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In honor of Skin Cancer Awareness Month, this episode explains what a full-body skin exam (skin check) is, why annual exams are recommended for most people, and what patients can expect at the visit, including gowning, the role of a medical assistant, and common comfort concerns. They outline how providers systematically examine the entire skin surface—including scalp, between toes, and sometimes genital areas—and discuss what dermatologists look for, from benign lesions to melanoma using the ABCDE criteria, plus basal cell, squamous cell, and precancerous actinic keratoses, often aided by a dermatoscope. The episode covers biopsies, liquid nitrogen freezing, risk factors like sun exposure, blistering sunburns, and certain occupations, and offers practical prep tips such as minimizing makeup and nail polish, bringing photos, and obtaining prior biopsy records.
00:00 Sun Exposure Risk Jobs
00:15 Skin Cancer Awareness Intro
00:58 What Is a Skin Check
01:55 Arrival and Gowning
03:56 Exam Steps and Chaperone
05:31 Surprising Areas Checked
06:31 What Dermatologists Spot
07:54 Melanoma ABCDEs Explained
10:20 Other Skin Cancers
12:59 Derm Exam Vocabulary
14:34 Biopsy Basics Demystified
16:14 First Visit Worries
18:28 Other Skin Issues and Time
19:25 Skin Exam vs Rash Visit
20:56 How Long It Takes
21:43 How to Prepare
23:39 Bring Records and History
24:41 How Often to Check
26:30 Risk Factors and Sun Exposure
28:18 When a Spot Looks Suspicious
30:18 Liquid Nitrogen Freezing
33:19 Final Tips and Encouragement
Creators and Guests
Host
Host
What is Skinside Out?
Welcome to Skinside Out, where science meets beauty, the ultimate dermatology podcast! Dive deep into the fascinating world of skin health with expert insights, evidence-based discussions, and myth-busting truths. Each episode explores the medical, cosmetic, and surgical aspects of dermatology, while keeping you informed about trending skincare topics. Whether you’re a skincare enthusiast, medical professional, or just curious about how to achieve your best skin, Skinside Out is your go-to resource for staying informed and inspired.
[00:00:00] Speaker 3: some occupations have. More sun exposure. So yesterday I did MOS on a patient who was a male carrier. She was out in the sun carrying male for decades and it gets multiple skin cancers.
[00:00:11] Speaker 2: Yeah.
[00:00:12] Speaker 3: , Pilots, they're at higher risk also.
Mm-hmm. More UV exposure.
Real skin, real science, real confidence with Dr. Zane Hussein. Welcome to.
[00:00:23] Speaker 3: Welcome to Skin Side Out. I'm your host, Dr. Zane with Heather and Courtney. So May is Skin Cancer Awareness Month. So I think it's really important to go over how a complete full body skin exam should look like. And it's really important because skin checks are our. You know, way to monitor our patients, make sure that they are free of skin cancer and if there is something suspicious, you know, we take care of it so that, you know, we can help our patients, you know, avoid skin cancer or cure them.
We're gonna break down the anatomy of a skin check. So let's get right into it. What is a skin check?
[00:00:59] Speaker 4: skin check or a full body skin exam, or total body skin exam some people call it is where your dermatology provider is looking anywhere and everywhere you're comfortable with them looking to make sure your skin is healthy, make sure your moles look benign.
It is important to normalize annual skin checks because a lot of people don't know that. Um, we recommend doing. Annual for most people. Um, and I think there are a lot of people who are nervous about a full body skin exam, um, whether, you know, they're nervous about what the process looks like or just like, um, being in a little paper gown.
Um, so we'll kind of walk you through that to hopefully get you more comfortable.
[00:01:45] Speaker: What do you mean? It's not crazy to be nervous about undressing in front of people you don't know and exposing all of your medical history.
[00:01:53] Speaker 3: Yeah. So what can you expect when you arrive for your full body skin exam?
[00:01:59] Speaker: Medical history.
All of that is pretty pertinent information, especially if you have a family history. You definitely wanna disclose that, whether it's a family history, melanoma, or even like a non-melanoma skin cancer, such as basal squamous cell. Um, typically you'll get called back by the medical assistant who will put you in a gown.
Um, everywhere that I've worked, we've always. Had the gown open in the back. So normally they'll tell you to get undressed. I usually tell patients to keep their. Um, underwear on and then, you know, but everyone's different. Sometimes people actually come in like without any underwear and that's fine too.
Whatever your comfort level is, we're comfortable too. , And so skin to skin. Skin to skin. Where we
[00:02:39] Speaker 4: gonna look at it all day. Exactly. I I get a lot of, um, people who like will apologize for things like, oh, I'm so sorry I didn't shave my legs. I'm like, girl, I don't care. Yeah. And then like, I have a lot of people will apologize for not having their toes.
Done. And I'm like, I would rather you not have nail polish on. Yeah. I thank them for that. Yeah. Because then we can look at your nails, which I think is really important and people don't really think about. And some people you know, come in with makeup and that's totally fine. It's just harder to look at the skin that way.
[00:03:10] Speaker: Yeah. Or they'll come in like, I'm sorry I didn't put any lotion on today. Yeah. And it's like an older man and it's like, you haven't put lotion on in like six years. Like that is not one day missed. That's like a whole process.
