What is the process for a Skin Cancer Clinic Check?
A full skin check is an examination of the skin using dermatoscopy.
OK, so you’ve spotted that this involves you removing your clothes. But stop! Skin Cancer doctors are sensitive to the fact that many people may be mildly embarrassed by the need to expose their skin for a full skin check. The doctor will examine your face and scalp with your clothes on. You will then be asked to remove your clothes down to the underweard, and cover yourself with a sheet.
The aim is to establish whether a skin lesion might be a melanoma, BCC, SCC or other type of skin cancer.
The Dermatoscope uses a special lens and light to view the skin at high magnification. Each lesion is viewed in turn through the dermatoscope, after which The skin cancer doctor will decide one of three things:
- The lesion is definitely benign – move onto the next lesion!
- The lesion is definitely a skin cancer – this will need treatment.
- It is unclear what the lesion is, and a skin cancer is a reasonable possibility – 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.
What is a mole scanner?
A ‘mole scanner’ is a common term for a dedicated ‘mole machine’ that has these features:
- Viewing on a computer or LCD screen in real time.
- Magnification to at least 30 times.
- Links to dedicated software.
- Mapping of the dermoscopy image to the macro or overview image.
- Side-by-side comparison of the images at a follow-up.
Many dermatologists and skin cancer doctors use only ‘hand-held’ dermoscopy.
Most Mole scanners & software cost well over $20,000.
Dr Beatty utilises both hand-held dermoscopy and The Microderm Visiomed D120 mole scanner.
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.
1: J Am Acad Dermatol, Breitbart EW et al, 2012 Feb;66(2):201-11