Skin checks are an extremely important tool we have in diagnosing skin cancer, and all the evidence suggests early detection is one of the most important factors for determining survival.
What is a skin check?
A skin check is what the name suggests. It’s a check of your skin. Specifically a check for skin cancer. It is usually done by a doctor and involves usually a full head to toe examination of your skin, checking you for signs of skin cancer and sun-damaged skin.
Why should I get a skin check?
Skin cancer is one of the most common cancers in the world. In Australia and New Zealand alone, Melanoma affects around 20000 people per year. Rates of all skin cancers (including Basal Cell Carcinoma and Squamous Cell Carcinoma) is even higher.
Unfortunately, although the increase is slowing, the rates of skin cancer are still increasing. Having your skin cancer diagnosed early is one of the best ways of reducing the impact of it and increasing the chances you will be cured of skin cancer.
It is a check of your skin, from head to toe. Fairly straight forward. It will involve getting undressed, usually down to the underwear, so that the doctor can examine your skin. You can’t do a skin check through the clothes – if you can’t see the skin, how can you possibly check it for signs of skin cancer?
The doctor will likely offer a check underneath your underwear, but won’t insist on it unless you are extremely high risk. Despite popular belief, you can get skin cancer where the sun doesn’t shine.
A chaperone can be provided for you and the doctor so please ask if you wish to have one and it is not offered. Don’t worry your doctor won’t be offended by this request.
How is it done?
The process varies between doctors – no doctor does skin checks in exactly the same way. However, the general principles are that it is a head to toe examination, front and back, down to but not including underneath the underwear. The doctor should look at your whole body, including areas you may not even have thought about like the scalp, in between your fingers and toes or underneath your feet, or in your armpits.
Typically I will check the eyes and inside the mouth also, including the inner side of the lips and the gums as these areas can be affected by skin cancer too albeit far less common. Not all doctors do this.
Some doctors ‘scan’ the body with the naked eye and then examine certain moles or lesions on your skin in closer detail. They should be using a dermatoscope (also called a dermoscope by some) to examine them in much closer detail.
This is a medical instrument that is more than just a magnifying glass. It uses polarised and non-polarised light to essentially look just underneath the surface of the skin, whereas a magnifying glass would simply show the top layer of the skin. This allows much greater detail and checking of the mole or suspicious lesion. Despite what anybody tells you, unless your skin cancer is very advanced, you simply cannot tell what is benign (harmless) and cancerous with the naked eye.
How long should a total body skin check take?
Every doctor is different, and every patient is different. Some doctors will be quick. Those who ‘scan’ then check a few more suspicious moles will be quicker than those, like me, who check every single mole. I usually take ~15-20 minutes to do a full head to toe skin check. I like to be thorough and methodical to avoid missing things.
Sometimes it takes more than 20 minutes if there’s hundreds of moles or multiple highly suspicious lesions, whereas sometimes it can be 5 minutes if there are very few moles. I’ve seen patients with over 200 moles, and others with just 1.
Usually, it takes only a few seconds to check a mole but sometimes it will take longer if it is not immediately recognisable as benign (harmless). Even at 5 seconds each at 100 moles that’s almost 10 minutes to check, plus time to dress/undress, and of course, the questions I need to ask to determine risk. In addition, we need to have a discussion about sun protection and anything we have found, discuss follow up arrangements etc.
There’s no ‘correct’ way of doing a skin check. Everybody does them differently. However you should have confidence in your doctor who is performing them, and they should be using the correct tools for the job.
How often should you have a skin check?
That depends on a number of factors, like your skin type, your family history, your personal history, and ongoing risk factors, so make sure you speak to your doctor. Most of my patients I recommend annual skin checks for, but it does vary.
Risk factors include:
- Previous skin cancer
- Family history of skin cancer
- Fitzpatrick Skin Type
- Number of moles
- Number of Atypical moles
Who can do a skin check?
The first person to speak to is your local GP. It is usually part of GP training and they may be able to your skin check for you, although this does vary by country. If they are not confident in doing a skin check they may refer you on to another doctor. There may be dedicated skin cancer clinics and of course the dermatologist. If you are unsure, speak to your GP first.
Photographs of your moles
A question I get asked a lot. ‘Do I need photographs of my moles?’ or ‘my dermatologist wanted me to get body photos but it costs hundreds of dollars, what should I do?’
Many doctors who do skin checks have the ability to take photographs of your moles. It usually doesn’t require too much special equipment, as many dermatoscopes have smartphone adapters which allow the doctor to take high-quality photos of your suspicious moles.
This may be useful for photographic surveillance or for simply showing you why it may be a concerning mole and need a biopsy, or the opposite and why it’s actually fine to leave it alone. As they say a picture paints a thousand words, and often I get good feedback about my photographs from patients.
Total body photography
Individual photographs can be helpful, but what about whole-body photography? Otherwise known as total body photography (TBP), this is the process by which you will have photos taken of your entire body, with the aim being to monitor and identify early changes to your moles.
Theoretically, this sounds great, however, the reality is that at current technology levels it isn’t terribly reliable. Also although different symptoms may vary, it typically only works on pigmented moles (lesions) which means it won’t pick up skin cancers which aren’t pigmented (dark moles).
For example, basal cell carcinoma (BCC) and Squamous cell carcinoma (SCC) may not be identified on total body photography, and these can be just as dangerous as Melanoma. The evidence for its use is weak. In low-risk individuals, there is no evidence that it is helpful, and potentially could be harmful if it misses something.
There is some evidence that it may be beneficial in high-risk individuals, but even then the evidence is weak. The Cancer Council guidelines cite this as level C evidence which means there is ‘some support for recommendation but care should be taken with its application’. Even the ‘practice point’ that suggests patients have Total body photography, by their very own definitions, has no evidence.
Like anything, Total body photography is a tool that can be used, in the right patients, in the right circumstances.
There are many algorithms we use as dermatologists, GPs and skin cancer doctors, but one of the most basic is the ABCDE approach. You will read about it on many websites, but it’s fairly straightforward to use.
A = asymmetry in shape
Usually, benign harmless moles are fairly symmetrical in shape. Skin cancers tend not to be symmetrical.
B = Border
Most melanomas and other skin cancers have irregular borders. Most benign lesions have regular, consistent borders.
Skin cancers often have more than 1 colour in them. Benign harmless lesions tend to only have 1 colour.
D = Diameter
Lesions over 6mm more likely to be potentially harmful including melanoma and other skin cancers
E = Evolution / Change
Anything that is changing or evolving is cancer until proven otherwise
Updated February 2020