[00:03:22] Speaker 3: you know about like normalizing it. I mean, we see it all. We see men, women, kids, and we do this all day long.
So there's nothing that's really gonna shock us.
[00:03:34] Speaker 4: Yeah. Yeah.
[00:03:34] Speaker 3: So, um, you know, just keep that in mind.
[00:03:38] Speaker 4: Just to, um, kind of like explain a little bit. You're not changing in front of people. Mm-hmm. We obviously like step out, let you undress and then, you know, prepare yourself and then we will come back in the room.
[00:03:51] Speaker 3: Yeah.
[00:03:52] Speaker: Yeah. Like a massage.
[00:03:54] Speaker 4: Yeah.
[00:03:56] Speaker 3: So now that we are ready for our skin exam, so what are the actual steps
[00:04:02] Speaker 4: every provider has their own systematic way of doing a full body skin exam. I've seen some people will have the patient lay completely down and start from like head to toe, then they flip over and then toes to head.
Um, I think we do it very similarly where we kind of. Start with the back of the scalp, work our way down, um, and then kind of toes forward too. Um, but every, every provider has their way of doing it to make sure that they're not missing anything. Um, so, you know, like I said, we'll look. Everywhere that you're comfortable looking.
Um,
[00:04:38] Speaker: and also, I was gonna add, there usually will be a medical assistant in the room. Yes. And that is kind of dually functioning. Number one, it's protecting the patient, it's also protecting the provider. but they also are documenting everything that the medical provider is seeing. So it's really important that that medical assistant is in there.
I think some people get a little freaked out about, yeah, I'm going in and I have. Yeah. This person who's just typing everything away and it feels really intimidating, but they are literally just tracking all of your moles and bumps and lumps and whatever, so that that medical note is really complete.
[00:05:11] Speaker 4: Mm-hmm. And I think, um, if there is something that you're concerned about or, um, nervous about, like if it's in a private area, the medical assistant can always turn around in the room. Mm-hmm. Yeah. Or step out. We do see, yeah, we do see that very commonly. And um, I think that makes people feel a little bit more comfortable.
[00:05:30] Speaker 3: Yeah. Um, what are some unusual areas that people are often surprised that we check? Um, so we talked about like, we do check, you know, the genital areas. Mm-hmm. Um, but between toes I find that mm-hmm. You know, patients are always shocked. Mm-hmm. I'm like, I've never had a skin check before that, you know, they checked before the to, but I'm like, skin cancer can occur there.
And I've had patients who've had skin cancer there.
[00:05:54] Speaker 4: Yeah.
[00:05:55] Speaker 3: Um,
[00:05:56] Speaker 4: years even in the hair.
[00:05:57] Speaker 3: Mm-hmm.
[00:05:57] Speaker 4: Yeah. People don't think about
[00:05:59] Speaker 3: Yeah. And in the mouth.
[00:06:02] Speaker 4: Mm-hmm. Mm-hmm.
[00:06:02] Speaker 3: You know, oral, um, you know, lesions can occur and then also in the back of the eye. So when I tell my patients, um, you know, just for health maintenance.
You know, if you're seeing your eye doctor, your dentist, if women are seeing their OBGYNs, it's really important that, you know, they get a thorough examination because they can sometimes see things that we can't see.
[00:06:25] Speaker: Mm-hmm.
[00:06:26] Speaker 3: So I always put that, um, you know, in my exam.
[00:06:29] Speaker: Yeah. What are you guys looking for during a skin exam? Lots of things.
[00:06:35] Speaker 3: Lots of things, everything. It comes with, you know, a lot of training and just doing a ton of skin checks. I mean, you're analyzing sometimes hundreds of lesions on a patient. Mm-hmm. You're looking for patterns, you're looking for, you know, unusual features you're looking for.
Um. Comparisons of lesions to other lesions. And you know, there's a lot that goes into it. And patients don't necessarily know that we're doing all this in our heads. Yeah. While we're looking. They're just thinking like, oh, you're just looking at me. Yeah. And you know, it didn't seem like you did anything.
I'm like, no, we're, we've been doing a lot actually. Yeah. And it took us years to be able to do this in an efficient manner. So what a patient may think of as a cursory look is actually a deep analysis of a lot of things going on in your skin, and not just lesions for, you know, that we're concerned about for skin cancer, but other things that we notice for your skin health and that can have other implications.
[00:07:35] Speaker 4: Yeah. Um, obviously we're looking for concerning things like skin cancer, but also, um, you know, we point out lots of genetic spots and, um, you might have growths that are very common and so, um, we kind of walk you through that process. But I think the classic way that people think about what we're looking for, especially for melanoma, is what we call the ABCDs.
these are. Criteria that we're looking for in moles to see, okay, is this a red flag? Should I biopsy this? What should I do? Um, so A stands for asymmetry. So if you were to cut the mole in half top versus bottom or left versus right, is it the same? Um, if not, could be a red flag. B is for borders. So if it's not, um, a nice circular border, if it's got kind of like wonky borders, that could be a red flag.
