A full body skin exam for skin cancer screening is offered to every patient who comes to Cinco Ranch Dermatology and is actually recommended for all new patients who have risk factors for skin cancer. Risk factors include a family history of skin cancer, sun exposure that has resulted in sunburns, any tanning bed history or smoking history, fair skin, numerous moles, lighter colored hair, and blue/green eye color. Even if you have none of these risk factors, a full body skin exam can give you some reassurance and also some answers about various spots on your skin. If you are coming in for a rash or acne, I sometimes cannot perform a full body skin exam because we will spending most of our time addressing those issues but please bring up your interest in a full body skin exam during your appointment if you feel you have the above risk factors. The full body skin exam is not something that can rushed through or quickly tacked onto the end of an appointment because I want to go slowly and meticulously over your skin to spot any skin cancers.
The full body skin check will include all visible skin. This involves examination of the scalp by parting the hair, full face, neck, chest, back, arms, legs, fingers, toes, nails, buttocks and genitalia. Most of the exam is done using a bright light but several lesions may also be checked with a specialized hand-held microscope called a dermatoscope. Photographs are frequently taken and kept securely in your medical record and will not be shared except if you request them be sent to your primary care physician.
The exam is done with your modesty in mind and with professionalism and respect. I always ask permission before moving forward with the exam and you are in complete control of what areas I exam, the pace of the exam, etc. I want you to be comfortable because I know it can be scary and off-putting to have a doctor look at you so thoroughly. While it may be awkward for you the first time, the reassurance of knowing that every part of your skin has been screened for skin cancer is worth it. Based on your skin exam, we can determine what frequency for follow up is appropriate for you.
I need sunscreen like I need water! The sun feels wonderful and is valuable source of Vitamin D. Unfortunately, UVA/UVB radiation from the sun is a carcinogen, just like smoking is. UVB is mostly responsible for sunburns while UVA is mostly responsible for sun damage, accelerated aging and the development of skin cancers. For many years, sunscreens only protected again UVB. We burned a lot less but we were still getting wrinkles, dark spots, and skin cancer! It is important to pick the right sunscreen as they are not all equal. My criteria for sunscreens include:
1) At least 30 SPF. It is pointless to put 5 or even 15 SPF. It does not give you adequate protection and you are short changing yourself with an inferior product. On the other hand, numbers that are very high (like 70 or 100) are not significantly better and give a false sense of security. The magic number seems to be at least 30.
2) Broad-Spectrum. This means that the sunscreen will cover both UVA and UVB. The best ingredients are zinc oxide or titanium dioxide. These are MINERAL sunscreens rather than CHEMICAL sunscreens (i.e. Avobenzone). They lay on the surface of the skin and act as a physical barrier rather than blocking the UV rays by a chemical mechanism. Mineral sunscreens also result in less skin reactions and are better tolerated by sensitive patients.
3) Water-resistant. If you are probably going to sweat some or especially if swimming. The package will tell you for how long the sunscreen is water-resistant (40 minutes, 80 minutes, etc) so watch the clock if you are swimming.
4) Cosmetically elegant. If you don't like it and don't enjoy putting it on, you won't use it and you might as well throw it away because it is taking up space in your bathroom.
5) Reapply, Reapply, Reapply. Even the best sunscreen that meets all the above criteria is naturally going to lose efficacy over time. A general rule of thumb is to reapply every 2 hours of sun exposure. Now even as a dermatologist, on a typical work-day, I'll apply in the morning and won't reapply every 2 hours. Take note, I work in an office with no windows yet I still put sunscreen on my face and neck every single day. If I'm going out after work, I'll reapply at that time. If you don't need a flashlight when going outside, you need sunscreen. UVA also penetrates glass so you need to think about that while in the car or sitting next to a window. On a sunny Saturday outside, you can bet I'll be putting it on at least every 2 hours, sitting in the shade, wearing a hat, etc.
6) Men: this goes for you, too! Sunscreen on the face daily is not just a ladies thing. Don't forget the top of your head if you don't have quite the protective layer there that you used to and you are not into wearing hats.
7) Where to put it: obviously the face needs protection every single day. The neck and chest tends to get neglected and I'm finding skin cancers there and heavy sun damage. The arms, especially the tops of the hands, which rarely get covered and thus are exposed constantly throughout your life.
There has been some criticism of sunscreen recently and even doubts that the sun is bad for your skin. I can only tell you what my experience is, seeing skin day in and day out, cutting out skin cancers on my patient's skin every single day. I can't make it through a day in my clinic in sunny Texas without diagnosing a skin cancer. Sun-damaged skin is not only not very pretty, it is significantly more at risk for developing these cancers. The evidence is crystal clear in support of sunscreen so I encourage you to take sun protection seriously or risk a cosmetically unappealing facial scar and leathery/wrinkled skin (at best) and at worst, your life.
My favorite sunscreens:
for dry facial skin and anti-aging: Elta MD UV Elements
for oily, acne-prone skin and rosacea: Elta MD UV clear
for the ultra-sensitive: Vanicream free and clear sunscreen
for babies: Babyganics mineral sunscreen, Cerave Baby, Elta UV Pure