Start the new year with a skin check

I hope everyone is having a safe and festive holiday season. With healthfulness being the laser focus the past two years because of the COVID-19 pandemic, taking care of ourselves continues to be at the forefront of ways to combat both the physical and mental toll the past 24 months have put on the world. Selfcare can mean a lot of different things but today I want to talk about selfcare in the sense of making sure to schedule your full body check (also called scan) at your local dermatologist.

Now, before I jump into this any further, I want to stress that I am not a doctor and this information is for awareness purposes, only. It is not intended to diagnose or treat any conditions, and should not be considered medical advice. You should always check with a board-certified dermatologist or general practice doctor with any health-related questions or before starting any medications or supplements. You should also follow the CDC COVID-19 and office rules, recommendations and regulations regarding the safety and availability of dermatology appointments during the pandemic.

Okay with that out of the way, let’s hop to it.

Before your skin check

For the sake of this post, anything on the skin will be called a lesion (vs. mole, pustule, etc).

Sun hat + shirt = great

For someone that does not have a history of atypical lesions or cancers, the going rate for a full body check appointment is once every 1 or 2 years depending on different variables. This means that it is very important for you to pay attention to your own skin and be prepared to talk about it. Appointments can be quick, so have a game plan in place of any areas of concern you have. This means looking in places you might not think such as under breast folds, in the hair (particularly for men or women with thinning hair), on the buttocks, or other hard-to-reach places. Since the getting ever-so-much-smaller tiny bikinis and going au naturale in tanning beds, more and more lesions are popping up in places which used to be shielded from the sun. Lesions have been found by stylists doing haircuts, estheticians performing facials and waxers who might uncover a spot during waxing appointments which can be so helpful in the early detection of something that needs to be checked out; someone that sees you monthly (and in sometimes compromising positions) may see a new spot or change you wouldn’t have noticed. It is important to note that atypical lesions can be caused by more than just the sun. Changes in nails, inside of the mouth and other places the sun doesn’t typically shine can produce strange lesions that need to be checked.

What are you looking for?

It is important to know that what you’d imagine is a funky looking mole is not the only thing of interest to a dermatologist. Melanoma is considered the most deadly and is probably the most well-known type of skin cancer (although the least common). There are other types of cancers and lesions. Basal and squamous cell carcinomas are two very different looking and behaving types of skin cancers. Actinic and seborrheic keratoses are also common lesions that could indicate something down the line may go awry. Autoimmune diseases such as lupus can manifest on the face in a butterfly-looking pattern. Hyperpigmentation can be an indicator of too much sun exposure which could lead to problems in the future. Lesions of concern can be scaly, crusty, oozing, pigmented, deep, quickly changing, infected or painful. Or, they can look relatively harmless. They can be raised on top of the skin, under the skin (like a lipoma), or flush with the skin.

In short, when in doubt, talk to your medical professional. This list is not inclusive and to further hammer the fact that I am not a doctor and this post is not diagnosing, I am purposefully not including photos here, but encourage you to schedule your exam, talk to your doctor and do your research.

Know and practice your ABCs….DEFs.

A – Atypical. Does your lesion just look funny? Is it an ugly duckling that is easily picked out from the rest? Does it have a strange color or pattern?

B – Border. Does your lesion look like a defined round or oval shape, or does it have undefined or squiggly borders? Does it morph into another lesion?

C- Color. Is your lesion one solid color or does it contain multiple colors? Does it look similar in color to other lesions on your body? Are the colors changing over time?

D – Diameter. Is your lesion larger than the size of a pencil eraser? Has it grown from barely visible to DEFINITELY THERE in a short period of time? Is it a larger lesion you haven’t had all your life?

E – Evolving. This is important regardless of size but also takes into account the quickness of the change. Have you had this lesion all your life and it has changed a little in 25 years? Did it start out as a bump but now is crusty? Does it keep coming back and now doesn’t heal, or starts to bleed? Did it grow quickly?

F – Funny. Back to my earlier paragraph, if it looks or acts weird, is in a spot that bothers you (e.g. your bra strap rubs on it and causes you discomfort), or is just causing you concern, bring it up.

