What happens at a skin exam

Before you go

Penn Medicine’s guidance: examine your own skin first and note anything you want looked at, then “remove any nail polish, wear your hair down so your scalp is accessible, and come with a clean face free of makeup.” Nail polish matters more than people expect. Melanoma under a nail presents as a dark streak, and polish hides it completely.

Bring your photographs and your notes. You get a limited number of minutes; spending them pointing rather than describing is a better use of them.

In the room

You change into a gown, usually keeping underwear on. The dermatologist “will carefully examine your skin from head to toe, including areas that are harder to see, like your back, scalp, ears, and between your toes.” For anything that warrants a closer look they use “a handheld magnifying tool called a dermatoscope.”

A dermatoscope is a lens and light source held against the skin. It suppresses surface reflection and lets the clinician see pigment structures below the surface that are invisible to the naked eye. It is the single biggest difference between a dermatologist looking at your mole and you looking at it.

If something needs a biopsy

It usually happens the same visit. The area is numbed, a small sample of skin is removed and sent to a lab, and you leave with “a small bandage and some care instructions.” Most people report little or no pain afterward, and results typically come back within a few days. The diagnosis page covers the four biopsy types and which one is used when.

Total body photography

Some practices offer total body photography: high-resolution images of the whole skin surface, stored as a baseline and compared at later visits so that new or changed lesions stand out. It is aimed at people with many moles or complex atypical mole patterns, where tracking change by eye is genuinely impractical.

The reported benefit is not only detection but restraint. The Melanoma Research Alliance notes that dermatologists using it are “performing fewer biopsies and those they do perform yield a higher ratio of melanoma to benign diagnoses.” Fewer unnecessary procedures, in other words.

Who benefits most

The American Cancer Society’s risk factors, condensed:

• UV exposure. “Exposure to UV rays is a major risk factor for most melanomas.” The pattern differs by site: melanoma on the trunk and legs is associated with frequent sunburns, especially in childhood, while face, neck, and arm melanomas track with constant cumulative exposure.
• Many moles, or atypical ones. “Someone who has many moles is more likely to develop melanoma.” Atypical moles raise risk, though most never become cancer.
• Fair skin, light eyes, red or blond hair, or skin that freckles or burns easily. Risk is “much higher for people with lighter skin tones.”
• Family history. “Around 1 in 10 people with melanoma have a family history.”
• Personal history of melanoma or of basal or squamous cell cancers.
• Age and sex. Risk rises with age. Before 50 it is higher in women; after 50, higher in men.
• A suppressed immune system: organ transplant recipients, people living with HIV, some blood cancers.
• Rare inherited conditions such as FAMMM syndrome and xeroderma pigmentosum, which carry very high lifetime risk.

Why your doctor may not simply tell you to get screened

On April 18, 2023, the US Preventive Services Task Force gave visual skin cancer screening a Grade I: “the current evidence is insufficient to assess the balance of benefits and harms of visual skin examination by a clinician to screen for skin cancer in adolescents and adults.”

It is worth being precise about what that does and does not mean, because it is widely misread in both directions.

• Grade I is not a finding that screening does not work. It is a finding that the studies needed to weigh benefit against harm have not been done.
• The statement covers asymptomatic adolescents and adults. It explicitly excludes people with a personal or family history of skin cancer, and people who have noticed a suspicious change.
• The harms it has in mind are real: overdiagnosis, and biopsies and scarring from lesions that would never have caused trouble.

So if you have noticed something, none of this applies to you. You are not being screened, you are being examined for a reason, and you should go. If you are asymptomatic and at low risk, a reasonable clinician may not push routine whole-body screening, and that is a defensible position rather than neglect. If you carry the risk factors above, the calculus is different and worth discussing directly.

Next

What happens after a biopsy →
How to find and vet a dermatologist →