health Organization and the Canadian Cancer Society. They have no place in a prevention strategy.

Clinique Omicron, the first choice for a skin exam

At our service points in Quebec, general practitioners perform skin examinations as part of medical consultations. If you have risk factors, a lesion that has changed, or simply need a professional opinion on a mole that concerns you, a medical consultation is the starting point. You can book an appointment online you can consult the price list page to know the available services.

Medical consultation | Clinique Omicron