In partnership with La Roche-Posay.
This summer saw La Roche-Posay and Skin Check Champion’s ‘House of Healthy Skin’ tour the east coast of Australia, providing 1342 individuals with a free skin check. Over 80% of those people had never had their skin checked before, so we took to Instagram to find out why before I passed your skin check questions onto the expert.
In this extract from the Glow Journal podcast, Dr Cara McDonald answers your questions on skin checks- from how to book a skin check, how often you need a skin check, and whether or not skin checks are really essential for every skin type.
To listen to the full interview, subscribe to the Glow Journal Podcast now on iTunes or Spotify
GLOW JOURNAL: The La Roche-Posay House of Healthy Skin tour wrapped last month, and for an alarming number of people, this was actually their very first skin check. For anyone who hasn’t had a skin check before and might be a little nervous, what can they expect? What does a skin check entail?
DR CARA MCDONALD: It’s a really good question, because I think people are always a little bit nervous about stripping off and feeling a bit exposed before they have a skin check. In general, what we do is get you to strip down to your underwear- for women, you would leave your bra and undies on, and for men just leave your underwear on. We will check areas around the genital area and breasts, particularly if you know of any lesions or have any spots to check specifically there. Otherwise we’ll tend to check the breasts and so on, but just work around the underwear if possible.
So generally you will strip down, usually with a gown. For me, I’ll pop up my patients behind a curtain, give them a gown, so that will actually strip down to their underwear, but then just pop a hospital gown on them or sometimes just a sheet over overlaying them, just to give them something to keep them a little bit warm and covered up while you’re checking over them.
And then, what we do is literally go from head to toe. I’ll go through the hairline, go through the scalp. It depends a lot on how much hair you have, and so on how likely you are to have skin lesions in your scalp. Men with short hair are more likely, especially if they’re balding, but generally we’ll go through the hairline and the hair, check behind the ears, check in the ears, check behind the neck and have a really good look at the face- the sun exposed areas are the areas that we might spend longer on. Again, it depends on your skin and your history.
We then just move down the body and check over the limbs, the trunk, between the toes and all other areas front and back.
So how long does that take? Because a question that emerged was “How can I possibly be receiving a thorough skin check when it’s over and done with so quickly?”
This is a good question, because there are so many variables with this. It’s one of those things. For me, it might take me three hours to do an Instagram post but I can do a skin check in 30 seconds because, for 15 years, I have been and skin doctor and that’s what I do all day every day.
Having said that, there are skin checks that may be very quick because the doctor or the other person doing it isn’t being thorough enough and isn’t checking everything. But for someone who’s very experienced, it is quite quick. It’s pattern recognition. As I said, it depends a lot on the person, how much sun exposure they’ve had, how many spots they have. I see some people, and within probably one second, I can tell you that they don’t have a skin cancer because of their skin type, their lack of previous damage and sun exposure and lack of suspicious or irregular lesions on their skin, and so it almost is a quick glance and checking a few spots with my light or dermatoscope and I’m done. And then another person who I might’ve seen every three months for 10 years, they still take me 20 minutes because they just have so many cancerous and precancerous lesions and I have to stop on every one and decide whether to biopsy it. It’s very variable.
Another thing we learned at the conclusion of the House of Healthy Skin tour was that over 81,000 people missed their skin check during Covid. How often should we be getting a skin check?
Look, it would be nice if we had a routine answer to that. For example, with your cervical smear, it’s now moved to one every five years. With breast screening, it’s a mammogram every two years after the age of 50. And I think some guidelines for this would be really, really helpful. It is quite complicated and it’s probably a little bit more complicated than something like breast cancer because the risk factors are so broad and diverse.
Certainly, as we get older, our risk increases as we have had more sun exposure. Our risk increases if we have previously had a lesion of concern or a skin cancer risk, it increases if we’ve got a strong family history… It is something that, probably in your twenties, you should at least get advice on how often you should have a skin check.
My general advice is everybody should have a skin check in their twenties, and if they’ve got any known risk factors, do it earlier rather than later. If you see somebody who knows what they’re doing, they will then be able to give you very good guidelines that are relevant to you. Often in your, say, twenties and thirties, you might only need a skin check every two to three years if you are low risk. As you get older, those skin checks should come a little bit closer. If you’ve got any of those risk factors I mentioned before, they might need to be as frequently as three monthly.
