Scope of this summary
Adolescents and adults with a changing, symptomatic or clinically suspicious skin lesion, or people already under risk-based surveillance. This page is not a recommendation for routine whole-body screening in asymptomatic average-risk people; the 2023 USPSTF statement found evidence insufficient for that question.
The Bottom Line
- Treat evolution as a major signal: new or changing size, shape, color, elevation, symptoms or an ugly-duckling lesion can be more informative than a single diameter threshold, including in darker skin and acral or nail sites.
- Examine the lesion with good light and dermoscopy when trained, document dimensions and morphology, and assess the rest of the skin and regional nodes when melanoma or high-risk squamous cancer is plausible.
- For suspected melanoma, choose a biopsy that captures the full lesion and depth when feasible so Breslow thickness and staging are not compromised; communicate the clinical differential to pathology.
- For suspected basal or cutaneous squamous cell carcinoma, obtain adequate tissue and record site, size, borders, recurrence, immunosuppression and neurologic symptoms because these determine risk and treatment.
- Build a result-notification and definitive-treatment plan at biopsy. A tissue sample is not completion of care until pathology, concordance, staging needs and treatment ownership are resolved.
Practical clinical workflow
1
Record onset and evolution, bleeding, pain, itch, ulceration, sun and tanning exposure, immunosuppression, prior skin cancer, family melanoma history and the patient鈥檚 reason for concern.
2
Use ABCDE and ugly-duckling assessment without excluding nodular, amelanotic, acral or nail melanoma that lacks the classic pattern; inspect palms, soles and nails when clinically indicated.
3
Photograph with consent and scale, map the site and select complete excisional sampling with narrow margins when feasible for melanoma suspicion or an appropriate deep partial biopsy when anatomy requires it.
4
Send high-risk or anatomically complex lesions promptly to dermatology or the appropriate surgical service and provide pathology, photographs and biopsy-site localization.
5
After diagnosis, stratify follow-up and surveillance by histology, stage, recurrence risk, immunosuppression and risk of additional primary cancers; reinforce ultraviolet protection.
Safety boundaries and escalation
- Do not shave superficially through a lesion when doing so would prevent reliable assessment of invasive melanoma depth.
- Rapid growth, spontaneous bleeding, induration, pain, numbness, a fixed node or disease in an immunosuppressed patient supports expedited specialist assessment.
- Acral and nail-unit lesions and lesions on deeply pigmented skin are vulnerable to delayed recognition; avoid assuming low risk from skin tone.
- A benign pathology label that does not match a persistent or changing clinical lesion needs pathology review, repeat sampling or specialist concordance.
Localization
The USPSTF I statement concerns screening people without symptoms and must not be used to defer evaluation of a suspicious lesion.
Source documents
Use the linked source documents for complete recommendations, evidence grading, exclusions and implementation detail.
- U.S. Preventive Services Task ForceSkin Cancer: ScreeningFinal Recommendation Statement; I statement 路 published 2023-04-18 路 accessed 2026-08-20view source
- American Academy of DermatologyGuidelines of Care for the Management of Primary Cutaneous MelanomaDOI 10.1016/j.jaad.2018.08.055 路 published 2019-01-01 路 accessed 2026-08-20view source
- American Academy of DermatologyBasal Cell Carcinoma Clinical Guidelinepublished 2018-03-01 路 accessed 2026-08-20view source
- American Academy of DermatologyCutaneous Squamous Cell Carcinoma Clinical Guidelinepublished 2018-03-01 路 accessed 2026-08-20view source
continue the learning
From guidance to deliberate practice and evidence
Choose what happens next. iatroX can carry this page's jurisdiction, source-check date and released version into an editable learning record, support your reflection, or let you browse the regional question bank while keeping this topic visible. No action records completion, starts a session or awards CPD/CME credit automatically.
Add this guidance review to CPD/CMEOpen an editable learning-log record with this page鈥檚 provenance attached. You confirm the activity, time, reflection and mappings.Reflect on this with TutorUse optional prompts to consider what you learned and what鈥攊f anything鈥攜ou may change. Suggestions are never inserted automatically.Browse the US question bankKeep this guidance topic in view, then choose your exam and filters. No session starts automatically.
Found a source update or regional discrepancy? Tell the iatroX editorial team.