History of sun exposure.

Personal or family history of skin cancer.

Inherited predisposing conditions

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  Xeroderma pigmentosum, Muir-Torre syndrome, Gorlin syndrome, albinism, basal cell nevus syndrome, others.

Full-body integument examination.

If patient presents initially without previous treatment, a biopsy should be performed at the time of evaluation to establish a diagnosis.

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  Full-thickness incisional versus excisional biopsies may be performed. Avoid shave biopsies.

Basal cell carcinoma: 2- to 5-mm margin. Larger margin for aggressive subtypes.

Squamous cell carcinoma

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  4 mm if lesion < 2 cm, well-differentiated, not invasive.

  
  
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  6 mm if lesion > 2 cm, poorly differentiated, invasive into fat, or in high-risk location (central face, ears, scalp, hands, feet, genitalia).

Melanoma: Excision margins determined by Breslow thickness.

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  In situ: 5-mm margin.

  
  
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  < 1 mm: 1-cm margin.

  
  
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  1 to 2 mm: 1- to 2-cm margin.

  
  
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  > 2 mm: 2 cm margin.

  
  
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  Stage II melanoma (depth > 2 mm or > 1 mm with ulceration) may require sentinel lymph node biopsy (surgical oncology consultation).

  
  
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  Stage III melanoma (positive lymph nodes) may require interferon (medical oncology consultation).