C is color. Um, so you can have two colors in a mole and it is typically fine, not always, but anything more than two could be a red flag, especially if it's, um, like it has this like white hue over it or potentially like bluish gray changes. Now there are some times. Benign moles that are bluish gray, but um, definitely more than two colors could be a red flag.
Um, d is diameter, so anything greater than six millimeters, which is about the size of a pencil eraser. Um, and then e is evolution. So something that's new or changing,
[00:09:09] Speaker 3: and these are very fundamental features. Yeah, this is something that you can do at home. Um, and you know, a lay person can follow these ABC Dees, but.
Skin cancer and melanoma don't always respect these. Yeah. Um, features. So that's where the nuance comes in. That's when, you know, when we're looking at lesions, we're doing a lot of analysis. We're often using a dermatoscope, which is a tool that helps us to magnify the pigment, the structures. We're looking at a lot of different structures under that polarized light.
And it does help us discern, you know, what are benign moles versus something that's more concerning and whether we need to biopsy it or not. So I do think that. Although this is a helpful framework, it's not, you know, dogma, but mm-hmm. You just have to be, you know, just following by the T. Um, and also there's some, you know, moles that have no color.
[00:10:02] Speaker 4: Mm-hmm.
[00:10:02] Speaker 3: A melan melanoma is extremely, you know, scary. Mm-hmm. I mean, just because it. The big, the biggest thing that we hear about melanoma is pigment, right?
[00:10:11] Speaker 4: Mm-hmm.
[00:10:12] Speaker 3: We don't expect it to be non pigmented.
[00:10:14] Speaker 4: Yeah. A lot of lesions don't read the textbook before they show up on your skin.
[00:10:18] Speaker 3: Yeah. Um, so melanoma's obviously something that we talk about a lot because it has a lot of fatal implications, but there are other skin cancers that we're looking for.
So, Courtney, what other skin cancers are we typically? Analyzing for,
[00:10:35] Speaker: so typically we're looking for basal cell, squamous cell skin cancers, um, precancerous spots called actionate keratosis, which can, um, develop into a skin cancer. Um, sometimes we're looking not at. Even the big picture of melanoma, but just atypical moles that might have some, um, you know, atypical features within the mole.
Um, I think sometimes people are always shocked because how basal cells and squamous cells can sometimes present, or, you know, sometimes they'll have a spot. I know we had a patient recently who thought she nicked herself with like a rose thorn and, you know, she comes back and it's still not healed.
Mm-hmm. And um, it ended up being I think, a basal, um, ba, a squama basal. Mm-hmm. So I, I think sometimes people are. A little shocked when a provider finds something and they're like, oh, this red spot. Like, that's nothing I've had, it's just a red spot. They kind of associate it with like a rash or, mm-hmm.
Just a mm-hmm. Yeah, a one off. But you'd be surprised to know, and then when that spot comes back is, you know, skin cancer.
[00:11:33] Speaker 3: So I had a patient I did most surgery on yesterday, who happens to be a physician. Who had thought this lesion on his forehead was due to like a car accident he was involved with.
Mm-hmm. Like five, six years ago. And it just, you know, never went away. He thought it was a shard of glass. From that. But the minute I look like, I'm like, that's not a chart of glass. That's, that's something that needs to be taken care of. So we biopsied it, came back as a basal cell and even doctors get fooled by it.
Um, you know, he was staring at it, it's like, like, like a target on the center of his forehead. Um, but, you know, thankfully, you know, we biopsied it and he's cured.
[00:12:13] Speaker: Mm-hmm. it's funny sometimes I feel like the things that patients are most concerned about mm-hmm. Are the things that we're like, yeah, that's, that's just a age spot.
But then it's like the things that they don't even think twice about. That's when you guys are like, Nope, we gotta biopsy that.
[00:12:27] Speaker 5: Yeah.
[00:12:27] Speaker 3: It's always a separate keratosis that they're,
[00:12:30] Speaker 5: yeah. They're so dark
[00:12:33] Speaker 3: and there are other rare tumors out there. So Merkel cell carcinoma. Um, sebaceous carcinoma. There's a lot of different, um, it's the D
[00:12:41] Speaker: 1D dermato or the
[00:12:44] Speaker 3: DFSP?
Yeah.
[00:12:45] Speaker: DFSP.
[00:12:45] Speaker 3: Yeah. Yeah. So there's a lot of them out there. So they could present very similarly and it really isn't until you do the biopsy and look under the microscope that you really establish the diagnosis.
[00:12:57] Speaker: Mm-hmm.
[00:12:59] Speaker 3: Um, so let's talk about some. Vocabulary nomenclature that we use, um, when we're doing our skin exams, sometimes we're, you know, obviously verbalizing our exams.
So what are some words that we typically use?
[00:13:10] Speaker: that throws patients off because they don't realize that the provider is, um, talking to the medical assistant so that they can scribe everything. And sometimes the patients are like, what language are you seeing? So that's really, again, just to help whoever is scribing make sure they're documenting all of those.
Those spots, but, um, benign is a good term that you wanna hear. Um, just meaning that it's not worrisome or not, um, you know, dangerous essentially nevus, which just means mole, um, or
[00:13:40] Speaker 4: nevi,
[00:13:41] Speaker: multiple moles, multiple. Um, separate keratosis, which are those genetic age spots, people call them barnacles. Um, I've heard all different wisdom
[00:13:50] Speaker 4: spots.
