Jennifer Goldwasser, MD
Full body skin examination: who, what, and when?
The US preventive services task force determined a few years ago that skin cancer screening exams were no longer recommended. At that time, they requested input from dermatologists, and I wrote to say that I have found full body skin exams to screen for skin cancer to be highly valuable in select populations. After all, it's better to be looked over than to be overlooked. So much for my opinion! Sadly, blanket statements are standard when it comes to government health recommendations. Individual risk factors vary widely for skin cancer, and I'd like to share my viewpoint on this with you.
Most skin cancer patients have at least some of these identifiable risk factors: light skin, a history of (occupational and/or recreational) overexposure to sun/light, many/unusual moles, a prior history of skin cancer or "pre-cancer", a genetic propensity, or immunosuppression (from medication or from certain common diseases like CLL). For most of my Westchester patients, periodic professional examinations are advisable, in my opinion.
So what is a full body skin exam, exactly? In my office, the protocol is to ask the patient to disrobe entirely, and to provide the patient with a cloth gown. It is best if the patient comes without makeup, hairpieces, hairspray, bulky jewelry, or nail polish. This allows visualization of the entire skin surface, from head to toe. I encourage my patients to point out areas of concern. This is no time for modesty--no body part is off limits. I wear magnifying headgear, and often take photos of individual lesions or areas of the body. The inspection is non-invasive, carries virtually no risk, and takes only about 10 minutes, usually. I routinely discover skin cancers that the patient had not noticed. Early detection of skin cancer impacts prognosis greatly.
How often should a full body skin exam be conducted? That varies greatly. I see some patients who are so low-risk, I feel comfortable simply recommending that they self-examine regularly, and ask their primary care physician to examine their skin annually. Most of my patients visit me annually for a full body skin exam, but some high-risk patients may come as often as quarterly. Self-exam is always advisable, and instructions on how to perform a self-exam are here:
You can use the change of seasons as a reminder to take 5-10 minutes to look yourself over. The first day of spring is almost here!