You’re getting dressed for work when you notice a new mole. Although it doesn’t look like the photos you’ve seen of skin cancer, you’re concerned after remembering past summers when you weren’t as diligent as you could have been with sunscreen.
While that mole may very well just be a mole, it’s a good idea to get it checked out, says Debra Jaliman, MD, a board-certified dermatologist in New York City and the author of Skin Rules: Trade Secrets from a Top New York Dermatologist.
“Everyone should have an annual skin check once they reach adulthood,” Dr. Jaliman explains. “If you have a history of skin cancer or any suspicious moles or other spots, you should consult a doctor even sooner.”
Unfortunately, all skin cancers don’t look the same and while Dr. Jaliman recommends doing regular at-home self-examinations to look for skin changes like new spots or older spots that have changed or look unusual, it’s a good idea to get any suspicious spots evaluated by your healthcare provider.
Types of skin cancer
Many people don’t realize sun damage is cumulative and that skin cancer can take 20 years or more to develop. The good news is skin cancer is also largely preventable and if caught early, through regular skin checks, is usually curable. There are three different skin cancer types that are most common.
- Basal cell carcinoma (BCC) is the most common form of skin cancer and often presents as a flesh-colored growth, a pearl-like bump or a pinkish patch of skin, according to Adnan Mir, MD, a board-certified pediatric dermatologist in New York and a committee chair for the Society for Pediatric Dermatology.
- Squamous cell carcinoma (SCC) is the second most common form of skin cancer. Dr. Mir says this type of cancer can appear as thick, rough scaly patches that may crust or bleed. “Several studies have found that cutaneous human papillomavirus infection can increase the risk of squamous-cell carcinoma,” Dr. Mir says, adding that this is another reason for parents to consider getting the HPV vaccine recommended for pre-teen boys and girls.
- Melanoma is the most serious form of skin cancer and men are more likely than women to die of melanoma, making regular skin exams critical for men who spend a considerable time outdoors. While the majority of melanomas are brown or black, some can present as pink, tan, or white.
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Who is at risk of skin cancer?
Skin cancer can affect people of all ages and ethnicities. Many people mistakenly believe if they tan and don’t burn that they’re safe from skin cancer, but Dr. Jaliman cautions that UV radiation from sun exposure damages the skin even if you don’t turn red and peel. There are some factors that put people at a greater overall risk of developing skin cancer.
Fair skin is the greatest risk factor of developing skin cancer. However, anyone can develop skin cancer, regardless of their skin color. “Although people of color are at a lower risk of developing skin cancer, if they are diagnosed with skin cancer, it’s often at a later stage because the symptoms are hard to recognize,” Dr. Mir says.
When skin cancer does occur in people of color, it often develops in areas such as inside the mouth, under the nails, palms of hands and lower extremities.
A relative with skin cancer
“Genetics and family history play a role and can increase your risk especially if you have a family history of melanoma, the most serious form of skin cancer,” Dr. Jaliman says. “Families tend to have similar skin types, which may increase your risk of developing a skin cancer if you have a strong family history of malignant melanomas.”
Age and gender
According to the American Academy of Dermatology Association, men over 50 also have a higher risk of developing melanoma than women.
Excessive time spent in the sun
“If you have had sunburns, lasting damage remains from even just one sunburn and puts you at risk,” Dr. Jaliman says. “Spending large amounts of time out in the sun without sun protection also increases your risk.”
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What to expect during your annual skin check
Just like visiting your primary care provider for an annual physical and your dentist to have your teeth cleaned and evaluated, you should also schedule an annual skin cancer screening. These full body exams are performed either by dermatologists or in some cases, by primary care providers as part of your annual physical.
Since most skin cancers are treatable with early detection, it’s important to get annual skin exams and to also consult your healthcare provider when you find a suspicious skin lesion.
“People often delay getting a skin check because they don’t have the time and also view other medical appointments as more important,” Dr. Jaliman says. “Many also mistakenly believe they aren’t at risk of developing skin cancer, but anyone who has spent considerable time in the sun is at risk.”
At your annual skin exam, your provider will thoroughly check your skin from your scalp to your feet, looking for any spots that may be itching, changing, or bleeding.
If your healthcare provider suspects any signs of skin cancer, you might need a skin biopsy. Your provider will use a local anesthetic to remove a portion of the tissue to be examined under a microscope. Results are typically available within a week and will show whether or not the lesion is benign or cancerous and if so, what type of skin cancer.
Insurance coverage for annual skin exams
Depending on your health plan, you may need to see your primary care provider first in order to get a referral to a dermatologist. With the introduction of telehealth, many primary care providers can now take photos of a patient’s suspicious lesions and forward them to a dermatologist for a consult. In the event the dermatologist suspects skin cancer, a follow-up appointment will be scheduled for further evaluation and a possible biopsy.
For those on Medicare Part B, dermatology services may be covered if deemed medically necessary for a condition. This might involve having your primary care provider evaluate any suspicious lesions first, before referring you to a dermatologist. Some Medicare Advantage plans offer additional coverage for dermatology services.
Skin checks for kids
While skin checks are recommended for adults, sometimes kids and teens need exams too, says Dr. Mir.
“Parents of children with a lot of moles should do self-exams and make an appointment with a pediatric dermatologist if they find moles that appear different than other moles or that meet the ABCDE criteria: Asymmetry (one half of the mole doesn’t match the other), Border irregularity, Color that is not uniform, Diameter greater than 6 mm (about the size of a pencil eraser), and Evolving size, shape or color.”
When getting a skin check, Dr. Mir says healthcare providers can also address other common skin conditions in children and teens including eczema, acne, and psoriasis.
“New prescription treatments in these areas work really well, so if a parent finds their child’s eczema or acne is responding to over-the-counter medications, we can prescribe something that’s more effective,” Dr. Mir says.
How to check for skin cancer at home
The American Academy of Dermatology recommends conducting skin checks at home once a month. While some people have found success in using skin cancer apps such as UMSkinCheck, MoleMapper, Miiskin, MoleScope and SkinVision to help them to identify potential skin cancers, a study published in the BMJ found these apps have a lack of testing to verify their effectiveness, a shortage of expert input when developing the technology and issues with the technology itself.
Rather than relying on technology that might not provide accurate results, Dr. Jaliman recommends performing self-checks at home and alerting your healthcare provider if you have any suspicious findings.
“During a self-exam, people want to look for changes in moles such as large diameter, asymmetry, an irregular border and various shades of color,” Dr. Jaliman says.
The American Cancer Society recommends standing in front of a full-length mirror in your home to perform a skin self-exam. Use a hand mirror or ask a spouse, friend or family member to check hard to see areas such as the back of your thighs.
Skin cancer prevention
There is no safe tanning technique and Dr. Mir recommends that children, teens, and adults all use a broad-spectrum mineral sunscreen when outdoors.
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“These sunscreens use zinc oxide or a combination of zinc and titanium oxide to block UV light,” Dr. Mir says. “It’s also important to remember to reapply sunscreen every two hours.”