The Skin Self-Exam: 7 Spots Most People Miss

South Africa’s UV index regularly hits 11 or above in summer — a level the World Health Organization classifies as “extreme” — yet the Cancer Association of South Africa (CANSA) estimates that melanoma is diagnosed in roughly 900 South Africans every year, and non-melanoma skin cancers number in the tens of thousands. Most of us have no regular access to a dermatologist. Learning to examine your own skin, thoroughly and systematically, is not a vanity exercise. It is a practical risk-reduction habit.

This guide focuses on the seven spots that dermatologists in both public and private practice say their patients consistently miss.

Before you start: what you’re looking for

The traditional “ABCDE” rule — Asymmetry, Border irregularity, Colour variation, Diameter over 6 mm, Evolution over time — was developed largely from research on fair-skinned populations. It still applies in South Africa, but dermatologists at Groote Schuur Hospital and the University of the Witwatersrand have emphasised that darker skin tones present specific patterns that the standard rule can miss.

In melanated skin, melanoma most commonly appears on the palms, soles, under nails, and in mucous membranes — areas with less pigment. These are called acral lentiginous melanomas, and they account for a disproportionately high share of melanoma diagnoses in Black South Africans compared with white South Africans. A lesion may be dark brown, blue-black, or even amelanotic (skin-coloured with no obvious pigment) — so “look for dark spots” is not sufficient guidance.

Set aside 10 minutes. You need a full-length mirror, a hand mirror, a bright light, and a comb or hair dryer. Do this check monthly, ideally on the same day each month so changes over time are easier to spot.

Spot 1: The scalp

Part your hair in sections and use the comb to expose the skin beneath. Use a hand mirror angled toward a bright overhead light, or ask a partner to check. Focus on the crown and the part line — areas that receive concentrated direct sun, especially during outdoor work, sport, or commuting without a hat. Basal cell carcinoma on the scalp can appear as a pearly or skin-coloured bump that bleeds easily; squamous cell carcinoma may look like a scaly, rough patch that does not heal.

Spot 2: Behind and inside the ears

The outer rim (helix) and the skin just behind the ear are direct sun traps. Pull the ear forward and check the fold of skin behind it. Look for persistent red or scaly patches, or any raised growth that has changed over the past few weeks.

Spot 3: The soles of the feet

This is the site where acral lentiginous melanoma most often appears in darker skin tones. Stand on a glass table with a mirror beneath, use a hand mirror on the floor, or photograph the soles with your phone. Look across the entire surface, including the heel and the arch. Any new dark streak, irregular patch, or non-healing sore warrants attention. Note that calluses can mask lesions — if a callus has a dark centre or irregular colouring within it, have it assessed.

Spot 4: Between the toes and under toenails

Separate each toe and check the web spaces for dark streaks, discolouration, or broken skin that does not heal. Under the nail — called the subungual space — is another acral site. A dark longitudinal streak (a line running from the base of the nail to the tip) that is new, widening, or uneven at the edges needs professional evaluation. This finding is called melanonychia, and while most cases are benign (especially in darker skin tones, where it is common), a changing streak should not be ignored.

Spot 5: The palms and under fingernails

Apply the same logic as the feet. Flatten your hands and check the full palm surface. Check under each fingernail for streaks. Hutchinson’s sign — pigmentation that has spread from the nail bed onto the surrounding skin fold — is a red-flag finding associated with subungual melanoma and needs urgent assessment.

Spot 6: The genitals and buttock folds

Melanoma can develop on any skin surface, including the vulva, penis, scrotum, perianal skin, and the skin folds of the buttocks. These areas are almost never sun-exposed, but acral and mucosal melanomas are not UV-dependent in the same way cutaneous melanomas are. Use a hand mirror. Look for any new pigmented lesion, ulcer, or growth that has changed in size or shape. Many people skip this area out of discomfort, which is precisely why dermatologists flag it.

Spot 7: The eyes and inside the mouth

Ocular melanoma — melanoma of the eye — is rare but real. CANSA advises having your optometrist examine the back of the eye (fundus) during routine eye checks. Inside the mouth, look for dark or irregularly bordered patches on the gums, palate, or inner cheeks. These mucosal sites do not require UV exposure to develop melanoma.

A note on darker skin tones and the “you can’t get skin cancer” myth

One of the most dangerous misconceptions circulating in South Africa is that Black and brown South Africans are immune to skin cancer because melanin is protective. Melanin does reduce UV penetration — significantly — but it does not eliminate risk, and it does not protect the acral and mucosal sites described above. Because of the myth, diagnosis in people with darker skin tones often happens at a later stage, when treatment is more difficult. A 2019 South African Medical Journal review found that Black patients presenting with melanoma at public hospitals tended to have more advanced disease at diagnosis than white patients, reflecting both the myth and the access gap.

No local SA data exists specifically quantifying the absolute survival difference by skin tone at diagnosis; the pattern is, however, consistent with findings from the United States National Cancer Institute showing a five-year survival rate of around 71% for Black patients versus 92% for white patients with melanoma — largely attributed to later-stage diagnosis. The mechanism is the same: later detection, not more aggressive biology.

Getting access to a skin check in South Africa

Most South Africans will not see a dermatologist unless they are referred. Here is how the pathway works in practice.

Public sector: Your first point of contact is your nearest Community Health Centre (CHC) or clinic. A nurse or general practitioner can assess a suspicious lesion and refer you to a district or regional hospital with a dermatology outpatient unit. Groote Schuur, Charlotte Maxeke Johannesburg Academic Hospital, and Inkosi Albert Luthuli Central Hospital all run dermatology services. Wait times at public facilities can be long — weeks to months — so do not delay reporting a changing lesion.

Private sector: A private GP consultation to assess a skin lesion costs approximately R600–R900. A private dermatologist consultation runs R1,200–R2,000 for an initial appointment, not including a biopsy (roughly R800–R2,500 extra depending on the laboratory). Dermoscopy (a magnified digital skin examination) may add another R300–R600.

Medical aid: Skin cancer treatment qualifies as a Prescribed Minimum Benefit (PMB) condition under Diagnosis Treatment Pair codes — meaning your medical aid cannot refuse to cover medically necessary treatment once a diagnosis is confirmed. Pre-diagnosis consultations, however, may draw from your savings or day-to-day benefits, so check your plan’s benefits schedule before booking.

Practical barrier — load-shedding and transport: Many public laboratories and digital referral systems are affected by load-shedding delays. If you are in a rural area, your nearest dermatology referral may require provincial transport. CANSA’s toll-free line (0800 22 6622) can help identify the nearest care centre and sometimes facilitates referrals.

When to see a doctor — don’t wait if you notice:

– A lesion that bleeds without injury, or does not heal after three weeks

– A dark streak under a nail that is widening or has pigment spreading onto the surrounding skin

– Any new growth on the sole or palm that has changed in the past month

– A lesion with multiple colours, uneven edges, or a diameter larger than 6 mm

– Any change to an existing mole — size, shape, colour, or texture

Bottom line

• Check your scalp, soles, between your toes, under your nails, and your genitals every month — these are the sites dermatologists say patients miss most often.
• Darker skin tones are not immune to skin cancer. Acral and mucosal melanomas occur regardless of UV exposure and are often diagnosed late because of a persistent myth.
• Use the ABCDE rule, but also watch for non-pigmented (skin-coloured) lesions that bleed easily or do not heal — melanoma is not always dark.
• Start at a CHC or clinic if you have no medical aid — you can be referred from there without needing a private specialist as a first step.
• Take monthly phone photos of areas you cannot easily see in real time; comparing images over three months is one of the most practical ways to catch slow change.