What is a full body check (or scan)

A full body scan is just that. While the process can vary slightly, you’ll be asked to undress and get into a fabric or paper gown. A team member or the dermatologist will visually scan your body for any areas, moles, patches or discoloration that could cause concern (this may also mean in areas you’ll want to be prepared for). Family history, Fitzpatrick type (1 being the fairest and most sensitive skin to the sun and 6 being the darkest), age, where you live, lifestyle, and medical history all are taken into account when doing a scan.

If something of concern does show itself the dermatologist will use a dermatoscope, which looks like a magnifying glass, to more closely look at the lesion. From here they can see indications of a benign lesion, or possible signs that point to it heading into the atypical range. Anything that indicates atypical will generally come with the recommendation to be biopsied and further investigated. A dermatoscope is a helpful tool, but cannot diagnose a lesion 100%.

What is a biopsy?

A biopsy is when the dermatologist or team member takes a sample of tissue to be viewed at the lab to determine if the cells are normal or atypical. Generally the first stop is a shave biopsy. Your practitioner will numb the area and use a small dermablade to remove the top layers of the lesion to have it tested over the course of a few weeks and usually gets a bandaid, or a small stitch or two at most. Punch biopsies are also possible.

If the results from the lab come back as atypical, your dermatologist and pathologist will determine just how atypical is it. Is it something to keep an eye on? Or is it heading towards a more severe case of atypia.

If the decision is that it is atypical enough to need to come out, the next step is usually an excision. An excision is done with local anesthetic in-office and is a deeper cut, typically involving stiches. This deeper removal helps to better understand how far and wide the lesion is. Sometimes it was just a little spot and the excision got it all, which is called “clear margins.” Sometimes there is more left, or it was deeper in the skin than the eye could see. Sometimes it comes back as more severely atypical and needs either another excision (called a re-excision), or Mohs surgery. The pathologist and your dermatologist will look at the cells and margins to determine the best next steps.

What if something comes back atypical?

As mentioned, your dermatologist will speak with you about options. There are a variety of topical and surgical options. A popular treatment for cancerous lesions is called Mohs surgery. This involves an in-office procedure which removes minimal amounts of tissue over what is called “stages.” It is similar to an excision, but the tissue is processed in-house at a lab in about 45 min- 1 hr to determine if margins are clear, or if more needs to be taken. The goal is to be conservative and is not unusual to go multiple stages until everything is clear. Your Mohs surgeon wants to preserve as much skin as possible, while making the incisions work with the contours of the area they’re working on to provide the best aesthetic and functional results possible.

Not all dermatologists are Mohs surgeons. Infact, most aren’t. So while biopsies may be within your dermatologist’s wheelhouse, once it becomes Mohs they may refer you to a Mohs specialist. Sometimes Mohs surgeons will also work with plastic surgeons as a team when working in particularly complex or delicate areas. Expect a long day so bring snacks, reading materials, and patience with you for a day of Mohs. With a skillful surgeon, a diet high in protein and vitamin C, proper environmental protection, following your doctor’s protocol and taking it easy, wounds can tend to heal really well into scars that are hardly visible.

In closing

The best thing is prevention. SPF, a healthy diet, hats and long sleeves, facial treatments and products to nourish and protect the skin are all important allies to skin health. However, not all troublesome lesions are caused by sun exposure. Getting checked on a regular basis is a good way to keep a pulse on how things are going, and to get ahead of anything that may be worrisome. With so many options, the good news is that when caught early, outcomes can be very favorable. It is said that it takes about 20 years for sun damage to really start to show itself. I’d say this makes sense, as I was a sun worshiper in my 20s and now find new hyperpigmented spots all the time.

All skin types can get skin cancers. While darker skin with more melanin may be at less risk than the fair skin/light-eyed Fitzpatrick 1 patients, it can still happen. So do yourself a selfcare favor in 2022: do a personal assessment for your own skin health to see where you’re doing great and where you could improve, and schedule your scan with your local dermatologist.

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