I first discovered this, it's in the middle of my back between my shoulder blades, I really couldn't see it. I went to the eye doctor, I was in there, regular eye tests, pressure. Went to my primary care doctor, he discovered a little size of the top of your finger, black mark. Then one day, I don't know, I just twisted around and when I got out of the shower and I looked and I saw this big brown, looked like a giant mole. And while she was looking, she happened to say, I see something on your scalp. He said, what do you see? She said, well it looks suspicious. And of course, the results were melanoma. Next, you're going to move your stethoscopes to the fifth left intercostal space between the sternum and the mid-axillary line. And you may hear a mid-systolic click between S1 and S2, which would suggest the presence of a mitral valve prolapse, most commonly found in young women. What? Now you're going to have mitral valve prolapse. Give me a break. Okay, now we're going to examine your partner's lungs. What are you listening for? Wheezing, rolls, bronchi, agaphy. Good. Now what are you looking for? Looking for? A general physical examination is an excellent opportunity to check your patient for suspicious moles. For example, when you're listening to lung sounds, why not be on the lookout for melanoma? How do we tell the difference between a mole and melanoma? When you see a suspicious mole, you're going to apply the ABCDEs. Asymmetry, border irregularity, color variation, diameter of 6 millimeters or greater, and evolution. Asking the patient if he or she has seen a mole that has changed. Don't forget to check for suspicious moles. The most common melanoma site in men is the back. The most common melanoma sites in women are the legs and the back. What is that? I don't think it's anything. For more information, visit www.FEMA.gov You're a popular guy, I know. Oh, sorry. I really gotta take this. Would you mind finishing the exam for me? By the way, your sclera is looking a little blue. Very funny. You sure you don't have osteogenesis imperfecta? Just saying. Good afternoon. The last patient, Mr. Lahey? I think I spotted a melanoma on his back. I began the physical exam, taking the opportunity to visually scan the skin along my way. I looked over his face while examining his head and neck. I looked at his abdomen while performing the GI exam. I glanced at the lower extremities while checking his reflexes. And finally, I looked over his chest and back while doing his cardiovascular and lung exams. But in order to do that, I had to lift up the patient's johnny, not just slide the stethoscope underneath. That's good. Don't be afraid to lift the johnny. Mr. Lahey, do you mind if we take another look at your back? He obviously has several moles and other spots. But this one stood out. This ugly duckling. So then I quickly went through the ABCDEs. Asymmetry. Border irregularity. Color variation. Diameter of six millimeters or greater. I see at least three abnormalities here. What about evolution? Well, I asked Mr. Lahey if any of the moles on his back had changed significantly, and he said... How do you expect me to know what my back looks like? Well, the back is a difficult location for you to check. But since you have a number of moles on your back, we can teach you how to use a mirror to take a look at your entire body, including your back, every month. Now, you've seen five doctors in the last three years. Have any of them examined your skin? I don't think so. I'm having a problem with my lungs, not my skin. In the future, please ask the doctor that examines your lungs to also take a look at the moles on your back. I encourage all of you to integrate a skin exam into every routine physical exam that you do, just as Dana did. I don't understand. Is something wrong? Do I have cancer? Well, Mr. Lahey, we are concerned about one of the moles on your back. So we're going to do a complete skin examination, and we're going to check some not-so-obvious places where melanomas might hide. We'll examine the scalp, mouth, genitalia, buttocks, palms, nails, and soles. Does that sound okay to you? The most common melanoma site in men is the back. The most common melanoma sites in women are the legs and the back. What next, then? Refer him to a dermatologist. I agree. When in doubt, refer. You might have saved his life. Good catch, checking Mr. Lahey for melanoma. Most people don't look. If you're examining the lungs, why not check the skin on the back? It just makes sense. And how about that? The mole behind your knee? It doesn't meet any of the ABCDEs. Plus, I used a mirror to check my entire body, and I have several spots that look similar. Okay. But if it ever changes, be sure to see a dermatologist about it. Looks like tendonitis again. Stay off your knee for at least a week. No running, no exercise, nothing high impact. Ibuprofen if it starts to hurt. Something wrong? Nothing at all. It's a good idea for me to also check your skin, look for any weird looking moles. Tell you what, can you please roll up your other pant leg? Let's take a look at your left leg too. The doctor here was wonderful. She took me right under her wing. I came in and saw her every three months. She'd check you from the soles of your feet to the roots of your hair. And it was wonderful. I watch my diet, I try and be really careful all the time, exercise the whole nine yards. And then when I'm going to die I'm going to have a big pimple on my back. If you have a doubt, check it out. I know, it rhymes. You're examining someone and you happen to take another little look. Maybe it's a good idea that you look around that area. Maybe it's a good idea that you look around a little more than that area. Yeah, keep looking. You might find something. Make somebody happy. C stands for color variation, which means that the lesion has multiple colors or multiple shades of the same color, like brown. D signifies the diameter being greater than six millimeters or the size of a pencil eraser. And do not forget E for evolution. You can see here how the mold can change in size, shape, or color. You

doctor-patient conversation

suspicious moles

melanoma

ABCDEs of identifying melanoma

early detection