Reference — Med-Surg
Skin Cancer Screening & ABCDE Reference
Most skin cancer is found by looking — by a nurse during an assessment, or by a patient who knows what to watch for. ABCDE and the ugly-duckling sign turn “a spot” into a reason to refer.
Educational use only. Screening guidance supports recognition and teaching; suspicious lesions need dermatology evaluation and biopsy for diagnosis. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
The ABCDE Rule
| — | Sign | What to look for |
|---|---|---|
| A | Asymmetry | One half doesn't match the other |
| B | Border | Irregular, ragged, notched, or blurred edges |
| C | Color | Varied — multiple shades of brown/black, or red/white/blue |
| D | Diameter | > 6 mm (pencil eraser) — though melanomas can be smaller |
| E | Evolving | Changing size, shape, or color; new itching, bleeding, or crusting |
Ugly-duckling sign: a lesion that simply looks different from the patient’s other moles — trust it even if it doesn’t tick every ABCDE box.
Who to Screen Closely
Higher risk: fair skin that burns easily, history of blistering/childhood sunburns or tanning-bed use, many or atypical (dysplastic) moles, personal or family history of skin cancer, and immunosuppression (organ transplant recipients have a markedly elevated SCC risk). Don’t skip darker skin tones — examine palms, soles, nail beds, and mucous membranes (acral melanoma).
Teaching the Self-Exam
Monthly, in good light with a full-length and hand mirror: check the whole body head to toe, including scalp, behind the ears, between the toes, soles, nails, and the back (use a mirror or a partner). Photograph moles to track change. Report any new, changing, non-healing, or bleeding lesion. Pair with annual professional skin checks for high-risk patients.
Biopsy & Prevention Notes
Suspected melanoma → excisional (full-thickness) biopsy so depth (Breslow) can be measured; shave biopsy can underestimate depth. BCC/SCC are often diagnosed by shave/punch biopsy and treated with excision or Mohs surgery.
Prevention counseling: broad-spectrum SPF 30+ reapplied every 2 hours, sun avoidance 10 a.m.–4 p.m., protective clothing/wide-brimmed hats/sunglasses, and no tanning beds. Childhood sun protection lowers lifetime risk.
NCLEX Pearls
- ✦ABCDE: Asymmetry, Border irregularity, Color variation, Diameter >6 mm, Evolving — plus the ugly-duckling sign.
- ✦Suspected melanoma gets EXCISIONAL biopsy (measures depth), not a shave.
- ✦Teach a monthly head-to-toe self-exam including scalp, soles, between toes, and nails.
- ✦Highest-impact prevention: SPF 30+ q2h, avoid peak sun, protective clothing, NO tanning beds.
- ✦Don't overlook acral sites and darker skin tones — palms, soles, nail beds, mucosa.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with Academy of Medical-Surgical Nurses (AMSN) · Current medical-surgical nursing standards. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →