Preventative measures like staying out of the sun, protective clothing, and applying — and reapplying — daily SPF are all crucial in the fight against skin cancer (not to mention delaying signs of aging like dark spots, wrinkles, and crepey skin), but if you really want to check off all the safe sun boxes, consider booking yourself an annual skin check with a board-certified dermatologist.
“The purpose of a skin check is to look at all of your skin — particularly in those areas that you have difficulty looking at — to make sure that you don't have skin cancer,” says Dr. Michelle Henry, Kiehl’s consulting board-certified dermatologist and ACGME fellowship-trained Mohs micrographic, reconstructive, and cosmetic surgeon. “Wherever you have skin, you can have skin cancer, so it's critical that we look at every single part of you.”
While skin cancer statistics are startling (according to the American Academy of Dermatology, it’s the most common cancer in the United States, with one in five Americans being diagnosed in their lifetime), early detection and treatment can yield very high survival rates and positive outcomes — hence why the Skin Cancer Foundation recommends yearly visits with a dermatologist to check every inch of skin.
Ahead, everything you need to know about skin checks, including why they are so critical in the treatment of skin cancer and what to expect at your very first appointment.
Why Are Skin Checks So Important?
To truly understand why so many experts recommend skin checks (also commonly referred to as skin exams or skin cancer screenings), Dr. Orit Markowitz, a board-certified dermatologist and skin cancer specialist, recommends reviewing the alarming statistics.
“Every year, you're more likely to find a skin cancer than you are to find breast, colon, lung, and prostate [cancer] combined, so it's a very common type of cancer,” Dr. Markowitz says.
Skin cancer also does not discriminate, so even if you have more melanin and a darker skin tone, you are still susceptible. In fact, the American Academy of Dermatology notes that skin cancer is frequently diagnosed later for people of color, which often means it’s at a later stage once it is finally found and that the cancer is harder to treat (and could have a lower survival rate). When it comes to melanoma specifically, Dr. Henry says the five-year survival rate for a person of color is around 65% while a white person’s five-year survival rate is above 90% “That's a stark contrast and a reason why we want to drive home the fact that no one is immune to melanoma and that we really need to protect ourselves,” Dr. Henry says.
Skin cancer can also present a little differently on darker skin tones. For example, Dr. Markowitz says that very early lesions can look like blackheads on darker skin tones. As the Skin Cancer Foundation explains, basal cell carcinomas may be pigmented on darker skin tones, as opposed to pearly, clear, pink, red, or white on lighter skin.
And while applying sunscreen every single day is certainly a habit you should be proud of, it doesn’t necessarily mean that you should forgo an annual skin check appointment. Case in point: although sun exposure can increase your risk of developing skin cancer, your genetics also determine your likelihood of developing melanoma, and these patches can be found in areas that don’t often see much sunlight.
“I've seen melanoma on the vaginal area, which is not getting sun,” Dr. Henry explains. “In patients of color, we often see melanoma on the soles of the feet, palms of the hands, and fingernails, which are areas that we don't historically think of as getting tons of sun.”
That type of melanoma is known as acral melanoma, and the Skin Cancer Foundation notes it is the most common form of melanoma in people of color. Dr. Henry adds that acral melanoma can be particularly aggressive if diagnosed in later stages. She says that, for many reasons, this could be due to a lower index of suspicion of skin cancer from both patients and physicians.
Your skin’s behavior or certain characteristics of the skin can be indicative of other serious health issues as well; Dr. Henry points to lupus, mycosis fungoides (a form of lymphoma), and sarcoidosis (a lung disorder) as three examples. This is why she also believes, outside of screening for cancer, skin checks should be viewed as an important part of preventative health care.
What Happens During A Skin Check?
This appointment allows your dermatologist to examine your skin — all of your skin — for points of concern. “The expectation should be that every nook and cranny of you is being looked at during that exam, including your scalp, behind your ears, bottom of your feet, in-between your toes, in the genitalia, et cetera,” Dr. Markowitz says.
To do so, once you reach the examination room you will be asked to disrobe and change into a gown. Dr. Henry notes that some doctors may ask you to remove your undergarments, while others will just move them around while checking. “Either way, you shouldn't be alarmed because it really is important that we look at everything,” Dr. Henry adds. Your doctor may also refer you to your ob-gyn or primary care doctor for the examination of the genital area.
Dr. Henry adds that she checks inside the eyelids, inside the mouth, under the tongue, and in the nose. She also always feels the lymph nodes, which is especially important for someone who has had cancer in the past. Photos may be taken in order to track changes on certain moles the next time you visit the office.
These examinations shouldn’t be done with just the naked eye either. According to Dr. Markowitz, your doctor should be utilizing a specialized magnifying tool called a dermatoscope, which allows them to get a closer, clearer image of a mole or area of the body and even catch cancers before they have any clinical features, or the ABCDEs of melanoma.
