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Dear Derm Authority: Full Skin Exam with No History – how do you handle?

On initial visits when patients state coming in for only “skin cancer screening”, and not aware of any issues, or requests “full skin exam” and no significant personal or family history, how do you handle these?

My office staff is great at briefing patients – We tell them to make sure to note any new or changing growths on the skin.   It is important to know your family history of melanoma and non-melanoma skin cancers – as they are different and convey different genetic risks.  Often, patients bucket all skin cancers as “melanoma” and this is not the case.

There is always a chance that will happen so I will still perform a mole check – evaluating the entire integumentary system (skin, hair, nails) for abnormal growths. Moles are pigmented skin lesions that can have malignant potential, but other skin lesions can also be malignant and not derived from moles- ex: basal cell, squamous cell, Merkel cell carcinoma.

Afterwards, we will probably do a follow up call to the patient to get their history. The standard of care is an annual exam. Some exceptions to this rule are if you have more than 100 pigmented lesions, a personal or family history of skin cancer, or have a history of blistering sunburns or extensive history of indoor tanning. If any of these apply, then your provider may encourage quarterly or biannual skin examinations.

So, as you can see, it is important that if a patient comes to you with no family history information or incomplete history, that you perform a thorough and complete mole check of the entire body of skin so that you can draw your own conclusions and start the baseline of filling in history for the patient.

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