I was sitting with friends at the beach the other day when the topic of skin checks came up. There we were, five women in our twenties, and only one of us could say they'd had one. That's concerning when you consider the fact that melanoma is the most common cancer affecting 15 to 39-year-old Australians.
The beauty writer in me was curious, so I quizzed them about why they'd never had a skin check. The general consensus was that they just didn't know how to go about it or were scared of having it checked. We're at the tail end of a generation that spent a lot of time outdoors, and while we do our best to apply sunscreen and wear a hat, we haven't been as skin cancer-savvy as we should have been, so the fear is very real.
I figured that if this was how my friends were feeling, a lot of other people would probably feel the same way. So I went to someone I knew would be able to answer all my burning questions about getting a skin check: Lisa Patulny, journalist and founder of Call Time On Melanoma, an education initiative that's become the go-to destination for young Australians who want to know the facts about melanoma.
Below, Lisa walks through everything you need to know about getting your skin checked, from what happens at an appointment right through to what happens if you need to get a mole removed.
How do you go about getting a skin check in Australia?
In Australia, we don’t have standardised skin checks, explains Lisa. "In part, this is because there isn’t sufficient empirical data to show that skin checks are always necessary for the average Jane (aka someone who hasn’t had skin cancer or melanoma before and carries no family risk). However, there is plenty of anecdotal evidence that skin checks save lives. (For instance, last year we had at least ten members of the Call Time On Melanoma community discover melanomas through skin checks who didn’t have a personal or family history.) For this reason, we believe everyone should have a yearly skin check."
Should you go to your GP or see a dermatologist?
A skin check can be performed by a dermatologist or GP (in their own practice, a medical centre or a skin cancer clinic). However Lisa explained that "a dermatologist is considered to be the gold standard since they are an expert on skin." The main reason for this is because studies have shown that GPs tend to excise more benign lesions and miss more lesions that should be removed. Additionally, a GP may or may not be up to date with current skin cancer literature and best practice, says Lisa. "They may not have studied skin cancer since uni, and even then it’s barely a blip in the curriculum from what we’re told. I’m not here to bash GPs, just stating facts. (I see a GP/skin cancer doctor myself - not a derm.) My point is, know who you are seeing and ask about their qualifications. If you see a derm, you’ll need a referral but for GPs and skin cancer doctors you won’t."
What can you expect from a skin check appointment?
It will vary depending on the type of doctor and type of appointment, but yes, you can generally expect to be asked to undress so that the doctor can look over all of your skin (unless you’re going in to discuss one lesion of concern, in which case you may not have your whole body checked).
Lisa explains that because skin checks aren’t standardised, procedures may vary. "Some doctors only look over your skin by eye (I wouldn’t feel comfortable with this - more on why below), some use a dermatoscope, and some do mole mapping in addition to a visual check. If you can manage it, I recommend mole mapping. It costs extra, but I believe it’s worth it. Mole mapping is a process where your whole body is photographed almost nude. (Undies on.) All moles, spots and dots are photographed close up, too. The photos are used to track teensy changes the eye may not pick up as quickly. It’s extra insurance."
What should you do if you think your skin check wasn’t as thorough as it should have been?
If you don’t feel that your skin check was as meticulous as it should have been, seek a second opinion, says Lisa. "Stuff the awkward conversation - you don’t owe anyone an explanation. My advice here is to be your own health advocate, always. These matters can be life and death, so if you’re not comfortable, find a new doctor."
Is there a checklist that we can tick off while we’re getting our skin checked?
Lisa recommends thinking about the following during your skin check: "Did your doctor check you everywhere? Did they ask about your scalp? Check your fingers, toes and the soles of your feet? Did they ask whether you have any moles in areas untouched by the sun? If not, ask them! A full body check isn’t a full body check if some moles are going unseen. Also, if your doctor isn’t using a dermatoscope, ask them why. I wouldn’t personally feel comfortable without this as many moles look fine to the eye but completely different under a scope."
If after your skin check your doctor tells you, “You don’t need to come back until you’re 50" or “Come back in five years,” Lisa recommends finding yourself another doctor. "We advocate for a yearly skin check for everyone, regardless of their skin tone. The thing about skin cancer and melanoma is that rates for recovery are really quite good if they’re caught early. After that? Anything can happen."
What should you do between skin checks?
We’re all familiar with the Slip, Slop, Slap, Seek, Slide slogan for sun safety. Wear sunscreen, hats and sunglasses, cover up in the sun and seek shade. Additionally, Lisa recommends regularly checking your skin at home. "The ABCDE method will help you know what to look for. If you have an already-suspicious mole I’d suggest booking in to see your doctor right away rather than monitoring it yourself."
What happens if your doctor/dermatologist thinks a mole is suspicious?
Typically they’ll discuss their thoughts with you and recommend a course of treatment. That might involve asking you to come back in a few weeks/months to see if the mole has changed. If the doctor suspects that the mole might be a melanoma, they’ll remove the whole thing (plus a border of skin around it, called ‘margins’) in an excision biopsy, then send the tissue to a pathologist to confirm a diagnosis.
If a mole is found to be melanoma, you’ll have a second removal procedure (called a wide local excision) where more ‘normal-looking’ skin from around the mole is removed, explains Lisa. "This is done to reduce the risk of the melanoma recurring. A pathologist will check the tissue for cancer cells until margins are clear. Depending on the melanoma, your doctor may recommend you have a sentinel lymph biopsy, too."
If you’re really worried about a mole but your doctor suggests monitoring it, can you request to have it cut out anyway?
"You can request it, sure. I don’t think I’ve heard of a situation where someone has asked to have a mole removed and the doctor has straight up turned them down. That said, sometimes the best advice really is to wait and monitor. I had a couple of questionable spots on the back of my calf last year and my doctor asked me to come back in 3 months to see if they had changed. When I went back, the spots had actually disappeared. Had I pushed to have them removed I would have had surgery for no reason."
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