Q.“I recently heard that skin self-examination and physicians’ full-body skin exams aren’t particularly useful for detecting skin cancers early and preventing deaths. Is this true? What should I expect if I go in for a full-body exam? How long does it take? Should I see a dermatologist, or can my family physician do this just as well?”
A. One recent study found that sufficient proof does not yet exist to prove that self-examination or whole-body skin exams reduce deaths from skin cancer. But simple common sense says otherwise: The earlier you find a skin cancer, the easier it is to treat successfully. Both skin self-examinations and professional skin exams are useful in early detection of skin cancers, including melanoma, the deadliest form of skin cancer. A study in The Journal of the National Cancer Institute, in fact, showed that skin self-exams could reduce the risk of advanced disease among melanoma patients and potentially decrease melanoma mortality by up to 63 percent. Physicians’ skin exams are likewise effective: The Journal of the American Medical Association reported that melanomas found by physicians tend to be thinner (thus at an earlier stage, and more easily cured) than those found by patients.
It is important to clarify the type of skin cancer you are referring to when discussing skin exams’ ability to prevent death. The most common skin cancer, with over a million cases diagnosed annually, is basal cell carcinoma (BCC). Basal cell carcinomas rarely metastasize (spread) and are unlikely to be fatal. Melanoma is less common than either basal or squamous cell carcinoma (the second most common skin cancer), but (when advanced), much more likely to spread throughout the body and lead to death. Therefore, it is essential to detect melanoma early, because the deeper the tumor grows, the worse the prognosis.
Dermatologists have special training that includes the diagnosis and management of skin cancers. When you see a dermatologist for a complete skin checkup, expect a 10-15-minute visit, including a review of your medical history and a head-to-toe skin examination. This is a good time to ask about any spots you are worried about; your dermatologist can educate you about what to look for, such as any changes in the size, color, borders, or shape of a mole. [Learn how to perform a skin self-exam.] Virtually any notable change in a mole should be checked out. Typically, a spot that the doctor suspects is cancerous will be biopsied. During a biopsy, a sliver of tissue is removed for evaluation by a pathologist, who confirms (or refutes) the dermatologist’s suspicions.At the least, your primary care physician should evaluate your skin during your annual health examination. If you have a question about your skin that he or she cannot answer, a referral to a dermatologist is appropriate. If you have a history of skin cancer or numerous moles, it is important to see a dermatologist for regular skin examinations at intervals ranging from three months to annually.