When To Get A Skin Check And What To Look For | Dr Michael

0:00So we'll start with when should you get a skin exam? Yeah. A couple things, a couple factors. So if you have a family history of melanoma in the States, insurance will approve getting skin exams. And family history means a vertical relative, first degree. So either mom, dad, brother, sister, or child, your insurance will approve a skin exam with a dermatologist. Okay. when I look at when do I think people should get skin checks in general is if you notice a changing mole and this is whether you are say you know 22 years old or 32 that should propel you to come into the dermatology clinic to get something examined but probably on average if you don't notice any moles changing rapidly growing in our 30s you should start getting baseline screening and then definitely other factors that play a role how many sunburns you've had in your life how many times you've used a tanning bed because that incidence of in particular melanoma is much higher in people who have tanned even if you've tanned a handful of times in the tanning bed that does increase your risk of melanoma the number of burns a couple of burns one burn increase your risk of melanoma so that would the context of your history is important but But, and this is important as well, melanoma is the third most common cancer in individuals in their 20s and 30s.

1:34The third most common cancer. So it's just luckily people don't get it much when they're 20 and 30, right? But it's the third most common cancer. But I also think this is a big thing. I don't think many people think about the C word in their 20s or 30s or even in their 40s, to be honest. I think you start thinking about it as you age. but actually you know I think more and more we're hearing about the increase of cancer in younger people whether it's bowel cancer or skin cancer and the importance of getting it checked now I think people might not know what to specifically look for when a mole changes and I'll give you a personal example of this so I was on holiday in June and you know I've got quite a lot of freckles and moles and I was just next to a friend who was a doctor and he pointed one out to me that you should be getting that chet because it looks like it's a bit jagged, would never have noticed it ever.

2:30I think people think about maybe if it's like, you know, you've got a mole, it's got bigger or whatever, but the ones that are very kind of like soft to the skin, I don't know and maybe it's just me, but we pay attention to them as much. So like, how can we be aware of this and what actually should we be looking for? So a couple of key things here, and this is where there's a lot of nuance between what you can do in your own skin cancer screening at your own house, what you should be looking at on your own skin. You should definitely get a baseline of what your moles look like, right? You can take photographs of them.

3:04You should look in all areas of your body, right? So that means in all nooks and crannies, between your toes, see if there's moles there or just spots in general and become familiar with what they look like. The at-home metrics of an asymmetric mole, irregular borders, the color, there's more than two colors or two colors or more, the diameter greater than six millimeters in change, which is evolution, those are very important things. For at-home, you're paying attention to changes on your own skin. But in the dermatology office, they mean zero to me. Absolutely nothing. This year, I have, and this is where my focus of what I'm trying to change within dermatology.

3:49So you have, it sounds like a physician say, hey, that mole is a little irregular. You should get it looked at. Well, if they weren't using a dermatoscope, truly, and not just using this, there's a massive gap in the understanding of dermoscopy, what these structures show. and the knowledge base across not just the United States. This is across the world. So people are using this tool and they don't understand what they're actually seeing. That's a problem. But for me, most melanomas I identify this year, I've had, I'm trying to think of cases and I have found it is August 18th. I have found over 140 melanomas for this year.

4:32The average dermatologist finds 20, 20 to 30. So it's August 140 miles. Well, and that's because you're using that device? Well, it's not just because I use a device. Yes, this is one, but it's also because my knowledge base on this device is there's massive gaps in our understanding of dermoscopy. So we need to use this device. So when you get a skin check, if somebody's not using a dermatoscope and not just on what they perceive to be irregular, like for instance, I hope you got that looked at. I can't see it, so I don't know what it even looks like, but I hope you got it looked at. But if they say you went in for your skin check and they just put this down on select moles, they cannot tell you for certain that there is not melanoma there.

5:16I look at every single mole, every single sunspot, every single pink spot, because even if it looks normal, completely normal, I cannot tell you that it is not melanoma without investigating it. And that is what that tool provides. because it provides detail on the pigment architecture, vascular structures, structures that are present in inside the actual skin. So it's not just looking at the outside, you are taking your purview within the skin. So, um, so I think what's really important people to understand here, what you're saying is, because I also will just point out people also get scared of doing this stuff because they're scared of the outcome, right?

5:57It's like it's fearful, It's scary getting this stuff done. But like say people do come in, right? And you're checking with that device. Dramatoscope, yes. Dramatoscope, thank you. How quickly can something go to something quite severe in skin cancer? Like, you know, so you have different stages of skin cancer, but how quickly do things develop? How quickly does melanoma skin cancer develop? Like that's what I guess the most critical point here is for people to understand. luckily most melanoma grows slower uh there is a rapidly growing type called nodular melanoma that grows fast so if you notice say you had a flat mole and that mole turned elevated and not just texturized but uh papular go get it checked that's an that's an urgency to get it looked at uh most moles or most melanomas they have a horizontal growth phase so they grow outward before they dive down.

6:56And figuring out when that timeline is, nobody knows. So we do not know if a melanoma is going to sit on the skin and grow outward for 30 years, two years, six weeks before it gets a vertical growth phase. But we do know that if we find melanoma early, essentially, if you find melanoma when it's in situ, meaning in the top layer of the skin, stage zero, nobody dies from it. We could eliminate deaths from melanoma that are skin related. Unfortunately, melanoma can occur internally, and that is not something we have the ability to screen for currently. But that is the rarity of rarity. It's not something you can discuss how to screen for.