[00:13:51] Speaker: Wisdom spots, yeah. No one likes the term age spot. It's not fun.
[00:13:55] Speaker 4: Weeds in the garden of life.
[00:13:57] Speaker: I like that.
[00:13:59] Speaker 3: Oh, I never heard that.
[00:14:00] Speaker 4: Oh really?
[00:14:02] Speaker: I love hearing the names that patients come up with for like the sks because, and it's SK will abbreviate it, but yeah, what they come up with is always really funny.
[00:14:10] Speaker 4: Yeah.
[00:14:11] Speaker 3: Cherry and Omas are one of my favorites. 'cause it's so cute. Like those look like little cherry.
[00:14:15] Speaker 4: Yeah.
[00:14:16] Speaker: Yeah. People call those blood moles.
[00:14:18] Speaker 3: Oh
[00:14:18] Speaker: yeah. Sounds a lot more treacherous. Mm-hmm. But those are benign.
[00:14:22] Speaker 4: I do though, like if somebody has like one and it's a decent size, they often think it's a mole and then they're worried about it because it's red.
Yeah, yeah,
[00:14:33] Speaker 3: yeah. And then what is a biopsy? I mean, I think patients hear that term and then they get. Nervous. What does
[00:14:41] Speaker 4: that
[00:14:41] Speaker 3: entail? Yes.
[00:14:41] Speaker 4: A biopsy is where we're taking a portion of the skin to test for it and see what's going on. So typically we'll send it off to an outside pathologist and they'll, um, freeze the tissue and look at it under a microscope to be able to see what's going on at a deeper level.
[00:14:58] Speaker 3: Yeah, and that's typically what a shaved biopsy? Correct. Usually for most of them that are raised. But sometimes we perform, you know, punch biopsies as well. And, you know, in both instances it gives us more information to establish the diagnosis. And that's what I always explain to our patients. Like, it's always better to be safe.
Mm-hmm. Rather than, sorry. Um, especially if it's something that we're concerned about. Mm-hmm. Um, and I know that sometimes they're worried about a scar, but then I also remind them like it's better to have a scar mm-hmm. Um, than potentially having. You know, a skin cancer that can, you know, cause a lot of destruction, sometimes even death.
[00:15:36] Speaker 4: Yeah.
[00:15:36] Speaker: Yeah. I think people hear the word biopsy and you just kind of think to all these other more invasive procedures, but truly a skin biopsy is over. Before you know it, I think, um, you know, you're just locally dumping the area, so there's not any, um, like. You're not in there for hours. It's a very quick procedure.
I mean, maybe sometimes even like two minutes flat. So it's not as invasive as like maybe like some other biopsies. Mm-hmm. Are like a thyroid bio, like, you know, I mean people assume it's, or
[00:16:04] Speaker 3: breast biopsy.
[00:16:05] Speaker: Yeah. Yeah. They're like going deep in there, but it's a very superficial shape of just that top layer.
[00:16:10] Speaker 3: Yeah. Yeah. The beauty of the skin is very easily accessible. Yeah. Um, so we've done many skin exams. What are the most common. I guess things that patients are worried about when they're getting their skin exam, especially for the first time.
[00:16:26] Speaker 4: Yeah. I think we always get the question like, do I have to be fully undressed?
Or like, how far do I undress? And, um, you know, like Courtney mentioned, it's common for most people to, um, remove everything except your underwear. Mm-hmm. Um, some females do leave bras on, but, um, it's really whatever you're comfortable with. Mm-hmm.
[00:16:50] Speaker 3: What about those questions though? I didn't shave. It's fine.
It's fine.
[00:16:55] Speaker 4: Me either, girl. Yeah.
[00:16:58] Speaker 3: Um, what if I'm on my period
[00:17:00] Speaker 4: fine. Don't care.
[00:17:01] Speaker 3: Mm-hmm. And then what if I'm embarrassed about something on my skin?
[00:17:08] Speaker: Don't be.
[00:17:10] Speaker 3: I mean, it's a no judgment zone.
[00:17:12] Speaker 4: Yeah. No judgment. I think, you know, like Dr. Hussein mentioned, we've probably seen it. Um, we, I think we are in the room with patients during a very vulnerable time, and so it's very common for people to feel that way, but you're in a safe place.
[00:17:32] Speaker: For us, it's, this is every day. So, you know, I think patients don't realize that side of it in their head. We, I think as providers also always need to empathize that, yeah, this is their first time.
Mm-hmm. Like they have concerns, they're nervous. And even though this is something so typical for you guys, this is like a really, this could be like. Someone's like worst day of the week that they've been like fearing for the last week. Yeah. You know, oh, I really don't wanna go get this skin check. What if I have melanoma, yada yada.
So, but again, like also for people to realize that yeah, this is just a daily occurrence. Mm-hmm. Um, for us. So it's not even something we really think twice about.
[00:18:08] Speaker 3: Yeah. Yeah. And then I always try to avoid any type of shame. I don't want them to really harp on their own insecurities. I always try to like make it a positive experience mm-hmm.
