Have you ever had your skin checked by a dermatologist? With summer wrapping up and another year of high-intensity Florida sun in the books, now is probably the right time. But what exactly is a skin check? Who needs one? How often? And what actually happens in that exam room? Those are the questions I want to answer in this first column.
A skin check — technically, a skin cancer screening — is the bread and butter of dermatology. It is a full evaluation of your skin, the largest and (in my admittedly biased opinion) most important organ in your body. Your skin is a canvas of your life experiences and a window into your internal health. Most patients come in to be checked for skin cancer, but here is what many do not realize: while I am looking for cancer, I am also assessing for other chronic or acute skin conditions you may not even know you have. To a dermatologist, that part is second nature.
The visit itself
A visit starts like any other doctor’s appointment. You check in, wait to be called, and get placed in an exam room. In my clinic, a medical assistant brings you back and documents the findings during your exam, which lets me stay focused on the task at hand: your skin. Before the exam, the medical assistant will ask about your skin cancer history, your family history and other pertinent information. Then they will ask you to undress to at least your undergarments. Skin cancer can hide anywhere, even though it is far more common in sun-exposed areas.
Once you have had time to change, I knock to make sure you are ready before I come in. If you are a new patient, I introduce myself, answer any questions and begin the exam: a head-to-toe look at your skin, searching for anything that is not “normal.”
So what counts as normal, and what counts as abnormal? Honestly, that is what thousands of skin checks and years of residency and experience train you to recognize — and it is a topic I look forward to covering in future columns. The most concerning abnormal finding, of course, is skin cancer, of which there are several types (another column for another month). But what happens when we find one?
The biopsy, demystified
When we find a spot we suspect is skin cancer, we biopsy it — meaning we either shave off or “punch out” a small piece of skin. That may sound gruesome, but it is a minor procedure. First, we numb the area with local anesthetic, the same kind of shot the dentist gives you before filling a cavity. I always tell patients it is less painful than the dental version, though I will admit that may just be my own bias — I do not like dentist visits.
Once the skin is numb, you cannot feel pain. You might notice a dull pressure, but never anything sharp — and if you do, tell us. We can always add more numbing medicine. Then we remove the suspicious piece of skin. With a shave biopsy, we use a chemical solution or cautery to stop any superficial bleeding and the spot heals on its own in about a week. With a punch biopsy — named because the instrument works like a tiny hole punch, removing a small plug of skin — you may need a stitch or two, and a quick return visit to have them removed.
How often do you need one?
The frequency of skin checks depends on many factors: Have you had skin cancer before? How long ago? What does your skin look like? The general rule of thumb is once a year, but consider two patients at opposite ends of the spectrum.
The first is a 30-year-old man with no personal or family history of skin cancer. He tans easily, has never burned and has no moles (or nevi, as we call them). His risk over the next year or two is low enough that I am comfortable seeing him every two to three years — unless, of course, something changes or a new spot concerns him.
The second is a 75-year-old woman with a history of three basal cell carcinomas (the most common skin cancer) and three squamous cell carcinomas (a higher-risk type). She has fair skin that always burns, and she grew up in the era before sunscreen was widely available — when the beach routine was iodine and baby oil for a better tan. She needs a skin check every six months.
Most of us fall somewhere in between. The bottom line: there is never a wrong time to get a skin check, especially if you have never had one. And if you have a new or changing spot on your skin, please see a dermatologist — sooner rather than later.
Have a skin question you would like answered in a future column? Send it to skindermatologypv@gmail.com and it may appear in this space.
Mitch Brady, DO, is a dermatologist in Ponte Vedra Beach.
