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Melanoma Self-Monitoring and Documentation Sheet

A Comprehensive Guide for Tracking Skin Changes

Oncology

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Last updated: Mar 24, 2025

Personal Information

  • Name: _________________
  • Date of Birth: _________________
  • Medical Record Number: _________________

Monthly Skin Check Record

Body Mapping

Mark the location of any suspicious spots on the diagram below:

[Body diagram placeholder]

ABCDE Criteria Checklist

For each suspicious spot, evaluate:

  • Asymmetry: ☐ Yes ☐ No
  • Border irregularity: ☐ Yes ☐ No
  • Color variation: ☐ Yes ☐ No
  • Diameter >6mm: ☐ Yes ☐ No
  • Evolving/changing: ☐ Yes ☐ No

Tracking Table

Date Location Size Color Changes Noted Photo Taken
☐ Yes ☐ No
☐ Yes ☐ No

Follow-up Appointments

Date Doctor Notes

Important Reminders

  • Perform skin checks monthly
  • Take photos of suspicious spots
  • Contact your healthcare provider if you notice concerning changes
  • Keep this document updated and bring to appointments

Emergency Contact Information

Dermatologist/Oncologist: _________________ Phone: _________________

Clinic Address: _________________

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