Good lighting is required to examine the skin for early skin cancers. Standard office ceiling lighting is rarely satisfactory. A wall or floor mounted gooseneck lamp added as a supplement is very helpful.
The areas of skin cancer involvement are usually areas of either maximum sun exposure (i.e. the face and dorsum of the hands) or areas of intermittent severe sun exposure: back and arms of men and women and the lower legs of women. It is important in female patients to examine the legs, particularly below the knees. Wearing dresses as a child is the probable reason for this increased of melanomas on the legs of women as compared to men.
Ideally, all patients should be examined clothing free. This is not practical in most practice settings. High risk patients should have such an examination, but for the average patient removing the shirt exposes 60% of the body surface area to scrutiny, and a larger percentage of sun-damaged skin. Examining the lower legs of women should be routine in this context.
It is important not to be distracted by one lesion. If one notices a basal cell carcinoma on the face one can stop an examination and miss a melanoma on the back. The risk factors are similar. It is important to do an examination as thorough on a patient with a known or suspect pathology as one would do for a patient that was simply at high risk. In addition, it has been noted that approximately 40% of patients with one melanoma have a dysplastic nevus that is obvious at that same examination. It is important to review melanoma patients for dysplastic nevi at that first examination, and annually thereafter.