One in three Texans will develop skin cancer in their lifetime. A board-certified Texas physician explains the ABCDE rule, the ugly duckling sign, and the warning signs of basal cell, squamous cell, and melanoma — plus evidence-based sun protection.
By Dr. Kathryn Kline, MD · Board-Certified Family Medicine Physician (ABFM) · Published 2026-05-21
One in three Texans will develop some form of skin cancer in their lifetime. That's not a distant statistical abstraction — it's your neighbor, your coworker, or you. Nationally, about 5.4 million basal cell and squamous cell skin cancers are diagnosed each year, and an estimated 212,200 melanoma cases were projected for 2025 alone. Yet skin cancer remains one of the most preventable — and most survivable — cancers in medicine, provided you catch it early and understand what you're looking at when you check your own skin.
Texas ranks eighth-highest in the nation for ultraviolet (UV) radiation exposure, and that UV load drives more than 90 percent of melanoma cases. As summer arrives and outdoor time increases, understanding the warning signs of skin cancer isn't optional — it's essential primary care.
Skin cancer isn't one disease. It's a family of conditions with very different behaviors, prognoses, and appearances.
The ABCDE rule is a framework from the American Academy of Dermatology for evaluating moles: A — Asymmetry (one half doesn't match the other), B — Border (irregular, ragged, or blurred edges), C — Color (uneven coloring or multiple shades), D — Diameter (larger than 6 mm, the size of a pencil eraser), and E — Evolving (any change in size, shape, color, or symptoms over time). Any mole meeting one or more of these criteria should be evaluated by a physician.
Early melanoma often looks like an asymmetric mole with irregular borders, uneven coloring (mixed brown, black, pink, or blue), or a new spot that doesn't match your other moles (the 'ugly duckling' sign). Basal cell carcinoma typically appears as a pearly or waxy bump or a sore that won't heal. Squamous cell carcinoma often shows up as a firm red nodule or a flat, scaly, crusted lesion. Any new growth or changing spot should be evaluated.
The American Academy of Dermatology recommends a full-body skin self-examination once a month. Use a full-length mirror and a hand mirror to check hard-to-see areas — your back, scalp, between your toes, and the soles of your feet. Take photos of any moles you want to monitor so you can compare them over time. Patients at higher risk (fair skin, family history of melanoma, prior skin cancer, or many atypical moles) should also have a clinician examine their skin annually.
A telehealth visit is an excellent first step. Your physician can review a high-resolution image of a concerning spot, take a full risk-factor history, and determine whether the lesion needs in-person evaluation, dermatology referral, or biopsy. Most skin cancers ultimately require an in-person biopsy for definitive diagnosis, but telehealth is a fast, affordable way to triage suspicious spots — especially in rural Texas where dermatology access is limited. Trinity Family Medicine offers telehealth skin evaluations statewide starting at $49.99.
No — sunscreen is essential but not sufficient on its own. The American Academy of Dermatology recommends a multi-layered approach: broad-spectrum SPF 30+ sunscreen reapplied every two hours, protective clothing (long sleeves, wide-brimmed hats), UV-blocking sunglasses, seeking shade between 10 a.m. and 4 p.m., and avoiding tanning beds entirely. No sunscreen blocks 100 percent of UV, and higher SPF numbers do not extend the time between applications.
Texans at highest risk include those with fair skin, light hair, and light eyes; people who burn easily; anyone with a personal or family history of skin cancer; people with a history of five or more blistering sunburns (especially in childhood); outdoor workers with chronic sun exposure; people on immunosuppressive medications; and anyone who has used tanning beds. However, skin cancer can occur in people of all skin tones, and Texas's intense UV environment increases risk for all residents.