For the patient. Mm-hmm. Um, you know. I never wanna dwell on anything that they may be insecure about. So that's something that I think is important.
[00:18:27] Speaker: Yeah. Yeah. And if your provider brings up, so I know sometimes you guys will bring up, like if someone is dealing with like foot fungus or like, you know, derm and rosacea and it's like, I think sometimes people don't wanna ask about those things, but like maybe they are bothersome or maybe they didn't think about it.
You know, maybe their scalps been itchy the last couple months. Or like
[00:18:46] Speaker 4: sweating,
[00:18:46] Speaker: excessive, sweating. That's something that a lot of people I think, don't realize. That they can ask their dermatologist about. And so I think, yeah, when, when we're able to bring up those conversations, it's just to really make the patient's life easier and um, treat those
[00:19:01] Speaker 4: And for them to know that there are treatments out there.
Exactly.
[00:19:03] Speaker: Yeah. Yeah. They don't have to suffer.
[00:19:05] Speaker 3: What about the common question? Um, I have a bunch of other skin issues. That I wanna talk about. How do we address that?
[00:19:14] Speaker: You have a 15 minute,
[00:19:16] Speaker 3: I mean, it's very difficult when you got
[00:19:17] Speaker 4: your hand on the handle.
[00:19:19] Speaker 3: It's, it's very difficult. Um, you know, especially like, I think it's really important to try to stay on time.
I mean, I know doctors are notorious for running behind, um, and. I really do like distinguishing like a full body skin exam from other dermatologic concerns so that we can offer you the best experience, the best care treatment plan out there. Um, it's hard to devote all that time if you want a thorough skin exam.
I won't have time to really.
[00:19:47] Speaker 4: Right.
[00:19:48] Speaker 3: Delve into other things unless we do have time with them. Mm-hmm. You know, it could happen, but I wouldn't expect to, I would just make another appointment. Yeah. So we could really talk about those in depth.
[00:19:58] Speaker 4: Yeah, I, I think I've seen a couple patients where they book a skin exam and then it's also a full body rash.
And so I think that's really difficult to do and I don't think you would get. A true full body skin exam if you do have a rash that takes up a large surface area because we can't see what's going on with all that inflammation there,
[00:20:26] Speaker: and you don't want like an unnecessary biopsy. Mm-hmm. I remember you had that patient last year who had a really bad rash across her body and we didn't know what was.
She had a large history of skin cancer, but we didn't know what was skin cancer versus what was the rash. And
[00:20:38] Speaker 4: yeah,
[00:20:39] Speaker: we wanted to clear up the rash because we didn't wanna just unnecessarily biopsy her. Yeah. And then it come back as rash. So sometimes the things, sometimes they can overlap, you know what things look like and Yeah.
I always tell rash people, especially if
[00:20:50] Speaker 4: they're like picked at or traumatized.
[00:20:52] Speaker: Mm-hmm. Yeah. Yeah. I always tell 'em, clear the rash and then, you know, get your skin checked. But
[00:20:56] Speaker 3: how long does a skin exam typically take?
[00:20:59] Speaker 4: About 10 to 15 minutes.
[00:21:00] Speaker 3: Yeah.
[00:21:01] Speaker 4: It should. It should. I think there are some places where it takes 30 seconds.
[00:21:05] Speaker 3: Mm-hmm.
[00:21:06] Speaker 4: Um, so just make sure you feel comfortable where you're going and, um, you're getting a thorough exam. I think I do get a lot of patients who thank me for taking the time and doing a thorough exam because I think they've had previous.
[00:21:21] Speaker 3: Yeah. And like I said, like I hear from a lot of patients, oh, I've never had my dermatologist look at my scalp.
Or in the buttock area or between the toes. Um, I didn't even know that was a thing.
[00:21:33] Speaker 4: Mm-hmm.
[00:21:34] Speaker 3: And that's really part of a true comprehensive skin
[00:21:38] Default_2026-04-15_2: exam.
[00:21:39] Speaker 4: Mm-hmm.
[00:21:39] Speaker 3: So you should be looking all over.
[00:21:41] Speaker 4: Yeah.
[00:21:42] Speaker 3: Yeah. All right. So how should a patient prepare for their skin exam? Um, you know, they're getting ready for their appointment.
What should they be doing?
[00:21:52] Speaker: I think no makeup, if you can. Um, I try to tell patients to avoid that just because, especially the face, if they're looking at any spots of concern, makeup can hide those.
[00:22:03] Speaker 2: Mm-hmm.
[00:22:04] Speaker: Um, nail polish, if you have any concerns on the nails or even I think just in general trying to avoid that toe polish, you know, before you go in.
Mm-hmm. Um, I think bringing up newer, changing moles, especially because sometimes. A provider's not going to point out every single lesion that you have because we would be there all day. Yeah. Um, and some people are especially lesioning, um, I won't even say moly 'cause some people are just covered in like Cherry and Omas or sks.
Mm-hmm. But, um, I think if you are concerned about specific spots, even during the exam when they're looking you over, if they scan that and they don't say anything. They're assuming it's benign, the patient. Mm-hmm. At that point, if you are concerned, then I would just say, Hey, like, that's right. That's fine.
