Every birthday you should get your birthday suit checked. Period. Even though a panel of so called experts to the FDA said it was inconclusive whether skin cancer screenings should be recommended to those who are asymptomatic and with no family history, I can tell you from having seen it with my own eyes that skin cancer happens every day in those very people and that skin cancer screenings save lives.
The sad statistic is that one person dies every hour in this country from melanoma, most of these people were asymptomatic and unaware of changing moles before the diagnosis and had no family history of melanoma. In case it wasn’t obvious, the expert panel was not made up of dermatologists and they were basing their recommendations on the cost of screening rather than the benefit of lives saved. It may make sense statistically but it makes no sense if you’re the person who gets the skin cancer, especially when a skin cancer screening is painless and doesn’t take very much time.
That leads perfectly in to what a skin cancer screening should look like. I feel very strongly it should be done by a dermatologist and should not be delegated to an extender or anyone but the doctor themselves.
GETTING READY FOR YOUR VISIT
On the date of your visit start by doing a self-skin exam. This should be done every 3 months on your own but also a good idea to take a look before you see your dermatologist. Make a list of any specific spots or marks you would like the doctor to note and check.
Wear comfortable clothing that’s easy to remove. I usually recommend screenings be done in the late spring and early fall for this reason, or on your birthday if it’s easier to remember. Most patients don’t like coming in during the summer because they think if I don’t see the tan it doesn’t count. News flash: I will know anyway, and it does count even if I don’t see it. Actually it counts even if you wear sunscreen and you don’t burn. Your dermatologist can read your skin and know so much about you, better to confess up front, we don’t judge, we’re only here to inform and help you. One of my favorite lines from a tanned patient is them swearing up and down that they wore sunscreen. I don’t doubt it but the tan is a sign that whatever they did wasn’t enough to protect their skin. Another reason not to have a skin cancer screening in mid-summer is that if a biopsy needs to be done, it won’t heal as well if it gets sun exposure and may be more likely to leave behind discoloration. For some people knowing they have a skin cancer screening in the Fall helps them apply and reapply more sunscreen in the summer. I’ll take whatever I can get in motivating everyone to be more sun smart!
Once you’re in your dermatologist’s office you’ll be given a gown and asked to undress. In my office I have patients remove everything but their underwear: bra off, underwear on. Remove even socks and shoes, makeup and jewelry. It is also ideal to remove all nail polish before the visit so the dermatologist can examine your nails. Melanoma can occur anywhere even on the nail bed under your nails. It can happen in any skin type and is not usually sun related. Bob Marley died of melanoma of the toe that started under a nail. The diagnosis was delayed since he was a big soccer player and initially thought the change was due to trauma from playing soccer. Your dermatologist will most likely have a dermatoscope which is a device that helps see a few layers through the skin so we can evaluate pigment patterns in birthmarks and moles without removing them and without cutting into the skin. It’s painless and is used for lesions that need extra attention. They’ll look over every part of you from the top of your scalp to your palms and soles and between every finger and toe.
Here’s what I tell my patients:
- Look for A,B,C,D,E in brown spots:
- A: asymmetry
- B: border irregularity
- C: color variation. Most brown spots are uniform in color. If there are multiple colors or shades of brown or gray, show your dermatologist
- D: diameter greater than a pencil eraser head (if you still remember what a pencil looks like!)
- E: evolving. Any change in a previously stable spot needs to be evaluated
- Note any spots that are not brown but are pink or red that have changed or that haven’t healed when you expected them to. They may have started out looking like a pimple or even just a scrape but are still there weeks and even months later. They may have some scale or even bleeding when touched. These may be a sign of the non-melanoma types of skin cancer called basal cell or squamous cell carcinoma. They are fortunately much more common than melanoma, which can be deadly, but they still need to be treated as early as possible to minimize scarring and risk of spread.
- If you do have a family history of melanoma you need to be more vigilant since that raises your risk beyond even what sun exposure can do. Make sure to do self -skin exams every 2 months and consider seeing your dermatologist twice a year for a screening. Also see your ophthalmologist for regular eye exams since melanoma can also occur in the eyes.
Skin cancer screening can take as little as 5 minutes to as long as half an hour. It depends on how many moles you have, how much sun damage and your family history. The skin cancer screening ends with a discussion about sun smart behavior and what it means on a daily basis. This means wearing a hat and sunglasses when out in the sun, wearing sun protective clothing when possible, avoiding being out in midday sun, staying in the shade when you can, and wearing SPF 30 or higher sunscreen on a daily basis every day all year round.
Now you are fully informed, fully screened and armed with information to make every skin cancer screening a walk in the park … with sunscreen!