Skin Cancer Self-Exam: Monthly Guide for Texas Residents

‍A monthly self-exam is a supplement to, not a substitute for, an annual full-body skin exam with a board-certified dermatologist.

A monthly skin self-exam is one of the most useful things you can do between dermatology visits. It is not a replacement for one. In Texas, where ultraviolet exposure is year-round and cumulative, the case for a disciplined monthly check is especially strong. This guide walks through exactly how to do a self-exam, what to look for, what to photograph, and when to call a dermatologist. It is written by Bayou City Dermatology for patients across the Greater Houston area, and it is designed to pair with, not replace, your annual full-body skin exam.

Why Texas residents face elevated risk

Texas combines three factors that together raise skin cancer risk: high UV exposure, a year-round outdoor lifestyle, and a population that spends significant time in sun-intense environments for work.

• UV exposure. Houston's UV index routinely reaches 10 to 11 (extreme) during the summer months and does not fall below moderate in any month of the year (National Weather Service Houston/Galveston). The cumulative annual dose is among the highest in the United States.
• Outdoor lifestyle. Year-round temperate weather in much of Texas means golf, running, cycling, fishing, and outdoor work span more months than in most parts of the country.
• Occupational exposure. Construction, roofing, shipping, petrochemical, agriculture, and public safety workers in Harris and surrounding counties accumulate substantial sun exposure on the job. Non-melanoma skin cancer rates climb with cumulative lifetime UV.

The American Cancer Society estimates that more than 5 million cases of non-melanoma skin cancer are treated in the United States each year, and the Skin Cancer Foundation reports that approximately 1 in 5 Americans will develop skin cancer by age 70 (American Cancer Society, 2024; Skin Cancer Foundation, 2024). Early detection meaningfully improves outcomes. That is the premise of the self-exam.

The monthly self-exam ritual

Set aside 10 to 15 minutes. Pick a consistent day (the first of the month is easy to remember) and a consistent room with good, even light. You will need a full-length mirror, a hand mirror, and your smartphone for date-stamped photos. Do the exam without clothing, if private space allows, so you can see every area of skin.

Work through the body in a consistent order so that nothing gets skipped. The order below mirrors the American Academy of Dermatology's self-exam steps and adds detail for commonly missed areas.

Prep

1. Undress completely in a well-lit room.
2. Have a full-length mirror, a hand mirror, and your smartphone camera ready.
3. Pick a consistent starting point so you do not lose your place.

Step 1: Head and scalp

Part your hair in sections and look closely at the scalp. If your hair is long or dense, ask a partner to help or use a hairdryer on cool to separate the hair as you go. Examine the back of your neck and the hairline.

Step 2: Face, ears, and neck

Examine the front and sides of your face, including eyelids, the skin around the eyes, the nose, lips, and chin. Do not skip the ears. Check the front of each ear, behind each ear, and inside the ear openings (a hand mirror and a bright light help). Examine the full neck, front, sides, and back.

Step 3: Chest and abdomen

Look at your chest and upper body. Women should lift each breast to check the skin underneath. Continue down the abdomen to the waistline.

Step 4: Back

This is the hardest area to self-examine and one of the highest-yield areas to photograph. Stand with your back to the full-length mirror, hold the hand mirror, and systematically scan from the back of the neck down to the lower back and buttocks. Better still, ask a partner to photograph your back with your phone each month so you have a record to compare.

Step 5: Arms and hands

Raise each arm and look at the underarm. Examine the upper arms, forearms, and hands. Check the palms, the backs of the hands, between the fingers, and the nail beds. Nail-bed pigmented streaks are a specific pattern worth noting.

Step 6: Legs

Sit down and examine the fronts and backs of each leg, the inner thighs, and the backs of the knees. Women have a higher proportion of melanomas on the legs than men do.

Step 7: Feet

Check the tops of the feet, the soles, between each toe, and the toenail beds. Feet are one of the most commonly missed areas, and acral lentiginous melanoma, a subtype more common in patients with skin of color, can develop on the soles or under a nail.

Step 8: Genitals and buttocks

Use the hand mirror to examine the genitals and buttocks. Melanomas and non-melanoma skin cancers can develop in areas with limited or no sun exposure.

The areas most people miss

Four areas account for most "I didn't even know that was there" findings at full-body exams:

• Scalp. Especially in patients with denser hair or who do not part their hair regularly.
• Feet, including the soles and between toes. Rarely checked, anatomically important.
• Nail beds of fingers and toes. Subungual melanoma can present as a new, widening, or dark pigmented streak.
• Genitals and the perianal area. Often skipped out of habit or discomfort.

If you would feel more comfortable having a partner help with a hard-to-see area, ask. The goal is a complete check.

The ABCDE method

The American Academy of Dermatology's ABCDE rule is the simplest screening framework for melanoma (AAD, 2024).

