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Skin Screenings & Skin Safety--8 Questions with Dermatology Expert Melissa Wheeler, MPAS, PA-C

Melissa Wheeler, MPAS, PA-CMelissa Wheeler, MPAS, PA-C, is a board-certified physician assistant with the California Skin Institute. She has more than five years of clinical experience as a physician assistant specializing in both general and cosmetic dermatology. She encourages complete skin exams for all patients in the effort to decrease skin cancer and skin cancer mortality. Here, Melissa answers some important questions related to skin safety.

1. We've all been hearing more and more these days about skin checks and skin screenings. Why is it so important to get a skin screening with a trained medical professional?

If you're like most people, you may look at your skin from time to time, but you probably miss a lot of areas that an expert would look at more closely. Many patients I see come to me because of one particular skin concern, but then oftentimes I will notice something more worrisome that they didn't even know existed. So, it's always best to see a dermatology professional, who is trained to identify all types of skin problems. Plus, it's really difficult to check all areas of your skin--for instance, how well can you check your back, your scalp, or behind your ears? Because skin cancer is so common--one in five Americans will develop skin cancer in the course of a lifetime*--it's worth it to have your skin checked by an expert.

2. Can't primary care physicians do skin checks for patients?
It's true that some primary care physicians do a great job checking the skin as part of a physical, but others admit they aren't comfortable doing skin checks and don't typically do them for their patients. Certainly, if you have any family history of skin cancer or any risk factors, you should see a dermatologist.

3. How often should you have a skin screening?
The American Academy of Dermatology recommends one skin screening each year for adults age 40 and older, but if you have a personal history of skin cancer or a strong family history of skin cancer, you should have one done every six months and start at an earlier age. If you're under 40, talk with your physician about how much sun exposure you've had in your lifetime and any other risk factors, such as whether you've used tanning beds. That will help determine how soon you should start your skin screenings.

4. If you don't have any skin cancer risk factors--fair skin, lots of moles, history of skin cancer, history of sunburns/tanning/tanning bed use--should you still get a skin check?
Yes, you should have your skin checked regardless. Many people are surprised to hear that we often find melanoma--the most serious skin cancer--in patients with dark skin who don't usually burn or freckle. According to the Skin Cancer Foundation, African American and Asian American melanoma patients have a greater tendency than Caucasians to present with a more advanced disease at the time of diagnosis, which worsens their survival rate. As with other cancers, catching skin cancer early is much more likely to lead to a successful treatment.

5. What about sunscreens--what type should we use to protect our skin?
Always look for broad-spectrum protection (against both UVA and UVB rays), a high SPF rating and a "water-resistant" label. Many of my patients prefer sprays, which are OK, as long as you rub them in. And, check the date to make sure your sunscreen hasn't expired.

6. What about school-age kids? Should they use a daily sunscreen, even if they are in school all day?
Yes, and I think schools should do more to encourage sunscreen use. Excessive exposure to the sun at a young age raises your risk of skin cancer later in life. Here in California, kids often eat outside during lunch, so they could be out in the sun for two or three hours during a typical school day. Unfortunately, many schools don't have the resources to address sunscreen use, which is too bad.

7. Anything else you'd like to clarify, when it comes to skin cancer prevention?
I'd like to remind folks of the dangers of tanning beds. Many adults in our community still use tanning beds on a regular basis. And some tanning salons tell clients that their beds are "safe," or their rays are "safe," but that isn't true. There are no "safe" tanning beds. So I strongly advise all my patients to steer clear of them. (Note: The International Agency for Research on Cancer includes "ultraviolet tanning devices" on its list of the most dangerous cancer-causing substances, along with plutonium and cigarettes).

*Statistics from Skin Cancer Foundation "Fact Sheet"

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