7:33But we can screen your skin extremely well, and we can identify melanoma early. If we find it all in stage zero, nobody dies from it. If we find it in very early stages, stage one, the five-year survivorship is 99%, roughly. Pretty great odds. Soon as it goes past that point, it changes. And so that is really the power of a thorough skin exam with the appropriate understanding, the individual doing the skin check and the tools that they're utilizing. So utilizing a dermatoscope to inspect your skin will help keep you alive from skin cancer. well I guess that's actually a lot less fearful for people because I do think you know going to get checks on any type of cancer is scary and that is already a friction point right people I don't want to know and I know people know not knowing is worse but for the time being it feels safer so I think like knowing that actually if you can catch this I mean if you can catch anything early it's the best but actually knowing that the odds are pretty strong is really important I mean And I've already, before coming on here, because when I deep dive into research for these episodes, boy, do I deep dive.

8:48Even in myself, I know that it's important to go and get this stuff checked. But like, am I doing it? Am I making time? No. But, you know, now I'm doing an episode on this and diving into the research on it. You know, halfway through, I just stopped. And I booked an immediate appointment to kind of get everything checked. I'm happy to hear that. I was going to ask you, have you had a skin check yet? And if you haven't had it, if you've had a skin check, did they use a tool? Did they use a dermatoscope? Yeah, see, it was a couple of years ago that I went and had this done. And that was via Necco.

9:23So when they kind of came here to the UK, I was like, oh, I mean, it's quite a cool experience that you go on. But the thing that I found really great from, they test lots of different things, but the thing that I did find great, I'm healthy, so nothing kind of came up. The only thing that was interesting was the skin mapping, right? Sure. On these molds. And the thing is, if you get it done, you go every year, you can kind of see if things are changing because there's a record, which I think is great. So I think, you know, wherever you go, wherever it is, probably staying with the same place and the same person is probably a really helpful indicator because they'll have all of your notes and past histories, right?

9:59That's what I kind of think about. I think it's important. I think that getting full body mapping. So I'm going to dive a little deep onto this here. He's going to be deep. For me, I need to look at every spot with a dermatoscope. I don't need to know what your history is. Not that this is a negative thing. It's important to know you as a person and know what your risks are. But what I need to know is I need to understand what I'm seeing inside of your moles. Okay. And that, and I don't care whether you're in the UK, you're in, pick your place in Europe, you're in Australia and New Zealand, South America, there's a lot of dermoscopists there.

10:48There, I started my whole social media venture on trying to educate dermatologists. I did this for three years straight. I would post, you know, per year, thousands of cases. And there was a lot of pushback on the cases because there are small lesions that are invasive melanoma. Okay, these are invasive melanoma. How is that possible? And what I, by doing these, they were quizzes. What I recognized was the deficiency, the massive deficiency that we currently have in the understanding of dermoscopy, which is what we, the field of this tool, a dermatoscope, that is fairly universal across pretty much every country you can think of.

11:35We're deficient in that understanding. And for me, my objective is, has been now to say, look, if you were getting a skin cancer screening, one, we need to make sure people are using a dermatoscope, but two, we need to really identify how to change how we educate people that are providing skin cancer screening, whether that's a GP, a dermatologist, because you can get a screening that this goes back to, I think you said your mother had breast cancer. Is that correct? My aunt. Your aunt. My apologies. Yeah, your aunt. So we did breast cancer screening from 1930 to 1989. And we did that well. We tried different modalities.

12:19We tried in-office examination, counseling on home screening. To me, that's ABCD and E's of you looking for your moles, but palpating your breasts for lumps and bumps. And then mammography came along. And mammography changed the landscape for us to identify breast cancer. There was a large review in 20... That's how she was identified in that? through mammograms. Now, the key thing here is not only did mammograms identify it, it actually reduced mortality. If you can do screening for something, but it doesn't reduce mortality, is it worth doing screening? And that is actually one of the arguments for people not to get full body skin checks.

13:01Oh, it's not reducing melanoma mortality on a population level. There was a recent article in JAMA Dermatology. This is in 2026, a study done in Germany from 2009 to 2022. The population-based study didn't reduce melanoma mortality when they had population-level cancer screening compared to the other neighboring countries. That's surprising, but it's not surprising to me at all because, one, dermoscopy was not required. That is a key thing. Dermoscopy is not required. And in addition to that, the education on dermoscopy, where we currently are, August 2026 across the world is poor. And for things that are to me, red alarm melanomas, I would expect 99 % of dermatologists to answer that correctly or people that are providing skin cancer screening, and we're not doing it.

13:55So we need to augment that. Well, that's what people are now going to know when they go to get their molds checked, that they need this device. They need this device. I really want to quickly ask a couple of things regarding UV that I think is actually always in my mind with sunscreen because we basically talked about it just laying out in the sun or going out and walking your dog or whatever. But these are things that I actually have no idea on. So does someone need to wear sunscreen if it's cloudy? Yes, it does. you're sitting what if you're sitting beside a window like in a car um in a car it depends on the glass and that's the problem with this right so if somebody has laminated i know these are the things i hate i apologize in this setting because there's so many there's variables so i would say play it safe absolutely so wear sunscreen um working from home so you've got like your windows and the sun's coming in so not direct uh lights um i would so personally in my office right now i have a window next to me i don't have sunscreen on