How can you detect melanoma early?

The ABCDE rule (Asymmetry, Border, Color, Diameter, Evolution/change) is the best-known tool. Each additional feature a mole displays increases the chance that someone will notice it: with five features, 32% of non-dermatologists spotted it, compared with 8% when no features were present. But the rule has a blind spot: early melanomas 'in situ', the very first stage, actually show fewer features. You therefore cannot rely on the ABCDE rule alone for true early detection.

Checking your own skin, or having a partner do so, is worthwhile. Many melanomas are first noticed at home. Hard evidence that this reduces mortality is lacking in the available studies, but there are clear indications that self-examination promotes early discovery.

Targeted screening is most useful for people at the highest risk: older men with fair skin, people who have previously had a melanoma, or people with melanoma in their immediate family. Broad screening of the entire population is likely to lead to unnecessary biopsies of benign spots and high costs without proportionate benefit. The US Preventive Services Task Force therefore advises against routine screening for skin cancer in the general population.

A dermatologist can strengthen the assessment with dermoscopy, in which a magnifying instrument makes additional skin layers visible. AI is showing promising results, but has not yet surpassed the expertise of an experienced dermatologist and is for now considered a supporting tool.

UV radiation is the most important modifiable risk factor for melanoma. There is strong evidence that sun exposure contributes to its development. Sun protection is therefore the most concrete step you can take yourself to limit your risk. Note: the relationship between sunscreen and melanoma is not straightforward in the literature, possibly because people who use sunscreen spend more total hours in the sun.