10 Skin Cancer Exam Tips

A full-body skin examination requires more than identifying lesions that immediately catch the eye. Hair-bearing areas, mucosal surfaces, tattoos, scars, and even the umbilicus can contain findings that warrant closer evaluation.

For advanced practice providers conducting skin examinations, developing a consistent routine can help ensure easily overlooked areas receive appropriate attention. Chantel Hillestad, RN, MSN, DCNP, FNP-C, shared 10 practical considerations for performing a thorough full-body skin examination.

1. Prepare the Patient for the Examination

Before beginning, explain the sequence of the skin examination so the patient knows what to expect. Full-body examinations may cause anxiety or discomfort for some patients, and explaining the process beforehand can help patients feel more prepared.

Patients can also be encouraged to arrive without makeup or remove it before the examination so the face and surrounding skin can be thoroughly evaluated.

2. Examine Skin Covered by Body Hair

Hair-bearing areas should not be overlooked. Part through the scalp and examine the skin beneath the hair, then evaluate areas covered by eyebrows, facial hair, and beards.

Taking the time to systematically examine these areas can help identify lesions that might otherwise remain concealed, including melanoma hidden beneath dense facial or scalp hair.

3. Evaluate Lesion Texture and Mobility

Visual inspection is only one component of evaluating a skin lesion. Palpation can provide additional information about its texture, consistency, and mobility.

With gloves removed when clinically appropriate, use the palmar surface of the fingertips to assess texture. Actinic keratoses, for example, may have a rough or gritty texture, whereas lesions such as molluscum contagiosum and some nevi may feel smooth. Palpation can also help determine whether a lesion is mobile or fixed to underlying tissue.

Dermatofibromas typically have a firm texture and may demonstrate characteristic dimpling when manipulated. More broadly, incorporating palpation into the examination can provide information that may not be apparent through visual inspection alone.

4. Examine the Eyes and Eyelids

Include the eyelids and lash lines in the examination. Ask the patient to close their eyes and carefully evaluate the upper and lower eyelids, including the lash line and surrounding skin.

These small and sometimes overlooked areas should be incorporated into a consistent examination sequence rather than assessed only when a patient reports a concern.

5. Complete an Oral Examination

The examination should also include the oral cavity when indicated. Assess the inner and outer lips and gumline, and inspect the buccal mucosa and hard and soft palate.

Ask the patient to lift and move the tongue from side to side to allow visualization of the tongue and surrounding oral surfaces. A systematic approach can help prevent less visible areas from being skipped.

6. Palpate the Lymph Nodes

Include palpation of the cervical, axillary, and inguinal lymph nodes as clinically appropriate.

Note abnormalities such as enlargement, tenderness, firmness, or fixation that may warrant additional assessment in the context of the patient's history and other examination findings.

7. Don't Forget the Umbilicus

The umbilicus can be easy to overlook during a skin examination, but clinically significant lesions can occur there.

Primary umbilical melanoma is extremely rare but has been reported in the literature. In addition, a Sister Mary Joseph nodule is an umbilical or periumbilical metastatic lesion associated most commonly with gastrointestinal or gynecologic malignancies.^1,2

For clinicians, the practical takeaway is straightforward: make examination of the umbilicus part of the routine rather than treating it as an optional area.

8. Thoroughly Examine Tattoos

Evaluate the entirety of tattooed skin rather than allowing the tattoo itself to become visual background.

Dark and densely pigmented ink may make changes in underlying or adjacent skin more difficult to appreciate. Pay particular attention to lesions within tattoos and compare them with the patient's surrounding skin.

9. Examine Surgical Scars and Other Scar Tissue

Surgical scars, previous burns, and other areas of scarred or chronically damaged skin should also receive careful examination.

Skin cancers can develop in areas of previously damaged tissue, including burn scars. Ask about changes within scars and evaluate for concerning findings such as new growth, ulceration, bleeding, or other changes in appearance.³

10. Slow Down and Focus

A thorough skin examination requires concentration. If conversation becomes distracting during the examination, explain to the patient that you may pause the discussion briefly so you can focus on evaluating their skin carefully.

Approach the examination like a detective: assess every fold, groove, and easily overlooked area. Once the systematic examination is complete, take a step back and look at the patient's overall “landscape.”

Does one lesion look different from the others?

Maintaining a consistent examination sequence can make it easier to recognize what is expected—and what stands out.

References

1. Alhadlaq A, Kereet IM, Kamel B, et al. Characteristics and prognosis of skin cancer arising from burn scars: a systematic review. J Plast Surg Hand Surg. 2026;61:86-90. doi:10.2340/jphs.v61.45793
2. Salava A. The important role of palpation in the examination of solitary skin lesions: mnemonic of three T’s. Skin Health Dis. 2026;6(2):184-185. doi:10.1093/skinhd/vzaf115
3. Gibson JAG, Thompson WR, Konamme S, Bhattacharya S. Sister Mary Joseph nodule: a diagnostic challenge. BMJ Case Rep. 2018;2018:bcr2017223674. doi:10.1136/bcr-2017-223674
4. Suzuki, S., Yoshida, Y., Shiomi, T., Yanagihara, S., Kimura, R., & Yamamoto, O. (2016). Melanoma of the Umbilicus: A Patient Report, Precaution in Operative Strategy, and the First Histopathological Review of Published Cases. Yonago acta medica, 59(2), 183–187.