What to expect at a screening for skin cancer

What to expect at a screening for skin cancer

When detected early, the five-year survival rate for melanoma is 99 percent. That's why William Fiske, MD, a Yarmouth-based dermatologist, recommends regular skin cancer screenings.

"You can make the argument that a good candidate is someone with a significant history of sun exposure or someone who has a family history of melanoma, but anyone who's concerned about their health is a good candidate for skin screening," he said. "Anyone can get skin cancer."

Another way of looking at it is "if you're checking your skin and notice changes, then you should have a screening," he said.

Start with Self-exams

It's important that people look everywhere on their body, said Dr. Fiske.

"You can get melanoma in places that have not had sun exposure - between the toes, in the groin; really everywhere. That includes places you can't easily see yourself, like your back, so if there's a spouse or family member who can help, that's wonderful. If you don't have anyone who can help with those areas, use a full-length mirror and a hand mirror, and do your best."

"If you have a cluster of moles, don't try to memorize it. Take a picture and the next time you're looking at yourself, compare things. If there's something different, you'll pick it up right away."

If you're familiar with your skin, you're more likely to quickly notice changes, he said.

Warning signs to look for, according to Dr. Fiske include:

• A new mole or new growth.
• A sore that doesn't heal, which could be in the mouth, on your arms, on the bottom of your foot, wherever. The late Reggae singer Bob Marley died from melanoma that metastasized from his big toe to the rest of his body. "Anything that's new or changing, you'd want to zero in on."

If you find something concerning, see your primary care provider.

"They will have an idea if something's worrisome or not," Dr. Fiske said. "I see thousands of benign growths a day that might look very scary to a lay person."

Your primary care provider can refer you to a dermatologist if further screening seems appropriate.

What to Expect at a Screening

After you change into a gown in a dermatologist's exam room, the doctor and a physician's assistant will look over your entire body. "They're going to look over every square inch of skin, and there are approximately two square yards of skin in total," he said. "You should certainly expect a skin exam will encompass pretty much the entire skin surface, including under the arms and between the toes. It doesn't take long." Dr. Fiske starts with the scalp and works his was down to the feet. "No one's going to make anyone expose an area they don't want to, such as the groin, so some people will have a modified exam. Whatever the patient decides is honored.

Dr. Fiske said it's recommended that patients have a complete skin exam top to bottom once a year. "That's what I do for my patients," he said.

A first visit to a dermatologist does not necessarily always include a skin exam. "I want to meet you first just for comfort, so I get to know you a little bit," he said. "We will talk about specific problems you've had or any concerns you have. The skin exam may not occur on that first visit. Because it is kind of a sensitive exam, many doctors will want to do that on the second visit."

He recognized that many patients don't know what to expect and might feel a little afraid.

"That's why I use the time on the first meeting to really get a sense of how much at risk you are, what your sun exposure history is, what your habits are. For example, are you someone who goes down to Florida every winter?"

"Then I usually spend a lot of time talking about what being careful about the sun exposure really means, what sun protection really means. It's not just putting sunscreen on every morning, so that's usually a detailed conversation."

How to Protect Your Skin

Dr. Fiske is blunt about skin protection.

"One person in five is going to get skin cancer," he said. "The frequency of that is going up steadily and that's entirely a function of sun exposure. I make a strong push for zero tolerance for sun exposure, really trying to cover up as much as possible. Sunscreen's useful more as a backup than as a primary defense."

Dr. Fiske recently conducted a virtual event where he talked about the importance of screening and other aspects of skin care. He also talked about what he does to protect his skin while on vacation in sunny places. You can watch a video of the event here.