Objectives Clinical Assessments and Interventions Referral for Medical Action 36 Symptoms or signs of skin cancer Follow-up Actions If examination findings are negative, counsel employee regarding the im- portance of: ● Having periodic skin self-exam (see figure). ● Avoiding direct exposure to mid- day sun between the hours of 10 AM to 4 PM. ● Using a broad-spectrum (UVA and UVB protection) sun screen with sun protection factor of 15 or higher year-round to all exposed skin. ● Wearing protective clothing, such as wide-brimmed hat and sun- glasses when outdoors. ● Seeing personal health care provider annually (more fre- quently if at high risk) for an exam. If examination findings are positive, counsel employee regarding the im- portance of: ● Emphasizing medical treatment and follow-up. ● Providing emotional support. ● Assisting with return to work, as needed. ● Discussing ways to minimize sun exposure with protective clothing, sun screen, and the like. Obtain pertinent history. Assess area of skin where change is noticed. Advise regarding further evaluation. ● Inquire about symptoms (see Characteristics on page 35) and risk factors. ● Inspect skin for A-B-C-D-E. Asymmetrical shape. Border irregularity (uneven borders or rough edges). Color change (shades of brown, tan, red, white, blue, black—alone or in any combination). Diameter 5 millimeters (size of pencil eraser, about 1/4 inch or 6 millimeters). Evolving (lesion is evolving or changing). ● Arrange for medical evaluation with employee’s physician or dermatologist immediately. Examine your body front and back in the mirror, then right and left sides with arms raised. Bend elbows and look carefully at forearms, upper underarms and palms Look at the backs of your legs and feet, the spaces between your toes and on the sole. Examine the back of your neck and scalp with a hand mirror. Part hair for a closer look. Finally, check your back and buttocks with a hand mirror. Source: American Academy of Dermatology. Available at www.aad.org/public/exams/self.html. Reprinted with permission. Performing a Skin Self-Exam