Right. Um, so yeah, I think if you have any concerning moles, just making sure that you let your provider know is important.
[00:22:52] Speaker 4: Mm-hmm. Yeah. I'll oftentimes, like if, if they have multiple areas that they're worried about, I'll, you know, I'll just tell them when I get to that area. Yeah. Just point it out to me and we can talk about it.
Um. I think it's good to have either like a mental note of that or if you have photos of lesions and how they've been changing. That's helpful too. Um, I know we've mentioned that in a previous episode that photos, um. Are really helpful to see the chronologic pattern of a,
[00:23:25] Speaker 3: yeah,
[00:23:25] Speaker 4: of a spot.
[00:23:26] Speaker 3: Um, especially with patients who have a history of many atypical nevi or just funny looking moles.
Um, full body photography and mole mapping can be extremely helpful for discerning, um, those kind of changes as well.
[00:23:38] Speaker 4: Yeah. I think one thing we haven't mentioned, which is sometimes difficult to do but really, really helpful is getting previous records. Mm-hmm. Um, so if you've been to a different dermatology office and they've done biopsies, the most important thing that we can have is previous pathology.
We don't necessarily have to have every single visit note that they saw you for acne and shingles and yada yada, and a toenail. Mm-hmm. Um, whatever. But the biopsies are really helpful.
[00:24:06] Speaker: Yeah. And I would say getting your family history too. Mm-hmm. I mean,
[00:24:09] Speaker 4: yeah,
[00:24:10] Speaker: my parents are gonna kill me, but like, it's not, everyone has parents that disclose their history, um, medically, so.
Mm-hmm. I didn't even know that my dad had a skin cancer removed on his back until like last year. Mm-hmm. And this happened like years ago. Mm-hmm. So, like. I, yeah, I don't have any family history, but like I actually do. Yeah. Um, but it can just be helpful in like giving providers the full picture of things.
Especially like I said, a family history of melanoma. They might wanna be a little bit more cautious and if there is something that's changing there might be a little less hesitancy to biopsy it. So,
[00:24:40] Speaker 3: yeah. so how often should patients be checked?
[00:24:45] Speaker 4: mostly annually. Um, I think it depends on the skin type.
Mm-hmm. The age, your history. If you've had melanoma recently, then you should be getting skin exams every three months. Um, if you've had a basal or a squamous cell, that should be every six months for the first two years. Mm-hmm.
[00:25:04] Speaker 3: Are there patients that really don't need a skin check annually?
[00:25:08] Speaker 4: for darker skin types, you don't necessarily have to do mm-hmm.
Um, every year. Um, if you have a lot of moles, then I think it is safe to do, but some people do it like once every three years. It kind of depends on the person.
[00:25:23] Speaker 3: Yeah. Have you all had full body skin exams before?
[00:25:28] Speaker 4: Yeah.
[00:25:28] Speaker: Oh yeah. Heather just did mine like a month ago.
[00:25:31] Speaker 4: A month ago.
[00:25:31] Speaker: Oh, okay. My time's bad. I guess it was like three months ago.
You did it recently.
[00:25:36] Speaker 4: I feel like it was like almost a year ago. It was. Either way. We all the record. Have you?
[00:25:45] Speaker 3: That's my little secret.
[00:25:46] Speaker: Oh my gosh. Yeah. I've
[00:25:48] Speaker 3: never had a skin exam before.
[00:25:53] Speaker: Someone write the headline. That's crazy. And you're over here like preaching to these people.
[00:26:00] Speaker 3: I know. I know.
[00:26:01] Speaker: Like not even in school or anything. Like That's crazy.
[00:26:04] Speaker 4: Even when you were growing up. Well.
[00:26:06] Speaker 3: Would that dermatologist know?
[00:26:09] Speaker: No. Okay. Okay.
[00:26:13] Speaker 3: That is on my list, the 40 list.
[00:26:17] Speaker: Okay. It's coming up. It should have been on like your New Year's resolution list.
[00:26:21] Speaker 3: I think it was
[00:26:21] Speaker 4: years ago.
[00:26:22] Speaker: Yeah. Like 2010.
[00:26:26] Speaker 3: Yes. We'll get to that. Um. So the risk factors that do make us a little bit more worried, you know, the family history, sun exposure, I actually ask about burns. Mm-hmm. Like if you had like a blistering sunburn, because even like a single blistering sunburn increases your risk of melanoma.
[00:26:45] Speaker 4: Yeah. Much greater.
[00:26:46] Speaker 3: Mm-hmm. Also like I, like I talk about like occupation, because some occupations have. More sun exposure. So yesterday I did MOS on a patient who was a male carrier. She was out in the sun carrying male for decades and it gets multiple skin cancers.
[00:27:01] Speaker 2: Yeah.
[00:27:02] Speaker 3: Um, so that's something, pilots, they're at higher risk also.
Mm-hmm. More UV exposure. So I think that's always also important to, you know, note. Um, and then also just, you know, sports. You know, things like that, like lifeguarding in the past. Mm-hmm. Those are all things that oftentimes are associated with a lot of sun exposure
[00:27:23] Speaker: farmers.
