Adding this to an exam can lead to "higher diagnostic accuracy and fewer missed melanomas," according to a specialist MD.
Though the American Academy of Dermatology lists basal cell carcinoma as the most common type of skin cancer, its experts rank melanoma is both the “deadliest” and “the most serious skin cancer,” particularly due to its ability to spread.
But if it’s caught early, the 5-year relative survival rate for melanoma is about 99% to 100%, according to the American Cancer Society. When melanoma spreads to lymph nodes or distant organs, the survival rate drops to roughly 76% and 35%, respectively.
For dermatologists who specialize in skin cancer detection, those numbers highlight a simple truth: Timing matters. “Early detection is the ball game to me. It changes everything with melanoma,” says Michael Christopher, MD, a board-certified dermatologist at Ironwood Dermatology in Tucson, Arizona. He explains that early detection is often the difference between a simple removal and life-threatening cancer.
Despite a growing public awareness around skin cancer and its signs, early melanoma can still slip through the cracks. But according to Dr. Christopher, asking one simple question during your next skin check could improve the odds of catching it early.
What to ask your dermatologist
Because exam techniques can vary widely, Dr. Christopher urges people to take an active role in their skin checks. He says the most important question to ask your provider is: “Will you be using a dermatoscope during my skin check?”
“A skin exam is only as good as the process behind it,” explains Dr. Christopher. If dermoscopy isn’t part of the evaluation, he advises asking why and considering being evaluated by a dermatologist who uses it routinely and skillfully.
According to Dr. Christopher, once clinicians become accustomed to dermoscopy, it’s hard to imagine practicing without it. “A modern skin exam should be systematic, head-to-toe, and with utilization of a dermatoscope on every pink and pigmented spot,” he says. “Once you appreciate the level of information provided with its use, you understand the significant risk of overlooking a skin cancer that looks normal clinically but is actually invasive melanoma.”
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What happens during a dermoscopy exam
Dermoscopy is a noninvasive method of examining signs of skin cancer using magnification and specialized lighting, which are provided by a tool called a dermatoscope. “This allows observation and assessment of different structures, pigment networks, and vascular patterns that the naked eye cannot see,” Dr. Christopher says. “That added layer of information is essential to separate an ordinary-looking benign spot from an early melanoma.”
Compared to visual exams alone, research strongly supports that using a dermatoscope makes a difference. “Numerous studies, including meta-analyses, have shown higher diagnostic accuracy and fewer missed melanomas when dermoscopy is added,” says Dr. Christopher.
Why melanoma is sometimes missed
Routine skin checks are an important part of detecting skin cancer, but not all exams are conducted the same way. Dermoscopy is considered the gold standard for melanoma detection, but it isn’t used universally yet.
“Early melanoma is still missed because skin exams are not uniform,” says Dr. Christopher. One dermatologist may examine every mole and pink spot with a dermatoscope, while another may rely on a naked-eye evaluation or only use a dermatoscope selectively. Dr. Christopher notes that the difference in exam styles is impactful because dermoscopy can be far more accurate, depending on the examiner’s training and experience, and that routine skin exams can sometimes offer a false sense of reassurance.
Melanoma misconceptions
Another challenge is that many people don’t realize that melanoma can be subtle. “The most common misconception is that melanoma has to be raised, dark, irregular, large, or symptomatic,” Dr. Christopher says. But most of the melanomas he finds don’t fit those descriptions—which helps explain why a naked-eye skin exam often isn’t enough to detect early-stage melanomas.
“Melanoma can be small, flat, light-colored, pink, be uniform in color with regular borders, and even look like a normal mole,” he explains. “Self-checks are important to understand what’s on your body, and what may be changing, but people should know that a spot does not have to look significant to be dangerous.”
About the expert
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