THE HOWS AND WHYS OF SKIN CHECKS
THE HOWS AND WHYS OF SKIN CHECKS WITH DR. NAKHLA
The board certified dermatologist answers all of our questions about this critical cancer screening.
- Written by:
- Lena Raff
Let us be clear: skin checks are a vital way to care for your health. Just as you would get regular pap smears or colonoscopies, this appointment with a board certified dermatologist can catch, and therefore, prevent dangerous cancers like melanoma. So why don’t more people get them? Our theory: fear of the unknown. Lucky for you, the experts here at VIOLET GREY have the board-certified dermatologist and dermatologic surgeon (not to mention founder of the bestselling brand Eighth Day) Dr. Antony Nakhla on speed dial, and he was kind enough to answer all of the questions you’ve been too afraid to ask, so that you can feel prepared and informed when walking into this oft-neglected and incredibly important appointment.
VIOLET GREY: How do I prepare for a skin check? Can I see the same doctor who does my botox?
DR. ANTONY NAKHLA: First and foremost, be sure to make an appointment for a skin cancer screening with a board certified dermatologist or a licensed medical practitioner in a dermatology practice with a supervising physician that is board certified in dermatology. Beware that not every doctor who claims to be a skin expert is, in fact, an expert. Of all specialties in medicine, skin expert posers are the most common. This occurs in both the cosmetic/beauty realm and medical realm of dermatology. Dermatology is the gold standard specialty devoted entirely to the study of the diseases and health of human skin, hair, and nails. While your aesthetician, plastic surgeon, primary doctor, or OB/GYN are professionals in their own respective fields, these are not skin experts and all are entirely unqualified to provide dermatological advice or perform a thorough skin cancer screening. With all of the nuance and detail involved, trust no one other than a board certified dermatologist.
VG: Is it okay to wear makeup to a skin check?
DAN: No, we need to be able to see your skin. You should remove all makeup prior to your visit and avoid self tanners as well.
VG: What exactly are you looking for during the exam?
DAN: Your dermatology practitioner is looking for lesions that are new to you or have changed, so first alert them of anything that has recently shown up on your skin, increased in size, is bleeding, painful, or irritated. The practitioner will look for certain subtleties that fall under the "ABCDEs of melanoma":
Asymmetry (if you draw a line through a mole, does it fold perfectly in half?)
Border irregularity (jagged edges)
Color (dark brown, black, multicolored)
Diameter (greater than 5mm or the size of a pencil eraser)
Evolving - a spot that is changing in size, shape, or color
VG: Will I have to be naked during the exam?
DAN: Yes, you will be naked, though your medical provider may provide a garment or gown. You also may decline certain areas to be examined, although it is not advised to do so. Skin cancer can occur anywhere, including on genital skin, in gluteal folds, in between toe webs, etc. so you will want the assessment to be thorough.
VG: How often should I be getting skin checks?
DAN: Depending on your personal and family history, this may range from once a year to once a quarter. People with many multicolored moles and those with a family history of skin cancer are at higher risk and should be checked more often. Everyone should be checked at least once a year to make sure nothing has changed and that they remain healthy.
VG: What are some unlikely places I should look for cancerous moles? Are there places women in particular should look?
DAN: The lower extremities are particularly important for younger women, so be sure to look closely there. Partners can examine one another's backs and hard-to-see areas like the scalp—it’s good to be as thorough as possible as these moles can emerge anywhere on the body.
VG: Will you be able to tell me on the spot if a mole is cancerous?
DAN: Sometimes yes, but most often no. The screening process is to assess suspicion, which is followed by a definitive biopsy.
VG: Is it painful to have a mole removed or biopsied? What is the recovery process like?
DAN: It is typically not painful. Local numbing is used to take a skin biopsy, so the only pain is from the lidocaine injection, after which there is no pain or recovery time. The two main types of biopsies are either shave biopsies, where the skin is tangentially shaved, which results in a scab, or a punch biopsy which uses a small cookie cutter type of instrument and requires a stitch once the plug of skin is removed.
VG: Do potentially dangerous moles look different on different skin tones?
DAN: There is nuance in evaluating different skin tones in dermatology, and yes, different conditions appear differently on varying skin types. For example, the most common subtype of melanoma seen in Black or Asian skin occurs as a sunspot on the palms, soles, and fingernails. It is extremely lethal, and often goes undiagnosed since many people with darker skin types believe they are not at risk for skin cancer. This melanoma type, called acral lentiginous melanoma, happens to be the type of cancer that Bob Marley died from.
VG: Is skin cancer genetic? Is someone at higher risk if they have family history?
DAN: Yes, there is a strong genetic association with all skin cancers and UV damage. For melanoma, the more deadly skin cancer, genetics alone play a role in addition to UV damage, which is why melanomas can occur in areas that have had very little sun exposure. People with a family history of skin cancer, especially melanoma, should be particularly careful about sun protection and make sure to be diligent about skin checks.
VG: Can I do my own skin check at home? What should I keep an eye out for between checks?
DAN: Performing a self exam using the ABCDE method I mentioned previously is recommended in between appointments with a dermatologist so you can stay aware and notify your doctor of any changes or areas of concern.