[00:27:23] Speaker 3: Yep.
[00:27:24] Speaker 4: Mm-hmm.
[00:27:24] Speaker: Farmers,
[00:27:25] Speaker 4: do you think we're, you know, maybe towards the end of our careers, do you think we're gonna see less skin cancers?
I, I feel like a lot of younger people are like really in tune with their sunscreen use. Yeah.
[00:27:39] Speaker 3: But I'm also seeing a resurgence of tanning.
[00:27:42] Speaker 4: Mm mm-hmm.
[00:27:44] Speaker: And people not using sunscreen 'cause they think it's
[00:27:47] Speaker 3: Oh, toxic.
[00:27:47] Speaker: Yeah.
[00:27:48] Speaker 4: True. Yeah.
[00:27:48] Speaker 3: Yeah. So,
[00:27:49] Speaker 4: so probably not,
[00:27:50] Speaker 3: who knows? There's more awareness.
[00:27:52] Speaker 4: Yeah.
[00:27:52] Speaker 3: But also a lot of people doing things that aren't too smart.
[00:27:56] Speaker 4: Yeah.
[00:27:57] Speaker: And who knows, like with our ozone, like not to get into climate change, but like with the ozone, you know, more so when I was in
[00:28:02] Speaker 4: South Africa, I burned so quickly.
[00:28:05] Speaker: Yeah.
[00:28:05] Speaker 4: Yeah. Yeah. Yeah. But yeah,
[00:28:08] Speaker: I know, I, um, feel like I need to do like a topical chemo on my chest 'cause I just feel like I've had so many blistering sunburns
[00:28:15] Speaker 4: there.
Yeah. Yeah.
[00:28:18] Speaker 3: Um, all right, so let's end off with a real patient scenario. So patient comes in and they're coming in for a routine skin check and had a spot that they thought was nothing. So walk me through how we would handle this patient for a skin check.
[00:28:36] Speaker 4: Like if we pointed something out and we were worried about it and they mm-hmm.
[00:28:40] Speaker 3: Yep. Um, they thought it was like nothing, but we're worried about it.
[00:28:44] Speaker 4: Okay.
[00:28:45] Speaker 3: Mm-hmm.
[00:28:45] Speaker 4: I like to explain why I am worried about it, um, without getting like too scientifical. Um, I think a lot of. Trust with your provider, um, is very important. And so if we have a reason for why we feel like this spot and not the one right next to it, I think it is, um, very important to listen to what they have to say.
[00:29:17] Speaker: I think reassuring them that even if it does come back as a skin cancer, you know, we can treat it. We treat it there in the office for the most part. So I think just reassuring them that like. Almost like a, we'll get through it together, because sometimes I think people just get anxious, like they think.
Worst case scenario.
[00:29:35] Speaker 3: So now that you know what the anatomy of a skin exam is, I think hopefully it relieves some anxiety for patients who never had one before. Um, it really is. You know, a painless exam, unless we're doing like a biopsy. But it's really not that bad. And I think it's always empowering to have that knowledge and the reassurance.
Um, you know, and I know that there are always patients who'd rather not know than know because they just rather not know. Mm-hmm. And, you know, ignorance is bliss, but. I don't like that approach. Um, I think that if there's something that we can do that's relatively easy and can avoid future harm, I'm all for it.
[00:30:18] Speaker: Yeah., I don't think that we touched on, um, another very common procedure that we do during skin exams, but freezing with liquid nitrogen. Mm-hmm. Especially for like, um. I don't wanna say our older patients, but like people who have lived longer, um, sometimes your provider might whip out this shiny beautiful can and it's usually blue and silver and um, when they spray it, it looks like a gun and it's just liquid nitrogen, which treats the precancerous spots.
Um. It usually will have a little bit of like a so cold it burns feeling. But that is a, I feel like a common thing we usually will do during skin checks too. Yeah.
[00:30:53] Speaker 3: And we use it also on benign lesions, like se keratosis, warts.
[00:30:57] Speaker: Mm-hmm.
[00:30:57] Speaker 3: Um, skin tags, a variety of different things, but it is our handy tool.
[00:31:01] Speaker: Yeah. Don't be scared of the can.
[00:31:03] Speaker 3: Some people do get really scared of the They.
[00:31:05] Speaker: Yeah. They do
[00:31:05] Speaker 3: not. They even see it and
[00:31:06] Speaker 4: they're like, why'd you bring that in?
[00:31:08] Speaker: Yeah. They like immediately clock it and you're trying to hide it. You're like, no, it's okay. Hopefully we don't need this just stay case. Just in case it's, if I don't bring it, I'm gonna need it.
[00:31:16] Speaker 2: Yeah.
[00:31:16] Speaker 3: It does look a little menacing, doesn't it? Yeah.
[00:31:18] Speaker: Yeah,
[00:31:19] Speaker 3: yeah.
[00:31:19] Speaker 2: Yeah.
[00:31:20] Speaker: I had a provider that used to put a little like needle tip on there just so that like, oh, for more focal. Mm-hmm. Points and, but whenever she had a freezer, like a wart for kids, they would freak out because they thought that she was gonna like.
