Skin self-examination
SSE; self skin examination; whole body self check
Skin self-examination empowers patients to detect new or changing lesions between clinic visits and is a low-cost, evidence-supported adjunct to formal surveillance — particularly important for melanoma survivors, patients with multiple naevi or family history, and immunosuppressed individuals. The technique is straightforward but rarely demonstrated well: a head-to-toe systematic inspection, including hard-to-see areas, every 2–3 months. Key messages — ABCDE for individual lesions, ugly duckling sign for the lesion that looks unlike the others, and a low threshold for asking a partner / mirror to inspect the back and scalp.
Who should do it
- Melanoma survivors — lifelong.
- Multiple atypical naevi or dysplastic naevus syndrome.
- Family history of melanoma in first-degree relatives.
- Organ-transplant recipients, immunosuppressed patients, prior keratinocyte cancer.
- Genetic predisposition — CDKN2A, BAP1, Gorlin, Lynch / Muir-Torre, XP, Fanconi.
- Fitzpatrick I–II skin with significant occupational or recreational sun exposure.
- Anyone over 40 in primary care — annual self-checks reasonable.
Technique
- Set up — well-lit room, full-length mirror plus hand mirror, undressed, hair tied back.
- Examine systematically head to toe — face, scalp, neck, front of torso, abdomen, then back (using hand mirror or asking a partner / family member).
- Don't miss: scalp, behind ears, in skin folds, groin, between toes, soles of feet, palms, under nails, mucosal lips, behind the knees, genital and buttock area.
- For each lesion — note size, colour, shape, edge, surface; compare with neighbouring naevi.
- Photograph any new or changed lesion with a smartphone alongside a reference (e.g. coin) for size; record date and location.
What to look for
- ABCDE — Asymmetry, Border irregularity, Colour variegation, Diameter ≥ 6 mm, Evolution.
- Ugly duckling sign — the lesion that looks unlike the patient's other naevi.
- New pigmented lesions in an adult (most naevi appear before age 25).
- Sore, itchy, bleeding or non-healing lesions of any kind.
- Change in size, colour or shape of an existing lesion.
- Specific red flags — pearly papule (BCC), keratotic plaque (AK / SCC), persistent ulcer (cSCC / BCC), pigmented streak in a fingernail (subungual melanoma).
Frequency
- High-risk patients (melanoma survivor, multiple atypical naevi, OTR) — every 2 months.
- Moderate risk (family history, prior NMSC) — every 3 months.
- General population — at least annually; more often if patient notices a new lesion.
- Establish a routine — same day of the month, after a shower.
When to see a clinician
- Any lesion meeting any ABCDE criterion or ugly-duckling sign.
- Any non-healing sore > 4 weeks.
- Any change in an existing naevus over weeks to months.
- Any pigmented streak in a nail.
- Photographs of the lesion taken at home are valuable to GPs and dermatologists.
- UK 2-week-wait referral pathway — NICE NG12.
References
- Berwick M et al. Screening for cutaneous melanoma by skin self-examination. J Natl Cancer Inst; 1996.
- NICE NG12. Suspected cancer: recognition and referral. London: NICE; 2015 (last updated 15 April 2026).
- NICE NG14. Melanoma: assessment and management. London: NICE; 2015 (last updated 27 July 2022).
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