When to get checked by a dermatologist, and what questions to ask

Skin cancer is the most common cancer in certain age groups yet people don’t realize how important it is to be screened for early detection.

 Woman scratches her arm. (photo credit: FLICKR)
Woman scratches her arm.
(photo credit: FLICKR)

In recent years awareness of the importance of screening tests to ensure that cancer is detected early has risen significantly. For breast cancer, awareness is so high that many cases are detected every year through mammography when the disease is at a very early stage and there are numerous treatment options. On the other hand, skin cancer, which is the most common in some age groups, is rarely detected early since there is little in terms of awareness. We asked Dr. Mor Miodovnik, a specialist in dermatology and medical oncology, how often one should get examined by a dermatologist, and what’s important to know.

"The recommendation is that every person visits the dermatologist at least once a year for a 'mole review', to check all moles and lesions on the skin," Miodownik explained. Unfortunately, there are no guidelines and this isn’t a familiar screening test like mammography or a colonoscopy, but it's as important as other well-known screening tests."

It’s commonly thought that only people with fair skin are at risk for developing skin cancer and therefore should be examined by a dermatologist, but Miodovnik says this is incorrect. She states that extensive sun exposure can cause more skin cancer to people with fair skin, but the risk of skin tumors also exists among people with darker skin, so they also need to be tested.. Melanoma in the nail, for example, is characterized by relatively dark skin.

How is the test performed?

The dermatologist will do a complete and thorough examination of the skin.  Miodovnik clarifies that the test should include the scalp, hands and feet and intimate areas, as melanoma and other skin tumors can develop even in places not exposed to the sun. If the doctor notices a suspected lesion, a biopsy is taken and the tissue checked to accurately diagnose the nature of the lesion.

 A woman receives treatment for her skin with a facial (Illustrative) (credit: PIXABAY) A woman receives treatment for her skin with a facial (Illustrative) (credit: PIXABAY)

In some cases, when a dermatologist diagnoses a precancerous lesion, it may be treated by freezing it with liquid nitrogen or prescribing topical treatment with an ointment. If it’s unclear if the mole is cancerous or not, the whole thing is removed along with an area of skin around the spot.  Miodovnik adds that a dermatologist should know the follow-up protocol of patients at risk and make sure it’s followed through. If someone receives a skin cancer diagnosis, checks might be performed more frequently i.e. every six months.

Make sure your dermatologist uses a dermoscope. According to Miodovnik, "Dermoscope is actually an integral tool which utilizes polarized light and magnification of structures 10 times on average and helps to see structures with a better resolution and distinguish between benign and malignant lesion" Also, there’s a possibility of photographed surveillance which allows for a more accurate and effective examination people of multiple moles or pigmented lesions. Photographing the lesions allows an objective comparison between time points and identifying changes in dimension and time.

You can also detect suspicious lesions and ask the doctor to check them. Miodovnik says to look for asymmetry i.e.the two halves of the mole don’t match up, irregular borders, a lesion has several colors, a spot is over 6 mm i.e. the size of a pencil eraser and any changes you see over a period of several months such as the spot grows, loses color or bleeds. Also look for the 'ugly duckling' sign, an abnormal lesion in the patient's permanent lesion landscape. All of these are red flags and you should see a dermatologist as quickly as possible.

If you have cancer

Miodovnik explained that UV radiation causes damage to cellular DNA in several ways, leading to a chain of events at the end of which the cell becomes cancerous. One of the errors in DNA occurs early in the process and leads to damage to a protein called BRAF. This damage is detected in about 50% of melanomas. Today, there’s an effective, goal-directed treatment for advanced melanoma that inhibits the activity of the defective protein. The doctor should check for the presence of the defective gene, which leads to the formation of the defective protein in any case of advanced melanoma to identify patients who will benefit from this treatment.

Even in cases where melanoma is advanced, there are two effective treatment options. Miodovnik explains that one is immunotherapy, which uses the patient's immune system as a third party to effectively identify the cancer cells and lead to their attack. A second is targeted therapy of the BRAF inhibitor,  which acts directly on the cancer cell.