Stab him with the table. Oh, oh. She's like, this is not touching you. Like Yeah. Yeah.
[00:31:34] Speaker 3: I honestly think I've seen like an attending that by accidentally like poke them it. Oh,
[00:31:41] Speaker 4: wow.
[00:31:42] Speaker 3: Yeah. So, yeah, don't do that. You know, I have an idea. What if we got like, know little
[00:31:48] Speaker 4: holsters?
[00:31:48] Speaker 3: Yeah. That were like, oh my god, little animals or like, you know, something that like would be friendly and
[00:31:53] Speaker: that's a much better idea than your edible sunscreen.
[00:31:57] Speaker 4: Edible sunscreen,
[00:31:58] Speaker: yeah. He wants to market edible sunscreen, which I'm pretty sure the FDA is like, no, like you can't do that,
[00:32:03] Speaker 4: but, oh, like, like. Drug, a supplement that you take
[00:32:07] Speaker: because he says when he slithers his sunscreen on, he gets it in his mouth. And I said, that sounds like a very niche problem that I don't think anyone else has.
But I like the other idea. I think Pete's offices could use it. Yeah. Especially like for
[00:32:20] Speaker 3: warts. And then even adults could appreciate it. Like a
[00:32:23] Speaker: friendly little zebra that's like. Yeah. You know, something fun
[00:32:27] Speaker 3: Elmo.
[00:32:28] Speaker: Yeah.
[00:32:29] Speaker 3: Right. An axel lot.
[00:32:32] Speaker: An axel lot cookie monster. The possibilities are endless. Really?
[00:32:37] Speaker 3: Yeah.
Bluey comment, comment
[00:32:39] Speaker 4: your choice down
[00:32:40] Speaker 3: below.
[00:32:40] Speaker: Yeah.
[00:32:40] Speaker 3: Yeah. What would you want your, what your favorite liquid
[00:32:42] Speaker: nitrogen cover to be?
[00:32:45] Speaker 3: How about a dragon and like the Yeah. You know, the, the freezing kind of like, no,
[00:32:49] Speaker 4: I think the elephant's a good idea with like the trunk could be.
[00:32:51] Speaker: I like that. Yeah.
[00:32:53] Speaker 3: Or Olaf like.
Freezing coming outta it, it
[00:32:55] Speaker: or
[00:32:56] Default_2026-04-15_2: something
[00:32:56] Speaker 4: like
[00:32:56] Speaker: what? Let it freeze.
[00:32:57] Speaker 4: What could
[00:32:58] Speaker: let your SK go, let it go?
[00:33:00] Speaker 4: What could be the handle? Like the handle could be like something, I don't know. What the trunk of the elephant.
[00:33:10] Speaker: We're gonna get a whiteboard in tomorrow and start planning our recover ideas
[00:33:15] Speaker 4: get both.
It's
[00:33:15] Speaker: being patented so no one take it. It's trademarked.
[00:33:19] Speaker 3: All right, so now that we've gone through what a skin exam should look like, I do think that this should hopefully relieve some anxiety. Um, and this is an exam where you can speak with your provider, like if you have questions. You can ask your questions.
It's no judgment zone. Um, we're here to educate you and also make sure that you're safe and healthy. So there's no dumb questions. Ask away. Um, and if you're really concerned about something, you know, even if it's something that you know, you thought you've had for a while. Or, you know, just recently I've noticed, I mean, it's never a bad idea to just come in and get seen for that.
Um, I think having peace of mind is such a valuable thing. And I always, you know, I'm always shocked with like, these patients who've been worried about something for years and they were just worried just to come in because they didn't wanna face the reality. But it's just easier to have that sigh of relief.
Everything's okay.
[00:34:19] Speaker 2: Mm-hmm.
[00:34:20] Speaker 3: And if it's not okay, then we can do something about it and be proactive.
[00:34:24] Speaker: Mm-hmm.
[00:34:25] Speaker 3: Yeah. Yeah. any other final tips for our skin exams?
[00:34:28] Speaker: You can wear a lotion on the day of your skin exam. You can wear lotion.
[00:34:33] Speaker 4: Yeah, it's totally fine.
[00:34:34] Speaker: Yeah. It's encouraged.
[00:34:36] Speaker 3: Yes.
[00:34:36] Speaker 4: Yeah, so you don't take your sock off and it just flakes everywhere.
[00:34:42] Speaker 3: And if you've never had a skin exam like myself, make sure
[00:34:46] Speaker: Yeah. Practice what you preach.
[00:34:48] Speaker 3: Make sure she's in your board certified rheumatologist and their team.
[00:34:53] Speaker: I'm shook. I am genuinely like the one thing people are gonna get from this episode is like, oh. He didn't get. Yeah.
[00:34:59] Speaker 6: Well if he didn't, why should I?
[00:35:03] Speaker: Yeah, don't listen.
[00:35:04] Speaker 3: Yeah, don't listen.
[00:35:05] Speaker: Just go get it.
[00:35:08] Speaker 3: Yeah. So book your skin check and we're always happy to see you. Um, if you have any questions about skin exams, um, you know, drop some questions, um, below please like follow. But until next time, skin side
[00:35:21] Speaker 4: out out.