When a dermatologist says to keep an eye on a spot, it usually means the spot does not look worrying enough to remove today, but something about it is worth checking again. The plan is to compare the spot with itself over time: you watch it at home, and the dermatologist looks at it again on a set date. If it changes, a biopsy is often the next step. If it stays the same, that is reassuring.
Here is what monitoring involves, how to do your part, and when not to wait for the next visit.
Why a dermatologist may watch a spot instead of biopsying it right away
Most moles and spots are harmless, and a biopsy is a small procedure with its own downsides. The National Cancer Institute notes that a biopsy can cause scarring and infection. So when a spot has a feature that is a little unusual but not clearly concerning, watching it can be the more sensible choice.
Change over time is one of the most useful signals a dermatologist has. The E in the American Academy of Dermatology's ABCDEs of melanoma stands for "evolving." A spot that stays the same across checks is reassuring. A spot that changes gets a closer look.
A dermatologist may suggest watching a spot when:
- It has one slightly unusual feature, but nothing that clearly points to skin cancer.
- You have many moles that look alike, and comparing them over time is more useful than removing them all.
- They want a second look at a spot before deciding whether a biopsy is needed.
Watching is a choice, not a rule. If you would feel better with a biopsy now, it is reasonable to ask whether that is an option.
How monitoring works: baseline photos, measurements and a re-check date
Monitoring works by setting a baseline and comparing back to it. That often includes:
- Photos. Close-up pictures of the spot, and sometimes a wider shot showing where it sits on your body.
- Measurements or notes. The size, shape and color recorded in your chart.
- A re-check date. A set time to look at the spot again and compare it with the baseline.
How a spot is recorded and when it is re-checked varies by practice and by the spot. Before you leave the office, ask:
- Which spot is being watched? Ask them to point to it, or show you a photo.
- What made you want to watch it?
- How is it being recorded, and should I take my own photos?
- When should I come back, and should I book that visit now?
- What changes should bring me in sooner?
Write down the answers and put the re-check date in your calendar.
Tracking the spot at home between visits
Your job between visits is to notice change, not to diagnose. A simple routine helps:
- Pick a regular schedule. Looking every day makes slow changes hard to notice. Checking on a set schedule, such as once a month, gives you something to compare.
- Take photos the same way each time. Use the same room, light and distance. Put a small ruler next to the spot for scale, and date each photo.
- Use mirrors or a helper. For your back, scalp or the backs of your legs, use a hand mirror with a full-length mirror, or ask someone you trust to take the photos.
- Map your spots. The AAD offers a free body mole map you can download to mark where your moles are.
- Check the rest of your skin too. Look over your whole body, including your scalp, palms, soles, nails and between your toes, not only the spot being watched.
Changes that mean you should come back before your re-check
Do not wait for your scheduled visit if the spot shows any of the ABCDE warning signs:
- Asymmetry: one half starts to look different from the other.
- Border: the edge becomes ragged, notched or blurry.
- Color: it darkens, lightens in patches, or shows new colors such as black, red, white or blue.
- Diameter: it grows. The AAD notes melanomas are usually larger than 6 millimeters (about the size of a pencil eraser), though they can be smaller.
- Evolving: any change in size, shape, color or height.
Come in sooner, too, if the spot:
- Itches, bleeds, oozes or crusts without an injury
- Becomes raised, or develops a bump within it
- Turns into a sore that does not heal
- Starts to look different from your other spots
If a biopsy is recommended later
If the spot changes, or the dermatologist decides it should be checked under a microscope, the usual next step is a biopsy. In a shave biopsy, the skin is numbed and the spot, or part of it, is removed with a thin blade. The sample goes to a lab, where a pathologist examines it. The site is bandaged and may leave a small mark as it heals.
At Bay Ridge Dermatology, shave biopsies are done in the office. You can read about the practice's in-office procedures. If a biopsy shows melanoma, the diagnosis is made in the office and patients are referred to NYC cancer centers for treatment.
For more on what a full skin exam involves and how to check your skin, see our skin cancer screening guide.
When to call a dermatologist rather than wait
Monitoring only works if changes get looked at, and a dermatologist can only act on changes they know about. Call rather than waiting for your next visit if:
- You notice any of the changes above
- The spot changes quickly over a few weeks
- A new spot appears that looks different from your others
- You cannot tell whether it has changed, and it is on your mind
- You missed your re-check date or are not sure when it was
Calling about a spot that worries you is not overreacting. Getting it looked at is how you get an answer.
Seeing a dermatologist in Bay Ridge
Bay Ridge Dermatology is at 515 84th Street, 1st Floor, Brooklyn, NY 11209. You can find hours and directions on the contact page. If you have a spot to re-check or a new one to show someone, you can book online or call (347) 497-4984.
This article is general information, not medical advice. For advice about your own skin, see a dermatologist.