Length of time the lesion has been present

Associated symptoms: Pain, scabbing, itching, bleeding, and hyperkeratosis

Sun exposure history, tanning bed use

History of facial surgery, especially surrounding the nose

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  Previous surgery may affect reconstructive options

  
  
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  Primary tumor versus recurrent tumor

  
  
  
  
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    Previous treatment with cryotherapy, topical medications, electrodesiccation and/or curettage

    
    
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    Scar in area of malignancy

Complicating comorbidities: Cardiopulmonary/peripheral vascular disease, diabetes, tobacco product use, steroid use, anticoagulation, and chemotherapy

Supplementation with vitamin E, fish oil, krill oil, omega, and garlic

History of radiation, immunosuppression (organ transplant recipient, AIDS)

Personal or family history of skin cancer

Genetic conditions: Xerodermapigmentosum, Gorlin’s (nevoid basal cell) syndrome, albinism

Detailed evaluation of affected area and surrounding face/neck to assess the lesion with or without dermatoscopic analysis/magnification

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  Characteristics of affected area (e.g., hair bearing, adjacent skin laxity, and pigmentation)

Skin lesion findings

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  Size, color, shape of lesion, skin irregularity, hyperkeratosis, and ulceration

  
  
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  Confirm absence of involvement of deeper structures (e.g., parotid and facial nerve)

Lymph node examination to assess for signs of metastatic disease

Full body integument examination

Establish a diagnosis: If patient presents without previous treatment, a biopsy should be performed.

Full-thickness incisional versus excisional biopsies may be performed

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  If the concern is for an atypical pigmented lesion, an excisional or shave biopsy should be performed to evaluate as much of the lesion as possible to minimize sampling error

  
  
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  Avoid shave biopsies of a portion of a pigmented lesion as they may lead to incomplete assessment of the lesion, particularly in melanoma, where the depth of a tumor is critical to prognosis

  
  
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  Shave biopsyis an acceptable method of assessment if the concern is for a nonmelanoma skin cancer (basal or squamous cell carcinomas)

Imaging may be necessary after an initial diagnosis is established, especially if deeper tissue invasion is a concern or in lesions of the scalp where one is suspicious of possible bony penetration

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  Magnetic resonance imaging (MRI): Useful adjunct to determine extent of tumor and lymph node status in cases of aggressive tumor histology (e.g., perineural invasion)