I see many skin concerns, perform many surgical and cosmetic procedures. But one of the most common appointments involves checking a concerning lesion, or performing a “total body skin exam.”
It is very common to my profession, but most people do not really know what to expect when their health care provider, hairdresser, friend or other loved one, encourages them to “get that checked.” (It never ceases to amaze me how many skin cancers were first spotted by the hairdresser!)
If it is a new patient appointment, the check-in will involve gathering general medical/surgical background information. I am especially interested in things like family history of melanoma, history of tanning bed use, history of second degree (blistering) burns - especially prior to adolescence. These things all significantly inform the likelihood of a person developing melanoma at some point. In fact, I heard at one dermatology conference that if an individual has two immediate relatives who have had melanoma, and that person has more than 100 moles, that it is a statistical inevitability that they were develop melanoma at some point in their life! On the other hand, I have personally diagnosed and treated melanoma in several patients with no family history of melanoma, no significant sunburns, and no prior tanning bed use, so my preference is to be proactive in having a specialist check any concerning lesions.
Which brings us to another great question, what does concerning mean? What many of us have heard is the ABCDE rule.
And while I often review the ABCDEs with my patients, what I’m more likely to say is to watch any new lesions very closely, and to let me know if any new or existing skin lesion is growing or changing in any progressive way over time. That can mean an increase in size, a change in shape, a darkening, lightening, or developing a new symptom like bleeding. Really any spot that looks different than it used to is worth having checked.
What will that check look like? I am especially interested in whatever lesion or lesions brought an individual in to the office, but for as many times as the lesion in question ends up to be skin cancer, at least as many times I happen to find a spot somewhere else that is cancerous that the patient did not even know was there. I am especially interested in the scalp, face, back of the neck, shoulders, forearms, and the backs of the lower legs. Although melanoma can appear literally anywhere on the skin (even between the toes), basal cell carcinoma and squamous cell carcinoma are more likely to develop in sun exposed areas.
Do you have to see your primary care provider first? The short answer is no. You can call our office directly and be scheduled without a referral. The long answer is that some insurance companies require a referral to specialty services, so it’s worth checking with your insurance carrier. Kari Knight Dermatology has contracts with Regence, Premera, and First Choice Health, none of which require referral from primary care. Some dermatology practices require a patient to see primary care first and get a referral, so call the dermatology practice you plan to see directly and ask if they require a referral.
Hopefully that helped answer some questions about total body skin checks. Feel free to comment any questions related to skin checks and we’ll do our best to answer. Or for more pressing questions please feel free to call the office!
Be well and love preventative medicine,
Kari Knight FNP-C DCNP