What People With Eczema Need to Know About Self-Screening for Skin Cancer

According to the American Academy of Dermatology (AAD), rates of skin cancer are on the rise in the United States. The good news is that having eczema does not necessarily make you more likely to develop skin cancer. However, severe eczema – especially when it’s actively flaring – can sometimes make it harder to recognize the early warning signs of certain types of skin cancer. This means that if you have eczema, getting to know your own skin, doing regular screenings and following up with your dermatologist if you see anything unusual is particularly important.

Expert advice on what you need to know

“Though skin cancer typically looks similar for people with and without eczema,” said Dr. Benjamin Ungar, assistant professor of dermatology at Mount Sinai Medical Center, “active eczema may ‘hide’ skin cancers to some extent, obscuring the ability to detect them. This is particularly true for sun-exposed areas such as the face, neck and forearms.”

Susan Tofte, assistant professor of dermatology at Oregon Health & Science University, added that skin cancers can sometimes be scaly, tender, ulcerate and bleed, much like severe eczema, so it’s important to relieve eczema-related inflammation as much as possible in order to effectively screen for skin cancer. But everyone, she says, should look for skin cancer regardless of whether they have eczema.

To help yourself screen for any irregularities, examine your skin regularly (monthly, as per the Skin Cancer Foundation) and look for anything that’s different or suspicious. Self exams are the most practical way to find skin cancer early, says the American Academy of Dermatology, when it’s still highly treatable.

The challenge? You might need a couple mirrors and a loved one to help you. And, of course, if you notice anything that’s new or changing, you’ll want to contact your care provider right away.

How to perform a skin cancer self-exam

As a best practice, the Skin Cancer Foundation recommends you check everywhere for signs of skin cancer: under the hair on your scalp, toenails and fingernails, on both sides of your hands, on the tops and bottoms of your feet, and even around your anus and genitals.

Look for anything out of the ordinary to you, or that’s evolved since your last self-check. If you see something that fits this profile, talk to a knowledgeable healthcare provider as soon as possible.

This is what to watch for:

• A growth that has increased in size and looks pearly, transparent, tan, brown, black, or multicolored.
• A mole, birthmark or brown spot that has grown in size or thickness, changed color or texture, or is bigger than a pencil eraser. Moles that are multicolored, asymmetrical, uneven around the edges, itchy, crusty, bleeding, or bigger than 6 mm (1/4 inch)should be checked out by a professional.
• A spot or sore that continues to itch, hurt, crust, scab, or bleed, or an open sore that doesn’t heal within about three weeks.
• Dark lesions on your palms, soles, fingertips or toes, or on mucous membranes lining your mouth, nose, vagina or anus.
• Scaly patches that are different from your usual eczema symptoms
• A brown or black streak under a nail and/or under the cuticle
• A mole or spot that looks different from others on your body, these are sometimes called “ugly ducklings.”

Skin cancer & skin of color

Although skin cancer can often look similar regardless of skin tone, Dr. Ungar noted that  individuals with darker skin are more likely to develop skin cancer on the palms of the hands and soles of the feet, as well as under toenails and fingernails, as opposed to on sun-exposed areas where skin cancer tends to appear on lighter skinned people (i.e. on the scalp, ears, face, neck, chest, shoulders, forearms, or lower legs.)

Step-by-step self exam

1. Examine your face including your lips, mouth and the tops, lobes, and backs of your ears.
2. Check out your scalp. A hair dryer can help part the hair for this, or a friend.
3. View your palms, as well as the top of your hands. Check between the fingers and under your nails (remove fake nails and polish).
4. Scan all sides of your arms and don’t forget your armpits.
5. Stand in front of a mirror and check your torso and sides. Lift breasts to check underneath.
6. Inspect your back with mirrors or a friend’s help. Check the tops of your shoulders, as well.
7. Using mirrors, look at your buttocks and the backs of your legs, move your butt cheeks if necessary and, yes, check in between, too.
8. A stool or chair can help when you’re viewing your legs and genitals. Put one foot up on the chair and examine the front of your leg and top of the foot. Use a mirror to check your private parts. Repeat for the second leg and don’t forget the soles of your feet and your toenails (without polish).

To help prevent skin cancer, Tofte reminds us to use sunscreen or sun protective clothing and hats, saying: “It’s just good practice for preventing damage from the sun which may lead to skin cancer.” If you are at particular risk, such as if there’s a history of skin cancer in your family member or you have naturally pale skin that burns easily (particularly with red hair and blue or green eyes), she recommends a professional skin cancer screening yearly. Want to learn more about what skin cancer can look like? The Skin Cancer Foundation and American Cancer Foundation have useful pictures. But remember, everyone’s skin looks different, if you see something concerning or atypical, even if it doesn’t match skin cancer photos, get it checked by a professional. Finding and treating skin cancer early can save your life.