“You cannot diagnose what you cannot see.” This quote, from a training course for dermatologists, summarizes a total body skin exam.1 A total body skin cancer physical exam is a complete inspection of your skin. Your doctor will visually inspect your skin. He or she will lightly touch the skin to see whether lesions are raised or flat.
One reason for doing a total body skin exam is to find skin cancers and pre-cancers. It is commonly done if you go to your doctor about an unusual or suspicious growth. A full exam is necessary, even if you are just worried about the one lesion you have found. If you have skin cancer in one spot, you are more likely to have another one somewhere else.
If you have had skin cancer, regular skin exams are done to check for recurrence or a second cancer. This type of exam may be done to screen for cancer even if you have no symptoms.
You might be nervous about having someone take such a close look at your body. Don’t let embarrassment stop you from making the appointment! You will be given a gown to wear, and your doctor will uncover one part at a time as need. Some dermatologists check the anus and genitalia as part of the exam. Many doctors only inspect these areas if you request it. Remember, your doctor has done countless skin exams; examining you is a matter of routine. The exam will be over in 10 to 20 minutes, after which you will have peace of mind.
How should I prepare for a physical exam for skin cancer?
Try not to shave or wax in the days prior to your appointment, so ingrown hairs, scabs, and pimples have a chance to heal. Remove nail polish and let down your hair because your doctor will look at your nails and scalp. Take off foundation and make-up before your appointment.
Perform your own skin self-examination before you see the doctor. You are the best person to recognize changes in your skin.
What will happen during the skin exam?
You will be given a gown to put on with the opening to the back.1 Your doctor will step out while you undress. You may ask to have a chaperone in the room during the examination. Some opposite-gender doctors will automatically ask a chaperone to be present if the examination will involve sensitive areas.
Your doctor will systematically check your skin from head to toe. All your nooks and crannies will be inspected: the back of your ears, the curve of your nose, between your toes, and more. Your doctor might feel your lymph nodes. Hard or enlarged lymph nodes can be a sign of cancer that has spread.2
Your doctor might take full body photographs. At future appointments, these photographs will help your doctor determine whether you have new growths.2 This is sometimes called “mole mapping.” Specific lesions may also be photographed so that they can be monitored over time.
What if the doctor finds something during a skin cancer physical exam?
Your doctor will be looking for growths with typical features of melanoma and signs of non-melanoma skin cancers. She or he will also look for “ugly ducklings.” These are growths that look different from your other marks and lesions.
If a lesion looks suspicious, your doctor may use a dermatoscope to get a closer look. A dermatoscope is a special magnifying glass with a light source. It helps your doctor to see skin structures that are invisible to the naked eye. This information helps to distinguish harmful lesions from harmless ones.3
Your doctor might decide to biopsy a lesion that appears to be skin cancer. Your doctor will remove a small sample of tissue from the lesion. There are several kinds of biopsy procedures. The skin sample will be sent to a pathologist, who will look at it under a microscope for cancer cells and make a definite diagnosis.
For suspected small non-melanoma skin cancers, your doctor may perform an “excisional biopsy” and remove the entire tumor.4 This means that the sample is taken and the tumor is treated in one step. The sample will still be sent to the lab to confirm the suspected diagnosis.
