How do you do a full skin check?
Women in particular may put off a visit to the skin cancer clinic because of the need to expose their skin for the mole scan.
The doctor initially examines your forearms, face and scalp with your clothes on. You are then asked to remove your clothes down to your underwear, lie on your back, & cover yourself with a sheet. The exposed skin is examined with the mole scanner. You are asked if you are worried about any lesions in the areas still covered up. Finally, you lie on your front, re-site the sheet, and the skin check is completed.
What process does the doctor follow?
The aim is to establish whether a skin lesion might be a melanoma, BCC, SCC or other type of skin cancer.
The doctor will make a decision for each lesion or mole that:
- The lesion is harmless – move onto the next lesion.
- The lesion is definitely a skin cancer – this will need treatment.
- The lesion might be a skin cancer – biopsy is required.
People have a tendency to developing the same ‘type’ of skin lesions.
It is important that each mole is viewed both in its own right, and in comparison to the other moles.
Finally, the doctor will advise regarding skin cancer prevention.
What is the evidence that skin cancer clinic checks are useful?
An important study from Germany started in 2003 and published in 2012 . This SCREEN project¹ involved just over 320,000 skin checks over 1 year period. The rate of death from melanoma fell by half over the following 5 years – these figures are quite impressive given that the melanoma is much more common in Queensland than Germany.
Those at higher risk have any of the following:
- Blue Eyes
- Red Hair
- Skin that easily burns
- A family history of skin cancer
- Previous multiple episodes of sunburn
- Previous blistering sunburn
- More than 100 moles
- Greater than 5 Atypical moles
- A previous skin cancer
The above is not exhaustive; increasing age is an important additional risk factor with any of the above. Those at higher risk of skin cancer should have a regular skin check (this is advised in Australian national guidelines for good reasons). A doctor trained in early diagnosis of skin cancer will be able to detect changes in skin lesions before a patient will be aware of such changes. This is a skill that takes considerable time & training to become adept at.
The key is to try to reduce rates of excisions or biopsies as well as increase early diagnosis of skin cancers.
What is the role for photographing moles?
Photographing individual skin lesions with dermoscopy can be helpful as a means to following up specific lesions that might cause concern. The decision whether to remove such a lesion or photograph and follow it up depend on an assessment of risk and discussion with the patient.
Whilst suspect lesions should obviously be biopsied, there are times when a lesion might not quite fit the criteria for being “suspect” and it be a reasonable option to re-examine the lesion in the near future. This is where a dedicated mole scanner comes in as it allows for direct side-by-side dermoscopic comparison.
Whole body photography has a well recognised place in the assessment and follow up of patients with numerous moles (over a hundred), particularly when there are also several “atypical” (dysplastic) moles. Dr Beatty does not offer whole body photography. However, he will recommend this when indicated.
Skin Cancer Self-Check
A skin cancer self-check is useful as an addition to a full skin check. A self-check may flag up a lesion requiring further attention. It’s not safe to rely on self checking because most skin cancers detected at a skin cancer clinic are not from lesions the person themselves was aware of.