“The majority of the melanomas, or even other skin cancers, that we're able to capture non-invasively don't even have any of those features. They don't have asymmetry border regularity, color variation, or a large diameter. We have no idea how long they've evolved because they're so new and small.”
The length of skin check appointments vary depending on the individual being examined. Dr. Markowitz says some patients may need an hour for an exam while others may need 15-20 minutes. “What is important in terms of timing is being able to take your time and look over everything, not just with your eyes, but also with a dermatoscope,” she says.
While you might be tempted to ask your primary care doctor to check over your skin during your physical, a board-certified dermatologist is the absolute best trained medical professional to perform a skin check.
What Happens If They Find Something On Your Skin?
If your doctor finds something concerning, they may do a biopsy in order to treat the spot or determine whether or not the patch of skin is cancerous. According to Dr. Henry, that’s usually a shave biopsy, wherein a little area of skin is cleaned, numbed, and shaved slightly using a small blade. “The amount of trauma that we induce with the biopsies is like nicking yourself shaving,” Dr. Henry says. “You honestly forget about it the next day.”
However, there are other types of biopsies, like punch biopsies, that are slightly more invasive and remove greater amounts of skin. (An article by Yale Medicine notes that these biopsies are preformed when “disease or tumor is thought to involve the deeper dermis” and when stitches will be placed.)
At Dr. Markowitz’s practice, she typically looks at a spot dermoscopically, does a non-cutting biopsy to determine if the spot needs to be removed, and then utilizes a punch biopsy for the removal. She also believes it’s the fear of having to get multiple moles or spots of skin biopsied every single time that deters people from booking regular skin checks. In her own practice, she reveals that it’s actually very rare that she needs to cut during appointments. If she does cut, she says it’s almost from a cosmetic perspective rather than diagnostic.
“For those that are familiar with skin exams, there are dermatologists that will do multiple shave biopsies on a patient,” Dr. Markowitz says. “In my practice, it is very rare that patients are walking out with any shave biopsy, unless it's something that they want removed because cosmetically it is going to look better. Or, it's something that I know I can shave biopsy and then later treat it, and the treatment is just going to take less if the lesion has been flattened a bit.”
In fact, in Dr. Markowitz’s practice, non-invasive lasers are sometimes used to treat basal cell cancer.
On the flip side, she says that some dermatologists may deter patients from booking a skin check by not being thorough enough in their examinations. In other words, the patient may then feel like they could just do the check by themselves.
How Often Should You Get A Skin Check?
According to Dr. Markowitz, low-risk patients should be getting skin checks once every year. “Low-risk means someone who doesn't have a history of skin cancer, doesn't have a primary relative with a history of melanoma, and doesn't have greater than six large atypical moles on the body,” she says.
If you’re in a higher risk category, you may be instructed to do bi-annual appointments. Dr. Markowitz says identifying with the above characteristics would put you in a higher risk category. The CDC notes you are at greater risk at developing skin cancer if you have a lighter skin color or skin that freckles or burns easily, have blonde or red hair, have blue or green eyes, or/and are in older age. Dr. Henry also added that having just five sunburns doubles your risk of developing melanoma.
Finally, if you’ve had a recent history of melanoma, Dr. Markowitz follows the World Health Organization’s recommendations of seeing patients every three months for the first two years.
Overall, Dr. Henry and Dr. Markowitz both believe more people need to be getting skin checks, so if you haven’t had one yet in 2021 or don’t have an appointment on your calendar, consider this your reminder. “Skin cancer screenings are probably — out of everything — the most important thing that I do because it's how I save lives,” Dr. Markowitz says.
If you’ve been informed that your health insurance will not cover this type of appointment and are concerned about cost, try searching for a free skin cancer screening in your area via the American Academy of Dermatology. Many local healthcare centers and hospitals also frequently offer free screenings annually, though some of these efforts may be paused due to COVID-19.
How Can I Reduce My Risk Of Skin Cancer?
At your annual skin check, your doctor will take the time to get to know your personal health history and may offer tips on how to improve your sun safety, like wearing sunscreen more consistently. Dr. Henry recommends SPF 30 for everyday use and SPF 50 if you plan on being outside for more than an hour.
Dr. Markowitz also suggests avoiding peak hours of the sun (according to the CDC, that’s from 10 a.m. to 4 p.m.) and wearing protective clothing that can help to block harmful UV rays. Not only will following all of these tips help reduce your risk of skin cancer but they also minimize signs of premature aging, like wrinkles and photo damage.
The Skin Cancer Foundation also recommends giving yourself a head-to-toe self-exam every month (similar to a breast self-exam). You should call your dermatologist or visit a doctor if you spot areas of skin that appear to be “new, changing, or unusual.” You can view the organization’s step-by-step instructions here. Remember—although you might feel like you don’t have time to spend at yet another doctor appointment, doing so might just save your life.