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Melanoma Self-Monitoring Progress Chart

A Personal Tracking Tool for Skin Changes

Dermatology

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Template Content

Last updated: Mar 24, 2025

Patient Information

Name: _________________ Date Started: ___________ Dermatologist: __________

Monthly Skin Check Record

ABCDE Monitoring Guidelines

  • Asymmetry: Mark any moles that are not symmetrical
  • Border: Note irregular, jagged, or poorly defined edges
  • Color: Document variations or changes in color
  • Diameter: Measure moles larger than 6mm (pencil eraser size)
  • Evolving: Track any changes in size, shape, or color

Monthly Documentation Table

Date Location Size Changes Noted Photos Taken Follow-up Needed
□ Yes □ No □ Yes □ No
□ Yes □ No □ Yes □ No
□ Yes □ No □ Yes □ No

Body Map

[Insert body diagram here]

Risk Factors Checklist

□ Family history of melanoma □ Fair skin, light hair, or light eyes □ History of severe sunburns □ Multiple moles (>50) □ Irregular or atypical moles

Important Reminders

  1. Perform skin checks monthly
  2. Take photos of concerning areas
  3. Use good lighting and a mirror
  4. Schedule annual professional skin exams
  5. Contact your dermatologist if you notice concerning changes

Emergency Warning Signs

  • Rapid growth of existing mole
  • New dark spot that appears different from other moles
  • Unexplained bleeding or itching
  • Changes in ABCDE characteristics

Notes Section

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