If you've never had a professional skin exam, you're not alone — most adults haven't. But once you're in your thirties, the math starts to matter. Skin cancer is the most common cancer in the United States, and the vast majority of cases are highly treatable when caught early. A yearly twenty-minute visit is one of the best returns on health time we can think of.
What we actually do during a screening
A full-body skin exam is exactly what it sounds like — head to toe, with the gown moved in sections for privacy. We look at every area of skin, including places you can't easily see yourself: scalp, ears, between fingers and toes, the backs of your legs. Most appointments take 20 to 30 minutes.
For anything that warrants closer attention, we use a dermatoscope — a small handheld magnifier with polarized light. It lets us see structures inside a mole that aren't visible to the naked eye, which dramatically improves accuracy. If something looks atypical, we'll talk about whether to biopsy it now or photograph it and check again in a few months.
The ABCDEs (and why most patients overweight one of them)
The classic teaching for spots to watch yourself is ABCDE: Asymmetry, Border irregularity, Color variation, Diameter larger than a pencil eraser, and Evolution — change over time. Of these, Evolution matters most. A mole you've had since childhood that hasn't changed is rarely concerning. A new spot that's grown, darkened, or started bleeding deserves a same-week appointment.
Who should be screened, and how often
- Every adult past 30, at least once — to establish a baseline.
- Annually if you have fair skin, freckles, or a family history of skin cancer.
- Annually if you've had any prior skin cancer or atypical moles.
- Annually if you spent significant time in the sun unprotected before age 25 — yes, this means most of us.
- More frequently for transplant recipients and others on immunosuppressive medications.
Between visits
Once a month, do a quick self-check after a shower while you're toweling off. You're looking for anything new, anything changing, or anything that doesn't match the rest of your moles. Phone photos are great — they make month-to-month comparison possible. If you have a partner, check each other's backs.
Daily SPF 30+ on exposed skin, year-round. Yes, even on cloudy New York days. Yes, even if you're mostly indoors — UVA passes through window glass. This is the single most effective thing you can do to reduce your risk.
The bottom line
Almost every skin cancer we catch in our office is something the patient didn't notice or assumed was nothing. That's not a failure on their part — most concerning spots look completely innocuous at first. That's the entire point of having someone trained to look. Twenty minutes a year is a small thing to give for that kind of peace of mind.
