_edited.png)
​
​
Personal and Family History
-
Do you have a personal history of skin cancer?
-
Yes
-
No
-
-
Has anyone in your immediate family (parents, siblings, or children) been diagnosed with skin cancer?
-
Yes
-
No
-
-
Have you ever been diagnosed with atypical moles (dysplastic nevi)?
-
Yes
-
No
-
-
Do you have a history of basal cell carcinoma (BCC) or squamous cell carcinoma (SCC)?
-
Yes
-
No
-
Skin Type and Features
-
Do you have a fair complexion, freckles, or light-colored eyes (blue, green, or hazel)?
-
Yes
-
No
-
-
Does your skin burn easily or rarely tan?
-
Yes
-
No
-
-
Do you have numerous freckles or moles (more than 25)?
-
Yes
-
No
-
-
Do you have any large moles (larger than 6mm/¼ inch in diameter)?
-
Yes
-
No
-
Sun Exposure and Lifestyle
-
Did you grow up in a region with high sun exposure (e.g., tropical or subtropical climates)?
-
Yes
-
No
-
-
Do you currently live in or frequently visit regions with intense sun exposure?
-
Yes
-
No
-
-
Have you experienced multiple severe sunburns in your lifetime?
-
Yes
-
No
-
-
Do you frequently spend time outdoors without adequate sun protection?
-
Yes
-
No
-
-
Have you used tanning beds or indoor tanning devices, even occasionally?
-
Yes
-
No
-
Changes in Skin or Moles
-
Have you noticed any new moles or growths on your skin that appeared after age 30?
-
Yes
-
No
-
-
Do you have any moles or spots that are asymmetrical, have irregular borders, vary in color, or are larger than 6mm?
-
Yes
-
No
-
-
Have you noticed any moles or spots that have changed in size, shape, color, or texture recently?
-
Yes
-
No
-
-
Do you have any moles that itch, bleed, crust, or refuse to heal?
-
Yes
-
No
-
Additional Risk Factors
-
Have you undergone an organ transplant, or are you on immunosuppressive therapy?
-
Yes
-
No
-
-
Do you work in a job with significant sun exposure (e.g., outdoor labor, construction, lifeguard)?
-
Yes
-
No
-
-
Are you over the age of 50?
-
Yes
-
No
-
​