Screening
Evidence is insufficient to assess the balance of benefits and harms of visual skin examination by a clinician for asymptomatic adolescents and adults.[81][82] In practice, all adults who receive an annual physical examination by their primary care physician should consider a full-body skin examination that includes evaluation of all skin lesions, to screen for melanoma and other skin cancers.
First-degree relatives of patients with melanoma should have regular screening by a dermatologist.[67] Patients at risk of melanoma may benefit from whole-body photography with sequential examinations, to facilitate earlier diagnosis.[67]
In practice, patients with one or more of the following risk factors should consider at least annual screening for melanoma:
Personal history of melanoma
Family history of melanoma in a first-degree relative
Family history of atypical nevi and/or melanoma, especially if the patient has atypical nevi
Presence of 5 or more atypical nevi
Presence of large (>20 cm) congenital nevi
Presence of genetic DNA repair defects, such as xeroderma pigmentosum
Immunosuppression, such as organ transplantation, long-term immunosuppressive medication for autoimmune diseases, or cancer such as chronic myeloid leukemia.
Consideration should also be given to screening patients with an absence of the above-listed risk factors if the patient has Fitzpatrick skin type I or II (light-colored skin that burns easily and rarely, if ever, tans) with a history of intense sun exposure as a child and numerous nevi (>50), especially if those nevi are dysplastic in appearance. Physicians can increase the chance of early detection in high-risk patients by explaining how to perform skin self examination at home, ensuring that the patient has a wall mirror at home and encouraging a spouse or loved one to assist with skin checks.[83]
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