• A is for Asymmetry. One half of the spot does not match the other.
• B is for Border. The border is irregular, scalloped, or poorly defined.
• C is for Color. The color varies from one area to another, with shades of brown, black, red, white, or blue.
• D is for Diameter. Melanomas are usually larger than 6 mm (about the size of a pencil eraser), though they can be smaller.
• E is for Evolving. The spot is changing in size, shape, color, elevation, or in any other trait. Evolution is often the single most important sign.

Apply ABCDE to individual spots as you work through your self-exam. A single criterion is enough to warrant a call.

The "ugly duckling" sign

Most of your moles share a family resemblance: similar size, similar color pattern, similar edges. The ugly duckling sign means the mole that looks different from the others deserves closer attention. Cleveland Clinic and the American Academy of Dermatology both endorse this sign as a useful complement to ABCDE, because the human brain is very good at pattern recognition and very good at noticing the one that does not belong (Cleveland Clinic; AAD).

Photo documentation: the smartphone workflow

Your phone is the most useful tool in your self-exam beyond your own eyes. A simple monthly workflow:

• Photograph each major body area (head, chest, abdomen, back, arms, legs, feet) with consistent framing and lighting.
• For any individual spot you are tracking, take a close-up photo with a ruler or coin for scale, and keep the angle consistent month to month.
• Save the photos into a dedicated album on your phone, labeled with the date. Most phones will date-stamp automatically in the metadata, but an album keeps them easy to compare.
• Bring the album to your annual full-body skin exam. Your dermatologist can use the timeline to assess change.

When to call a dermatologist

Do not wait for your annual appointment if any of the following apply to a spot:

• It is new in adulthood, particularly after age 30.
• It is changing in size, shape, or color.
• It meets any ABCDE criterion.
• It looks different from your other moles (ugly duckling).
• It itches, bleeds, crusts, or fails to heal over several weeks.
• It is a pigmented streak in a nail bed, especially if the streak is new or widening.
• You have a personal or family history of melanoma and anything concerning.

Call and request a short-notice evaluation. A spot-check appointment is quicker than a full-body exam and is the right first step if something specific is worrying you. Our skin cancer screening page has more detail, and urgent cases can often be seen quickly through our online scheduling.

How often annual dermatologist screenings should happen

General guidance from the American Academy of Dermatology is that adults at increased risk should have an annual full-body skin exam with a board-certified dermatologist. Risk factors include a personal history of skin cancer, a family history of melanoma, many moles or atypical moles, fair skin that burns easily, a history of significant sunburns, extensive outdoor exposure for work or recreation, and immunosuppression. For average-risk adults, the U.S. Preventive Services Task Force has found insufficient evidence to recommend universal routine screening, while the AAD recommends annual exams for high-risk groups (USPSTF; AAD, 2024).

In Texas, a meaningful share of the adult population falls into at least one risk category simply because of cumulative UV exposure. If you have never had a full-body exam, that conversation is a reasonable place to start. If your dermatologist has performed a Mohs excision or biopsied a lesion in the past, more frequent screening may be recommended. Learn more about Mohs surgery and our broader dermatology services.

Frequently Asked Questions

How often should I examine my skin?

A monthly self-exam is the cadence recommended by the American Academy of Dermatology and the Skin Cancer Foundation. Monthly is frequent enough to notice change while avoiding the fatigue that weekly checks can create. A monthly self-exam is complementary to, not a replacement for, an annual full-body skin exam with a board-certified dermatologist.

What does the ugly duckling sign mean?

The ugly duckling sign is a simple rule: the mole that looks different from your other moles deserves closer attention. Most of a person's moles share a family resemblance. A spot that does not belong visually, whether by color, size, shape, or evolution, is more likely to warrant evaluation.

What is the ABCDE method for skin cancer?

ABCDE stands for Asymmetry, Border, Color, Diameter, and Evolving. A mole that is asymmetric, has an irregular or poorly defined border, includes multiple colors, is larger than about 6 mm, or is changing in any way is a reason to see a dermatologist.

When should I call a dermatologist about a spot?

Call if a spot is new in adulthood, changing in size, shape, or color, itching, bleeding, crusting, or failing to heal over several weeks. Also call if a spot looks different from your other moles (the ugly duckling sign). Do not wait for your annual appointment if something is actively changing.

Does a monthly self-exam replace a dermatologist visit?

No. A monthly self-exam is a supplement to, not a substitute for, an annual full-body skin exam by a board-certified dermatologist. Dermatologists use magnification and, in many practices, dermoscopy to evaluate spots at a level of detail that a home exam cannot match, and they can examine areas that are difficult to see.

A monthly self-exam is a supplement to, not a substitute for, an annual full-body skin exam with a board-certified dermatologist.

The habit only works if the next layer is in place. If it has been more than a year since your last full-body exam, or you have never had one, book a full-body skin exam at Bayou City Dermatology.