As we start 2022, summer is already in full swing in Australia. The ongoing pandemic and surging Covid cases only mean more people are spending time on a beach in the sun than enjoying the comforts of air conditioned amenities. This is also the time when many patients are more aware of their skin and come for skin checks. In fact, many skin cancers we diagnose are found and first noticed by the patient, highlighting the importance of performing self skin checks.
Why are Self Skin Checks so Important?
Compared to other countries in the world, Australia has the highest incidence of skin cancer by a wide margin. While the public message of being sun smart has been effective in more recent years, many were still exposed to excess sun in the days of their youth.
Despite being written a while ago, this 2012 article in the Australian Family Physician provides a general guide regarding frequency of self-examination (see Table 1).
High risk: 3 monthly self-examination
Medium risk: 3-6 monthly self-examination
Low risk: Annual self-examination
You are typically higher risk if you have:
Fair skin type (particularly red hair, blue/green eyes, freckles).
Numerous moles (numbering in the dozens)
Past history or family history of skin cancers, especially melanoma
Previous (particularly numerous) sunburns
Where do I Check?
It is important to have a comprehensive check through your whole body. Places that people often miss include:
Back - Use a full-length mirror or get a partner to check
Behind the ears
Scalp - Sometimes your hairdresser may comment on a particular spot.
In between toes and underneath your feet
The American Academy of Dermatology has a brief guide on self-skin checks, including this short video embedded below.
What do I Look for?
As a start, the ABCDE rule for melanomas should be applied to any mole on your body. This is helpfully outlined by the Melanoma Institute of Australia, summarised in the image below.
The last point is perhaps the most important, relating to evolution. Anything changing could be suspicious, in particular: recurrent crusting, bleeding, change in colour or size.
Other helpful clues include:
Ugly duckling sign: Out of a group of similar spots, anything that is becoming cancerous will often stand out
Non-healing scab: Crusts which keep forming and falling off without healing
Non-healing wounds: A longstanding wound that isn't getting better after weeks
Fast growing lump: A firm lump that is growing quickly over weeks should be treated with caution
Learning about Skin Cancers
Sometimes a patient comes to me with significant concerns about a spot, yet it is something clearly benign. While another patient may be requesting a routine check, only for me to find some pre-cancerous or even cancerous change.
In either case, I don't simply say whether something is cancer or not. It is important for me to explain what the spot is and also outline the reasoning for my clinical opinion. Since there is so much to know about skin cancers, in my approach I see every skin check as an opportunity to further equip and educate patients so that they become more effective at monitoring their own skin and looking out for cancers.
If you're ever not sure about a spot, or want to learn more about skin cancers, don't hesitate to visit your local doctor with an interest in skin cancer medicine. We are sure to listen and help!
Broader Reading: Beyond the Basics
While there are many types of skin cancers, patients who seek to know more about specifics can have a browse of DermNet NZ, an excellent and reputable source of information. Topics are written in a manner that can be understandable to patients with technical words underlined with pop-up definitions to help overcome jargon. You may choose to begin with reading about the main three types of skin cancers:
