A skin check, where a dermatologist examines your skin for any potential dangerous marks and moles, can feel intimidating. You have to deal with the personal questions, the crinkly gown — and the fear that your doctor might find a dangerous, speckled outlier.
It’s awkward, but that doesn’t mean you can skip them. After all, skin cancer is the most common cancer in the U.S. If a derm catches it early with a skin check, however, the survival rate is very high.
While recommendations vary by organization, in general, the Skin Cancer Foundation recommends all adults get an annual skin screening. For people who are considered high-risk — e.g., those with many moles, fair skin and hair, a history of sunburns, or a personal or family history of skin cancer — these skin checks are critical. Young patients with no risk factors might only need to come in once every two to five years, while someone with a history of melanoma may need a check every three to six months.
Research shows men are less likely to perform monthly self-exams or see a dermatologist regularly, so it’s important to note these recommendations apply to everyone. Additionally, skin checks are usually fully or at least partly covered by insurance, which means one less excuse for making an appointment.
Now that you know the basics of getting an appointment, here’s what to expect when you bare it all the next time you get a skin check.
The naked truth
Do you have to get undressed for a skin check? Yes. “We don’t have X-ray vision,” says Dr. Beth Goldstein, a North Carolina-based dermatologist. “If we can’t see it, we can’t evaluate it.”
That means you’ll need to remove your clothing and put on one of the aforementioned crinkly gowns. Women usually have to remove their bras, but can often keep on their underwear.
Some doctors screen the genital area, especially if the patient has a concerning spot there, but genital screening isn’t generally necessary for patients getting regular gynecologic or urologic exams. (That’s because fewer than 1 percent of all melanomas are found in the genital area.)
It’s important to take off any jewelry or nail polish and come in makeup-free. Any of these could obscure concerning spots on the face, head, nail beds and elsewhere.
During a skin check, your provider will check your entire body, from head to toe. If there are any moles or spots that you’re worried about, the doctor will also take a close look at those, wherever they are.
In some areas, dermatologists pay particularly close attention. A skin check helps a doctor look for two types of cancers: melanoma, the most severe, life-threatening type, and basal and squamous cell skin cancers, which are more common and much less deadly.
Basal and squamous cell skin cancers are often found in areas that get the most sun exposure, like your head, your neck or the tops of your hands. In men, melanomas, (abnormal, cancerous moles) most often occur on the back, while in women, they tend to appear on arms and legs.
Your dermatologist will also pay close attention to hard-to-see spots, like your back, your butt, behind your ears and your scalp. In between skin checks, Atlanta-based dermatologist Dr. Mary Alice Mina recommends patients ask their hairdressers to take a peak for anything worrisome on their scalps.
While a lot of the skin check is done with the naked eye, your dermatologist might also use a small magnifying device called a dermatoscope to look at moles or skin lesions in greater detail.
What your doc’s looking for
A typical skin check only lasts around 15 minutes, all the more reason to squeeze one into your schedule when you can. Your derm is able to cover all the bases in that short time.
“A lot is going on during a skin check that patients may not even be aware of!” says Mina. “Even when you’re just chatting and introducing yourself, a dermatologist is assessing a patient’s skin, the tone, texture, sun damage.”
When looking for moles, dermatologists follow the ABCDEs of skin cancer: asymmetry, border irregularity, color change, diameter over 6 millimeters and evolution, or any changes in the mole. However, there are certain types of melanomas, called “amelanotic” because of the absence of melanin, that are unpigmented and could be missed. This is, of course, a scary prospect, but amelanotic melanomas are relatively rare and often are still caught by a trained dermatologist.
Besides moles, dermatologists also look out for other signs of potential concern, such as redness or swelling, tenderness or pain, changes in skin texture or scars where there’s no history of trauma. Each of these might hint at a bigger issue.
While skin checks are primarily aimed at detecting skin cancer, dermatologists can also recognize other skin conditions like psoriasis, rosacea, eczema and rashes. If they see something that indicates one of these other conditions, they’ll likely recommend a follow-up appointment.
After you check off your skin check
If your doctor finds a suspicious spot during your skin check, they’ll remove a small area of your skin in a quick biopsy and send the tissue sample off to a lab to be analyzed. The biopsy is usually done right then and there. Don’t worry: Through the magic of local anesthetic, it’s generally painless, and you’ll get the results within a week or so.
If the spot is cancerous, the next steps will depend on the size and type of the cancer. Treatment often involves an excision (surgically removing all of the cancer and the surrounding area). Caught early enough, skin cancers typically have an excellent prognosis, with high survival rates and extra incentives to keep a close eye out for recurrence. Protecting your skin is an all-year, lifelong process, but from dermatologists to sunscreen and proper attire and more, you’ve got a lot of help on your side.