Skin Cancer Screening: What to Expect
Did you know that one in every three cancers diagnosed is a skin cancer? There are between two and three million non-melanoma skin cancers and 132,000 melanoma skin cancers diagnosed globally each year, according to the World Health Organization.
And it seems that regardless of your location, these skin cancers are still a concern. According to the British Skin Foundation, at least 100,000 new cases of skin cancer are diagnosed in the United Kingdom each year. “Rates of malignant melanoma are rising faster than any other type of common cancer,” says Lisa Bickerstaffe, the foundation’s communications officer.
The Australian Institute of Health and Welfare estimated that 12,960 new cases of melanoma were diagnosed in 2015, while the American Cancer Society projected a whopping 73,870 new cases last year.
Some good news: the survival rate is extremely high if caught early. The average survival rate of those diagnosed with melanoma increased from 49 percent in 1950 to 91 percent today, according to the American Cancer Society. Regular checkups by a dermatologist are incredibly important – they can help catch any abnormalities, including early signs or symptoms of skin cancer before they become a serious problem.
If you’ve never had a skin cancer screening, the idea can be nerve-racking. Stripping down to your underwear and putting on a hospital gown is uncomfortable enough. But what happens if the doctor finds something abnormal? Knowing what to expect at a total body skin exam (TBSE) before you go can help reduce anxiety about your appointment. A TBSE is an examination of all of your skin, from your scalp to your toes.
“It can feel embarrassing for you to have all of your parts looked at,” says Tsippora Shainhouse, MD, FAAD, a board-certified dermatologist in Los Angeles and a clinical instructor at the University of Southern California, who performs at least 20 skin cancer screens every clinic day, “but it’s important to point out any new skin issues to your dermatologist. They look at unclothed bodies all day, and are comfortable looking at all body parts with a professional eye. If you feel at all uncomfortable, speak up.”
How to Prepare for Your Appointment
“If it’s the first time you have seen a particular doctor or dermatologist, make them aware of your skin history,” says Bickerstaffe. “And make sure you let them know if there’s a family history of skin cancer.” If you’ve had a previous biopsy, bring pathology records so the dermatologist is up to date on the site, diagnosis, treatment and approximate date.
What Happens At the Exam
You’ll be asked to fully undress and put on a standard paper gown, open in the back. “If you don’t want your genital area examined, you may leave your underwear on,” advises Dr. Shainhouse. “Many dermatologists will not automatically do a genital exam. If yours doesn’t, and you have a spot or bump that concerns you, do ask them to look.”
The entire exam shouldn’t take more than a few minutes. “Your dermatologist should use their naked eye, as well as a magnifying tool, such as a dermatoscope — a tool that can help differentiate benign (harmless) from malignant (cancerous) lesions — to examine the surface features more closely,” says Dr. Shainhouse.
“I start with the neck and chest, work my way down each arm, examine the abdomen and breast area and then examine the sides and back of the trunk. I look at the groin area, then the front of each leg, and then examine the feet, between the toes and the toenails. I then ask the patient to stand up, and I examine the backs of the legs, the buttocks and the waist area. I then examine the scalp by parting the hair all over. I examine the back of the neck and behind the ears, the sides and front of the neck, and finally, the entire face, including lips, tongue, ears and eyelids.”
Benign and Precancerous Spots
If you have any irritating, benign lesions, or surface pre-cancerous spots, they can be treated with liquid nitrogen (LN2). “LN2 is very cold and it’s used to frostbite the abnormal cells, so that they lyse (burst) and die and flake off,” explains Dr. Shainhouse. This process will be done on the spot: “The dermatologist will take a metal can with a tiny nozzle and spray the concerning spot for a few seconds; It will look white and icy. After letting it thaw for a few seconds, the process may be repeated, to make sure that the full-thickness of the cells are frozen,” she says. You’ll develop a blister or scaly spot within a few days, which will heal within a few weeks.
Removal of Suspicious Marks
If your dermatologist identifies a mark that may be cancerous, they will order a biopsy. “This takes a few minutes to set up and perform, and you’ll only feel the initial injection for the local anesthetic,” says Dr. Shainhouse. “First, a photograph of the lesion is taken to document the appearance and the site. Then consent is signed that you permit the lesion to be biopsied and sent to the pathology lab to make a slide for further evaluation…The site is then injected with a small amount of lidocaine with epinephrine; it will feel numb within seconds.”
There are two types of biopsies: a shave and a punch. “For a shave biopsy, a small blade is used to shave off the lesion. Aluminum chloride or electrocautery is used to stop any bleeding. Ointment and a Band-Aid are placed on the site and the specimen is placed into a labelled jar,” says Dr. Shainhouse. “For a punch biopsy, a tool with a tiny cookie-cutter end is used to cut out the lesion in question. After cleaning and numbing the area, the area is ‘punched’ out and one to two stitches are usually placed. These need to be taken out in seven to 14 days, depending on the site.”
Getting Your Biopsy Results
It can take up to two weeks for the dermatologist’s office to receive results from the lab. Some offices require that you return in two to three weeks to discuss your biopsy results, which doesn’t necessarily mean that further treatment will be required or performed on that day. Others will call patients with any result, benign or malignant, while some will call only for malignant lesions. So be sure to clarify what to expect with your dermatologist.
If cells are cancerous and “an excision is necessary, you will need to schedule that,” says Dr. Shainhouse. “It’s fairly similar to the biopsy procedure, but will require stitches, which takes a bit longer, so you will be scheduled for a longer, 20- to 30-minute visit.”
Checking Yourself At Home
Typically, dermatologists recommend scheduling a total body skin exam at least once a year if you have a first-degree relative who’s had skin cancer or you’ve had precancerous or cancerous spots yourself. But between appointments, you aren’t off the hook. The largest population-based study of melanoma patients in Queensland, Australia showed that when patients performed self-examinations, they had thinner melanoma tumors than melanomas detected accidentally.
“The best way to detect skin cancer is to check your skin regularly, about once a month. You should examine the skin all over your body, from top to toe,” says Bickerstaffe. “Ask a friend or family member to look at areas you can’t see such as your scalp, ears and back.”
What skin cancer symptoms should you be looking for? “Moles or patches of skin that are growing, changing shape, developing new colors, inflamed, bleeding, crusting, red around the edges, particularly itchy, or behaving unusually,” advises Bickerstaffe. “If in doubt, get it checked out straight away.”
Arm yourself with the right information and know what to expect when it comes to skin cancer screenings and regular checkups with a dermatologist. Find a doctor who you’re comfortable with, and keep up with self-examinations too – you’ll go a long way in protecting your skin and overall health.