For average-risk adults without symptoms, no major US guideline body recommends routine visual skin cancer screening by a clinician — the US Preventive Services Task Force concluded in 2016 that current evidence is insufficient to assess the balance of benefits and harms of such screening. What the evidence does support is simpler and self-directed: knowing your own skin, checking it regularly with the ABCDE rule as a guide, and getting any changing lesion looked at promptly. Melanoma found early is highly curable; found late, it is among the most dangerous common cancers.
This article explains what routine checks can and cannot do, how a proper self-exam works, and when a spot warrants a clinician's attention. It publishes information, not medical advice — evaluation of any specific mole or lesion is a job for your own clinician or a dermatologist.
How common is skin cancer, and melanoma in particular?
Skin cancer is the most common cancer in the United States overall, per the CDC, with basal cell and squamous cell carcinomas — the two most common types — rarely life-threatening when treated. Melanoma is the serious one: per American Cancer Society estimates published in January 2025, roughly 100,000 new cases of invasive melanoma are expected in the US in 2025, along with more than 8,000 deaths. Melanoma can arise in existing moles or, more often, on previously normal skin, and rates are higher in people with lighter skin — though people with darker skin also get melanoma, often at later stages and on palms, soles, or under nails.
Why doesn't the USPSTF recommend routine screening?
The Task Force's 2016 statement (an 'I' statement, meaning insufficient evidence) was not a claim that screening is harmful — it was a judgment that studies had not yet shown whether visual screening by clinicians in the general population reduces melanoma deaths enough to outweigh harms like unnecessary biopsies and overdiagnosis, a term for slow-growing cancers detected that would never have caused problems. The UK-based research on screening trials remains limited, and the Task Force has not issued a replacement recommendation. The practical consequence for you is that early detection in the US largely runs on self-detection: studies reviewed by the American Academy of Dermatology suggest a substantial share of melanomas are first noticed by the people who have them, or by their partners.
How do I do a proper skin self-exam?
The American Academy of Dermatology encourages adults to check their own skin regularly — about once a month works for most people — in a well-lit room with a full-length mirror, a hand mirror, and ideally a partner for the back and scalp. The exam is systematic, not random:
- Face, ears, neck, chest, and belly, lifting arms to check underarms.
- Arms, elbows, hands — including palms, fingernails, and between fingers.
- Buttocks and genitals, then the front and backs of both legs.
- Feet — soles, toes, toenails, and between toes.
- Back, scalp, and back of neck, using the hand mirror or a helper.
Photographing moles on your phone and comparing month to month is a legitimate aid; change over time is often more telling than any single snapshot.
What does the ABCDE rule mean?
ABCDE is a mnemonic dermatologists use to describe features of melanoma, per the CDC and the American Academy of Dermatology:
- A — Asymmetry: one half of the spot does not match the other.
- B — Border: edges are irregular, ragged, or blurred.
- C — Color: uneven shades of brown, black, tan, red, white, or blue within the same lesion.
- D — Diameter: often larger than 6 millimeters — about the size of a pencil eraser — though smaller melanomas occur.
- E — Evolving: the spot is changing in size, shape, or color, or a mole starts itching, bleeding, or crusting.
One caution: not every melanoma follows the rule, and most spots that do are not melanoma. ABCDE is a reason to make an appointment, not a diagnosis.
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What raises melanoma risk?
The strongest factors are having many moles (more than about 50), atypical moles, a personal or family history of melanoma, very fair skin that freckles or burns easily, red or blonde hair, blue or green eyes, a history of blistering sunburns, and heavy use of indoor tanning. Per the World Health Organization's International Agency for Research on Cancer, tanning devices are classified as a Group 1 human carcinogen — the same category as tobacco smoke — and meta-analyses published by IARC researchers found first use before age 35 associated with a substantially increased melanoma risk. Protective behavior matters at every age: broad-spectrum sunscreen of SPF 30 or higher, clothing and wide-brimmed hats, shade in the middle of the day, and avoiding tanning beds.
What happens if a clinician is worried about a spot?
Evaluation usually starts with a dermatoscope — a handheld magnifying device with polarized light that reveals structures invisible to the eye. If the lesion is suspicious, the definitive step is a biopsy: all or part of the spot is removed under local anesthetic and examined under a microscope, since no imaging or visual technique replaces pathology. Biopsies are quick office procedures; the results then determine whether anything further is needed. A normal biopsy closes the loop, and an early melanoma detected this way is typically treated surgically with excellent survival — per the National Cancer Institute's SEER data, five-year survival for melanoma caught while localized exceeds 99 percent.
Do women need to check differently than men?
Not in technique, but in pattern awareness. Melanomas in women are more common on the lower legs, while men develop them more often on the trunk and back — which is one reason a partner's help with self-exams is genuinely useful. Chronic sun exposure sites matter less for melanoma than intermittent, intense exposure; a vacation sunburn matters more than daily commuting sun. Anyone who has had a melanoma or atypical mole removed follows a dermatologist's surveillance schedule, which is more intensive than any general advice.
When to talk to a clinician
Make an appointment if you find a spot that matches any ABCDE feature, a new mole after age 30, a mole that looks clearly different from all your others — the 'ugly duckling' sign dermatologists describe — a sore that does not heal within a few weeks, a scaly or crusted patch that bleeds repeatedly, or a dark streak in a fingernail or toenail, especially without injury. See someone urgently rather than waiting if a lesion is bleeding, growing quickly, or changing week to week. And if melanoma runs in your family, ask about a baseline full-body skin exam even without any suspicious spot.
Frequently asked questions
Can a dermatologist do a full-body screening exam if I ask?
Yes — many people at higher risk (many moles, fair skin, family history) see a dermatologist for periodic full-body skin exams, and anyone can request one. What the USPSTF's 2016 statement addresses is whether such exams should be universal public-health policy for asymptomatic adults; it does not prevent you and your clinician from deciding an exam makes sense for your skin and history.
Do 'screening apps' that photograph moles work?
Treat them with caution. Some smartphone applications have not been validated in rigorous studies, and evaluations of several apps have found inconsistent accuracy in flagging melanoma. A phone photograph is fine for tracking change over time and sharing with a real clinician — but per dermatology reviews, no app result should replace a professional skin exam or biopsy.
Does a dark spot under a toenail always mean melanoma?
Not always — a stubbed toe can cause a benign bruise under the nail, and bruises usually grow out with the nail. The concerning pattern, per dermatology guidance, is a dark band that appears without injury, widens toward the nail's edge, involves the skin around the nail, or persists. Subungual melanoma is uncommon but is exactly the kind of melanoma self-exams are meant to catch, so have it looked at.
Is sunscreen itself linked to cancer?
No credible evidence supports that. Per the CDC and the American Academy of Dermatology, broad-spectrum sunscreen use is recommended protection against UV damage, a proven cause of skin cancer. Concerns about absorption of certain chemical filters are under separate study; if that worries you, mineral sunscreens with zinc oxide or titanium dioxide sit on the skin rather than absorbing into it.