Is it worth it having a skin check?

Australians have one of the highest rates of skin cancer in the world.

The rate of melanoma has increased from 54 people per 100, 000 to 69 people per 100,000 between 2000 and 2023. 

Melanoma is the 3rd most common cancer diagnosed in Australia and the 11th highest in terms of mortality.

(Cancer Data in Australia,  31/08/2023, AIHW, https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/contents/rankings).

Like any cancer the sooner it is picked up the more likely a treatment will be curative. 

Skin cancer is unique in regards to the fact that it can be detected with non invasive methods. 

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When and how often should I have a skin check?

Currently there are no standardized recommendations for skin cancer screening in Australia unless you have previously had a skin cancer. 

General consensus is that under 18 a skin check should only be undertaken if there are concerns about a specific skin lesion, although if there is a family history of melanoma at an early age it may be advisable to have regular skin checks. Early melanomas can be indistinguishable from normal growing naevi (mole) early in their growth cycle, if there are concerns about a melanoma in a child it is recommended that they are reviewed by an experienced skin doctor. 

Over 18 and up until around 40 naevi (moles) and freckles will grow as normal. In this age group the recommendations will depend on skin type, number of growing naevi, signs of atypical growth, degree of sun exposure and evidence of photodamage to the skin. 

Over 50 generally the recommendation will be between 1-5 years (1-2 more common) and again it will depend on risk factors and appearance of the skin. 

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I have a lesion of concern but I have a skin check booked in 3 months, should I see a doctor earlier?

If you develop a skin lesion which is growing rapidly, bleeding, uncomfortable when touched, changing in shape, colors becoming more irregular or is nodular in shape, don't wait for your next skin check, have the lesion reviewed as soon as possible. 

If you have anything growing rapidly on your ears or lips please see someone urgently. 

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Who should I see for a skin check?

There is not a minimum legislative standard for doctors conducting skin cancer checks.

The general recommendation would be that you see a doctor who is experienced in the use of a dermatoscope, which is a specialized microscope which allows the user to see through the superficial layers of the skin.

It is advisable to see a doctor who has achieved their fellowship with either the Collage of Dermatologists(ACD), Royal Australian Collage of General Practitioners (RACGP) or Australian collage of Rural and Remote Medicine (ACRRUM).  In the case of the RACGP or ACRRUM the amount of skin cancer training is quite variable and further post fellowship training is beneficial, this should be in the form of a certificate or masters qualification and/or time spent working with a more experienced skin doctor. 

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What should I do to prepare for my skin check?

Prior to having your skin check it is advisable to remove any false nails and nail polish. 

Avoid a fake tan ideally for at least 1 week prior.

Let the doctors know if you have had any laser to your moles or previous radiotherapy. 

Bring all of you previous pathology reports from skin biopsies/excisions if possible.

Ask your family if they have ever had skin cancer and what type. 

If you have a loved one who is concerned about a specific lesion that you can't see, ask them to circle it on the day of your skin check. 

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What is involved in a skin check?

A full skin check involves a head to toe examination, including the scalp, mouth and toes. You can choose to opt out of any part of the examination, however, while skin cancer is more common on sun exposed areas it can occur anywhere where you have skin including under the nails, in the backs of the eyes and in the gastrointestinal system. 

Brest and genital examinations are offered.

It is recommended in addition to a full skin check that you also have regular dentist and optometrist reviewed including a retinal examination. 

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What about digital skin checks?​

Mole mapping and full body photography are still controversial within the skin cancer community. There are currently studies being conducted into their usefulness and also the use of AI to detect skin cancers. 

From personal experience they can be a useful adjunct in the early detection of melanoma. They are less effective in the detection of BCCs and non pigmented melanoma's. If you do have this imaging the images should be taken by a melanographer, they should have a certificate of dermoscopy. Your images should be reviewed by a suitably qualified doctor,  it is ideal that you meet the doctor who is reviewing your images and they have the opportunity to review skin lesions of concern. If you have lesions of concern which aren't imaged during the imaging process it is quite acceptable to request the doctor review the spot you are worried about. 

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I've been asked to come back in less than a year for a repeat appointment, is it really that important to come back that quickly?

​Yes, dermoscopy  is not an exact science, sometimes the decision is made to follow up lesions with atypical features rather than proceeding to a biopsy. When an early review is recommended your doctor will generally discuss with you their reasons for recommending a review over a biopsy. While biopsy may not always be recommended for a skin lesion it is always an option. ​

If the doctor has asked you to come back in less than 12 months this is an important appointment to keep because you have a lesion with atypical features which may be a skin cancer and a delay may have an impact on what type and the extent of treatment that you need.

Generally for red raised lesions the recommendation is a review in 1 month. 

For pigmented lesions the recommendation is a review in 3 months. 

You can come back sooner if the lesion is growing or you are concerned. 

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Can I ask for a second opinion?

Yes, you always have the right to ask for a second opinion or for further explanation from the original doctor. Skin clinics can have several doctors and the doctor completing the skin check may in some circumstances ask for a second opinion themselves, especially if the lesion has an atypical appearance. 

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I've had a spot on my face for years, I've seen a new doctor who has recommended a biopsy and its come back as a skin cancer, why has it been ignored by the other doctors I've seen before?

Skin lesions can change over time, and sometimes a skin cancer can grow in close proximity to a benign lesion. Early skin cancers can look like benign lesions. Sometimes precancerous sun damage can suddenly progress to a skin cancer rapidly. In this sort of situation its better to focus on how to manage the current skin cancer and on screening for future cancers.