A good skin cancer screening is a head-to-toe look at your skin, including places that are easy to miss, such as your scalp, ears, between your fingers and toes, the soles of your feet and your nails. It should also include a review of your risk factors, a closer look at any spot that stands out, time for you to point out spots that worry you, and a clear plan for anything that needs follow-up. You should leave knowing when to come back.
Use the checklist below to know what to expect, and to judge whether a screening covered the ground it should.
Head-to-toe coverage
A full-body skin exam covers all of your skin, not only the parts that see the sun. You usually change into a gown, and the exam moves area by area. A thorough exam includes:
- Scalp (with the hair parted to see the skin), face, ears and neck
- Chest, belly, back and underarms
- Arms, hands, palms and between the fingers
- Fingernails and toenails
- Legs, feet, soles and between the toes
- Buttock and genital skin, with your consent
Skin cancer can develop in places that get little sun. The AAD notes that in people with darker skin, it can appear in areas such as the palms, soles, nails, inside the mouth and the genital area.
You stay in control of the exam. You can ask to skip an area, or ask the dermatologist to explain what they are looking at as they go. To make the exam easier, MedlinePlus suggests skipping makeup and nail polish and wearing your hair loose.
A review of your risk factors
A screening is not only about your skin today. The dermatologist should ask about things that raise your risk, because they shape what to look for and how often you should come back. MedlinePlus lists risk factors that include:
- A personal or family history of skin cancer
- Many blistering sunburns
- Frequent sun exposure or tanning-bed use
- Many moles, large moles or unusual moles
- Fair skin, light eyes, blond or red hair, or skin that tans poorly
- A weakened immune system
Having a risk factor does not mean you will get skin cancer. Having none does not rule it out, either. Skin cancer can affect people of every skin tone.
A close look at individual spots
After the overview, the dermatologist looks more closely at any spot that stands out. Many dermatologists use a dermatoscope for this: a handheld magnifier with a light that shows patterns beneath the skin's surface that are hard to see with the eye alone. If you are curious how a spot is being examined, ask.
The AAD's ABCDEs of melanoma are a common guide to what makes a spot worth a closer look:
- Asymmetry: one half does not match the other.
- Border: the edge is irregular, ragged or poorly defined.
- Color: the color varies, with shades of tan, brown or black, or patches of white, red or blue.
- Diameter: melanomas are usually larger than 6 millimeters (about the size of a pencil eraser), though they can be smaller.
- Evolving: the spot is changing in size, shape or color, or looks different from the rest.
That last point is sometimes called the "ugly duckling" sign: a spot that does not look like your other moles. Not every skin cancer is a melanoma, either. Basal cell and squamous cell carcinomas can look like a shiny bump, a rough or scaly patch, or a sore that does not heal, so a good exam looks at more than moles.
Time to raise the spots you're worried about
You know your skin better than anyone. A good screening leaves room for you to point out:
- Anything new since your last exam
- A spot that has changed, itches, bleeds or crusts
- A sore that has not healed
- Spots in places you cannot easily see yourself
Bring photos if you have them. Dated phone pictures make it easier to tell whether something has changed.
A clear plan for anything flagged: watch, biopsy or refer
Before you leave, you should know what happens next for each spot that got attention. Generally, a spot falls into one of these groups:
- Nothing needed. It looks harmless.
- Watch it. It does not need removing now, but it is worth checking again at a set date, with notes or photos to compare.
- Biopsy. A sample, or the whole spot, is removed and sent to a lab, where a pathologist examines it under a microscope.
- Treat or refer. If a biopsy confirms skin cancer, you will talk through treatment, which may happen in the office or through a referral.
Ask how and when you will get any biopsy results.
A recommended interval for your next exam
There is no single schedule that fits everyone. MedlinePlus notes that people who have had skin cancer usually need a yearly screening. For everyone else, the right interval depends on your own risk and what the exam found. Your dermatologist should tell you when to come back. If they do not, ask.
How a screening works at Bay Ridge Dermatology
Bay Ridge Dermatology offers full-body skin exams. Dr. Evangeline Perez is a board-certified dermatologist with more than 20 years of experience.
- The exam: a full-body skin exam, with time to raise any spot you are worried about. The what to expect page covers a first visit.
- Biopsies: if a spot needs to be checked under a microscope, shave biopsies are done in the office. See the practice's in-office procedures.
- Melanoma: melanoma is diagnosed in the office, and patients are referred to NYC cancer centers for treatment.
- Other skin cancers: when it suits the cancer, some non-melanoma skin cancers can be treated in the office without surgery, using electrodesiccation and curettage (scraping followed by an electric current) or a deep shave with topical chemotherapy. Bay Ridge does not perform surgical excision or Mohs surgery. If one of those is recommended, ask the office about next steps.
- Insurance: the practice accepts most insurances, including Aetna, BCBS, Cigna, United, Medicare, Oxford, Empire and Humana. Whether a screening is covered depends on your plan, so check with your insurer or call the office.
For more on who should be screened and how to check your skin at home, see our skin cancer screening guide.
When to see a dermatologist between screenings
Do not wait for your next scheduled exam if you notice:
- A new spot that looks different from your other moles
- A mole or spot that is changing in size, shape or color
- A spot that itches, bleeds or crusts
- A sore that does not heal
- A new dark streak in a fingernail or toenail
- A shiny bump or a scaly patch that does not go away
The AAD advises seeing a board-certified dermatologist about any spot that is new, different from the others, or changing, itching or bleeding.
Booking a screening in Bay Ridge
Bay Ridge Dermatology is at 515 84th Street, 1st Floor, Brooklyn, NY 11209. The nearest subway stations are 86th St and 77th St on the R train. If you are due for a skin check, you can book online or call (347) 497-4984.
This article is general information, not medical advice. For advice about your own skin, see a dermatologist.