No matter your specialty, paying attention to abnormalities on your patients’ skin may save lives and protect you from potential liability. One in five Americans will develop skin cancer in their lifetime.¹ Because early diagnosis is key, all doctors should act upon unusual or ominous lesions or moles on patients’ skin. Suspicious spots should trigger a referral to a dermatologist, because the urgency of the situation can only be determined by expert examination and biopsy. 

When appropriate, educate your patients about what to look for while performing self-exams. Brown spots are usually harmless, but not always. Having more than 100 moles puts a patient at greater risk for melanoma. While many melanomas develop in areas exposed to the sun, they also develop in areas that are usually hidden from the sun. Be sure to examine the areas between the toes, underneath the nails, the palms of the hands and soles of the feet, and the eyes. 

Lina Feaster, MD, a family practice physician in St. Augustine, Florida, emphasizes the need for awareness: "I once found an unusual dark spot on the sole of a 12-year-old’s foot during a complete skin exam as part of a routine well-child physical. I sent the patient to a dermatologist for biopsy, which confirmed melanoma. Having caught this early, his life was spared from this particular lesion. I have never forgotten how important it is to watch out for melanomas not only in adults but also in children. Performing a complete skin exam entails not just examining sun-exposed areas, but also locations you’d least expect to find melanoma, like the sole of a foot." 

Here are the "ABCDEs" to look out for in moles or other skin lesions: 

• Asymmetry: If you draw a line through the mole, both sides should match. If not, the lesion should be evaluated. 
• Border: The borders of an early melanoma tend to be uneven. The edges may be scalloped or notched. 
• Color: Having a variety of colors is another warning sign. A melanoma may have brown, tan, black, red, or blue colors. 
• Diameter: Melanomas are usually larger in diameter than the size of the eraser on a pencil, but they sometimes may be smaller when first detected. 
• Evolving: Any change -- in size, shape, color, elevation, or other trait -- or any other symptom, such as bleeding, itching, or crusting, points to danger. 

Your patients can also take advantage of educational resources from the Skin Cancer Foundation at www.skincancer.org. 

Reference 

1. Skin cancer. American Academy of Dermatology. https://www.aad.org/media-resources/stats-and-facts/conditions/skin-cancer. Accessed March 19, 2015. 

Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.