Melanoma arising on the scalp, palms and soles, and oral mucosa may be overlooked. When performing self-examinations individuals will need to recruit someone to inspect their back, back of legs, and genital creases. When examining skin lesions, characteristics to be determined include asymmetry, border irregularity, color variation or enlarging diameter. A mole which itches, bleeds, or is painful needs excisional biopsy. For screening purposes, particular attention should be focused on populations at risk.
Skin type is a major determinant.
Other high risk groups include those with a family history for melanoma, atypical nevi, and those with a prior personal history of melanoma and non melanoma skin cancer. Current screening recommendations mandate annual digital rectal exam with FOBT for individuals over the age of 40, annual FOBT and FS in those over the age of 50, or whenever a higher index of suspension exists. Current practice is to proceed to colonoscopy if adenomatous polyps are detected. Because of the number of false negatives, BE as a screening modality is felt to be inadequate. Colonoscopy as a primary screening method is, at present, much too costly to be utilized for the general population, but may be warranted in certain high risks groups.