My biggest bit of advice here is that skin cancers or changing moles can actually happen at any time, so we’re always a little bit reluctant to say “You should have a skin check every one or two years,” because some people take that as “Oh, I’ve got this new spot, but my next skin check isn’t due for 18 months, so I’ll get it checked then.” So the really important advice is if you have anything you’re worried about, if you see something changing, you should get it checked then. It doesn’t matter if you had a skin check four weeks ago, it’s time to go again. We know, by definition, cancer is a lesion that is growing, evolving, changing. It is growing out of control. That’s what any sort of cancer is. On the skin, we can usually see that over a period of some months- sometimes even sooner. So if you see something and you think “Gosh, that looks a bit unusual,” and you notice it has changed, absolutely get it checked sooner rather than later.
This might seem pretty top level, but how do we go about booking a skin check if we haven’t done so before? Do we go to our GP, do we seek out a dermatologist, dermal clinician or dermoscopist…. Where do we begin?
A dermal clinician, definitely not. They are not a medically trained person and they don’t generally do diagnosis of skin lesions. There are some nurse practitioners or trained nurses who have been trained in skin checking and diagnosis, and they will generally be involved in programs where they do kind of a routine skin checks, for example, in corporations and so on. Anyone who’s had adequate training is a good place to start. If in doubt, go to your GP. The majority of GPs are competent in skin checks, and some of them are extremely good. If you don’t have a regular GP, then seek out a general practitioner who has experienced or has preference to do skin checks because some of them will just send you off automatically for a referral to a dermatologist, and they will generally have quite a wait list.
Is it important for everyone to get a skin check?
If you tan easily, if you’ve got a darker skin type, if you’ve got no particular lesions on your skin, no family history, no risks, then your chance of skin cancer is extremely low. If you actually keep an eye on your skin and you’re not out tanning and burning, then there’s no real reason that you should have to go and have a skin check so as long as you are educating yourself about what to look for and when to go and get something checked, and keeping an eye on your own skin, which is difficult but possible. If you don’t have any spots and dots on your skin, it’s not that hard to keep it keep an eye on your skin. If you see something new, it will be obvious if you don’t have much else.
As you get older, absolutely it’s worth considering a routine skin check. And like I said, I like to suggest that people have a skin check for the education reason, even if there’s nothing on their skin, because I love to explain to people what to look for, what to worry about, how to access help if they are worried about something, when not to take no for an answer and get another opinion. That’s where I see a skin check as being really, really valuable.
Now what about different skin tones and even different lifestyles? Do those elements affect how regularly a skin check is required?
Yes, completely. A skin of colour, particularly a dark, say, African skin type, your risk of skin cancer is minimal. It’s extremely low. Those beautiful people were designed to be in the sun. They are actually able to live and exist in the sun with very low risk because the pigment in their skin protects them. The pigment in our skin actually acts like a shade cloth, so it protects the cells that are at risk of becoming cancerous because they’re the ones that are dividing over time. So if you’ve got a darker skin type, you haven’t had sunburns, you don’t burn easily and you are protecting your skin as well, then your risk is really low. If you don’t feel like there’s anything that needs checking, you probably don’t need regular skin checks.
Having said that, we frequently see skin cancers in olive skin and people who have really felt that they never get burnt. They’ve never really had to worry about sun protection in the earlier years because they are easily tanned, and because of that, they then had a lot of chronic sun exposure over the years, which has then ended up with that DNA damage. So there is a middle ground. If you have an olive complexion, but you actually have had a lot of sun exposure, you are still at quite high risk of skin cancer. If your skin does not burn easily and you are very careful, you’re at very low risk. So there is a big difference in risk factor.
The fairer you are, the more sun exposure you’ve had, the more sunburns you’ve had, the more likely you are to get a skin cancer- so the more vigilant you should be with your own skin and you should try and get some professional checking as well.
To listen to the full interview with Dr McDonald, subscribe to the Glow Journal podcast now on iTunes or Spotify
