Skin Checks - Why see a dermatologist

Skin Checks

A dermatologist is an expert specialist in skin cancer and all skin related diseases. A skin specialist should have the letters FACD after their name, indicating their Fellowship of the Australasian College of Dermatologists. The Australasian College of Dermatology is the only Australian Medical Council accredited college in Australia to train dermatologists.

Skin cancer or ‘mole check’ clinics are different from seeing a dermatologist. They are staffed with doctors who have qualifications such as a diploma in dermatology, or a membership of the college of skin cancer medicine. These are not specialist qualifications. The Australian Health Practitioner Regulation Agency (AHPRA) and Medicare do not recognise these qualifications.

Q Dermatology is in the best position to understand you and your skin and provide specialist treatment with expert care.

What are skin checks?

Skin checks are an opportunity to have your skin thoroughly examined for skin cancers and precancerous changes in the skin. You may elect to have a skin check because of a new or changing mole, for example, or as a routine preventive health measure. Dermatologist are recognised by Australian Health Practitioner Regulation Agency (AHPRA) as experts in skin cancer, with a minimum of four years of specialised training required to become an accredited dermatologist in Australia, after an extensive and intensive selection process.

What does a skin check involve?

A full skin examination involves a thorough check of all your skin for any sign of precancerous or cancerous lesions. As part of your check, you will be asked to undress, keeping on your undergarments. Your dermatologist examines your skin completely, using a magnifying device called a Dermatoscope. Lesions that may require monitoring will be photographed, for reassessment at your next visit. Lesions requiring testing will be biopsied and sent for pathology.

What is a biopsy?

A biopsy involves removing a piece of skin to send for pathology testing. A dermatopathologist (doctor specialist in examining the histology of skin) then assesses this tissue under the microscope, and issues a report, usually providing a precise diagnosis.

There are various biopsy techniques and your dermatologist will select the most appropriate, depending on the lesion type and location on your body. Local anaesthetic is used to numb the skin, and the skin is cleaned before the biopsy is collected. The wound is then covered and you will receive instructions regarding care of the wound as it heals. A biopsy is a small procedure and generally takes only a few minutes, from beginning to end.

1. Shave biopsy

   This uses a curved blade, and leaves generally small graze-like wounds that heal quickly on most parts of the body, especially the face. A shave biopsy may intend to remove part of or the entire lesion, and is called a shave-excision if the intention is to remove a lesion completely. Shave biopsy is the most commonly used biopsy technique.

2. Punch biopsy

   A core-like instrument is used to take a 2 – 4mm sample, though occasionally larger punch biopsies are also required. Often small biopsies do not even require a stitch, as the wound heals quickly without one.

3. Incisional biopsy

   This is a partial biopsy of a lesion, involving use of scalpel to cut out part of a lesion or rash.

4. Excisional biopsies

   This involves complete excision of the lesion in question, with stitches used to close the hole left behind.

Who should have regular skin checks?

Early identification of skin cancer is always beneficial, and for this reason regular skin checks are prudent for most Australians – especially Queenslanders as our state has the highest skin cancer burden in the world. Patients who benefit particularly from regular skin checks include those with:

• History of skin cancer
• Family history of skin cancer
• Fair skin
• Immunosuppression (blood cancers and organ transplants)
• High mole count, or multiple abnormal-appearing moles
• Significant sun exposure, sunburns, solarium use

How often should I have my skin checked?

A yearly skin check is generally recommended for most Queenslanders, particularly given the high rate of skin cancers in our state. Some patients with a very low risk of skin cancer may choose to have their skin checked less often. Those with a history of skin cancer may require more regular skin checks. Your dermatologist will discuss a recommended frequency with you during your consultation. For example, six monthly skin checks are recommended after being diagnosed with an early (level 1) melanoma.

What should I do between skin checks?

Your dermatologist will make recommendations during your consultation as to how often you should return for skin checks. In between seeing your dermatologist, monitor your own skin regularly for new or changing spots. If you notice something on your skin that you feel may be of concern, please call to request an appointment to have this assessed by your dermatologist, rather than waiting for your next routine check. Q Dermatology will always ensure you are offered a prompt appointment in this situation.

The Cancer Council has some guidelines on skin self-exams at home:

https://www.cancer.org.au/preventing-cancer/sun-protection/check-for-signs-of-skin-cancer.html

How long is the waiting list for a skin check?

Q Dermatology always seeks to accommodate our patients as soon as possible. If you or your regular GP feel an urgent appointment is necessary to address your concern for skin cancer, please discuss this with us and we will do all that we can to ensure you are seen within days. An example of a reason for an urgent appointment is a suspected or confirmed melanoma.

What should I expect after a skin check?

If any suspicious lesions are detected, further diagnostic tests such as a skin biopsy may be advised. Based on the results, we would suggest a treatment plan that may include non-surgical methods or surgical removal. In addition, we advise regular self-examination of your skin at home. Should you notice any new or changing skin lesion in between appointments, contact Q Dermatology or your GP for an immediate review.

Cancer Council Australia offers guidelines on skin self-exams at home:

https://www.cancer.org.au/preventing-cancer/sun-protection/check-for-signs-of-skin-cancer.html