SKIN CHECK 101:
YOUR GUIDE TO EARLY DETECTION
High UV levels and the accompanying risk of skin cancer are part and parcel of a sun-drenched life Down Under. It’s a reality that makes sun protection crucial, and regular skin checks a necessity. However, many people continue to bury their heads in the sand – failing to check their skin for changes and play their part in early (potentially life-saving) skin cancer detection.
Designed to educate and empower Aussies to take charge of their skin health, this article answers all your burning questions about skin checks. From what to look for when checking your moles, to where you can go for a skin cancer screening, here’s everything you need to know.
WHY SHOULD I HAVE A SKIN CHECK?
While an enviable climate and outdoorsy lifestyle is great, it also means Australians are exposed to particularly high rates of UV radiation. For many parts of the country, the UV Index reaches 3 all year round – with much higher levels in summer. Unfortunately, this has earned us the unwanted honour of being named skin cancer capital of the world.1 In fact, according to Cancer Council Australia, skin cancer accounts for over 80% of new cancer cases diagnosed in the country each year.
While preventing skin cancer – via reduced sun exposure and the daily use of high SPF, broad-spectrum sunscreen and protective clothing – is the ultimate aim, early detection is also vital. Regular skin checks (both self-examinations and those conducted by a healthcare professional) can identify early skin changes and dramatically improve health outcomes for all Australians. This is particularly true for melanoma as, if detected early, 90% of cases can be successfully treated with surgery (1).
DO I NEED TO BOTHER CHECKING IF I'M TANNED?
If you think your darker skin tone keeps you safe from skin cancer, think again. The absence of a visible sun burn does not mean you’re not causing damage to your skin. According to the Skin Cancer Foundation, “Even if your skin type is not fair, tanning causes DNA injury that can lead to premature aging and skin cancer (2)."
Long-reformed sun worshippers aren’t out of the woods, either. In an interview with Glow Journal, dermatologist Dr Cara McDonald said, “I see people all the time that say ‘But I don’t go in the sun’, and it’s about understanding that the damage earlier will haunt you later… the DNA damage that’s caused by the sun can lie there dormant in those cells. When I say ‘dormant’, the DNA damage remains, and every time those cells divide there’s a risk of a mutation. If the DNA is already damaged, that risk is much higher.
“You can have had sun damage when you were in your childhood, teens or twenties, and then in your fifties and sixties when your body isn’t as good at controlling that cell division and checking for mutations… it’s later on that you pay for the damage you had earlier.”
The bottom line? Skin checks should be part of life for all Australians – regardless of complexion.
WHEN & WHERE SHOULD I HAVE A SKIN CANCER CHECK?
There’s no need to panic and race out for a mole screening, however. In fact, expert groups support a self-examination approach (as a first step) in the majority of cases. Cancer Council Australia officially recommends that individuals “become familiar with their skin, including skin not normally exposed to the sun, and consult a doctor if they notice any change in shape, colour or size of a lesion, or the development of a new lesion. (3)”
For those at high risk of skin cancer, however, a more vigilant approach is required. The Royal Australian College of Dermatologists recommends opportunistic clinical skin examinations every 6-12 months for those at high risk, while the Cancer Council advocates full skin examinations supported by total body photography and dermoscopy every 6 months (4).
Not sure if you’re high risk? Factors such as family history, skin, hair and eye colouring and number of moles can impact your risk of melanoma and non-melanoma skin cancers. It’s never too early to talk to your GP about your individual circumstances, and the best examination protocol for you.
Regardless of risk, many people self-select for a professional skin check, which can be performed by a GP, dermatologist or at a skin cancer screening clinic (5). In Australia, GPs see over one million patients a year for skin cancer consultations (6). Patients may then be referred to a dermatologist for further assessment.
This Cancer Council Factsheet provides tips for choosing between a GP or skin cancer clinic for your examination. To visit a dermatologist, you will require a referral. During a dermatologist skin check you can expect to undress to your underwear for a thorough examination. Your skin will be viewed under magnification, and photos or biopsies may be taken of any lesions that appear to be cancerous or pre-cancerous.
SKIN CHECK AT HOME:
HOW TO DO A SELF EXAMINATION
Now we’ve established the importance of self-examination for detecting early-stage skin cancers, the question remains – how exactly do you perform a skin check? And what are you looking for?
The Cancer Council recommends making a regular habit of checking your skin, from your face and scalp to your toes and soles of feet. This includes areas not exposed to the sun, such as between fingers and toes, and your nailbeds. You should undress completely, and examine your skin in good light, in front of a full-length mirror.
Make note of any changes to your skin, particularly moles and freckles that have changed shape, size or colour, and any skin sores that haven’t healed. Use a mirror to see tricky spots, or ask someone else to check these areas for you. (View the Cancer Council website for more detailed instructions and the identifying factors for different types of skin cancer.)
The Melanoma Institute of Australia advises using the ABCDE melanoma detection guide when checking your moles. The letters stand for Asymmetry, Border irregularity, Colour variation, Diameter and Evolving – with Evolving referring to “changes in size, shape, colour, elevation, or another trait (such as itching, bleeding or crusting).” A full description of the guidelines can be found at the link above.
SELECTING A SUNSCREEN IS YOUR FIRST LINE OF DEFENCE
While you can’t control your genetics, you CAN help protect your skin and reduce your skin cancer risk. And daily application of a high-SPF, broad-spectrum sunscreen is a crucial step. Even on days you’re just running errands or sitting at work.
Why? While those burning UVB rays fluctuate, UVA rays (the ones primarily responsible for premature ageing) are consistently high throughout the year. They are also able to cut through glass, such as car windscreens and office windows. “UVA penetrates deeper than UVB,” McDonald told Glow Journal. “Most UVA penetrates down into that dermis layer, which is underneath your cellular layer, but it does actually cause premature ageing and increases your risk of skin cancer as well.”
2. Australian Melanoma Research Foundation: Fast Facts About Melanoma
3. Skin Cancer Foundation: Tanning & Your Skin
4. Cancer Council Australia: Position Statement – Early Detection of Skin Cancer
5. Sinclair, R 2012, ‘Skin Checks’, Australian Family Physician, vol. 41, no. 7, pp464-469.
6. Cancer Council Australia: Types of Cancer – Skin Cancer