Dermatologists routinely perform a Total Body Skin Exam (TBSE), or skin cancer screening, as a standard part of preventative healthcare. This visual examination involves a thorough check of the entire skin surface, including the hair and nails, to look for suspicious growths or lesions. The primary goal of this procedure is to identify early signs of skin cancer before they become difficult to treat. This screening process is a foundational tool for monitoring skin health over time.
The Purpose of a Skin Examination
The central reason for a professional skin examination is the early detection of skin cancers, including melanoma, basal cell carcinoma, and squamous cell carcinoma. When these conditions are identified in their initial stages, treatment options are simpler and more effective. Dermatologists are trained to distinguish between a harmless mole or freckle and a potentially malignant lesion.
To aid detection, dermatologists rely on the standardized “ABCDE” rule, a set of visual criteria particularly used for melanoma. This mnemonic helps classify moles that exhibit concerning features. “A” stands for Asymmetry, meaning one half of the mole does not match the other half in shape.
“B” represents Border irregularity, where the edges are ragged, notched, or blurred rather than smooth. “C” refers to Color variation, indicating multiple shades of black, brown, tan, or areas of white, red, or blue within the lesion. “D” is for Diameter, typically noting lesions larger than six millimeters (about the size of a pencil eraser), though melanomas can be smaller.
The most telling sign is “E,” which stands for Evolving, meaning any change in size, shape, color, or elevation, or the development of new symptoms like bleeding or itching. By checking for these criteria, the physician can flag precancerous lesions and malignant growths that require further investigation.
What Happens During the Total Body Skin Exam (TBSE)?
The Total Body Skin Exam (TBSE) is a systematic procedure that usually takes about 10 to 20 minutes, though it can be longer depending on the number of moles present. Patients are asked to undress completely and put on a medical gown, which allows the dermatologist access to the entire skin surface. This preparation is necessary because skin cancers can appear anywhere, even in areas not exposed to the sun.
The examination begins with the physician methodically inspecting the skin from head to toe. They check the scalp by parting the hair, look behind the ears, and examine the face and neck. The physician will proceed to inspect the torso, arms, legs, and hands, paying close attention to the palms, soles of the feet, and between the toes.
During the inspection, the dermatologist frequently uses a specialized handheld device called a dermatoscope. This instrument provides bright light and magnification (often up to 10 times), allowing the physician to see subsurface structures and patterns within a mole not visible to the naked eye. The dermatoscope improves the accuracy of differentiating between a benign growth and an early skin cancer.
If a suspicious lesion is identified that meets the ABCDE criteria or has concerning dermoscopic features, the physician will discuss the next step. This usually involves a skin biopsy, a quick, in-office procedure where a small sample of the lesion is removed after local anesthesia. The tissue sample is then sent to a pathology lab for microscopic analysis to confirm whether cancerous or precancerous cells are present.
Determining Your Recommended Screening Frequency
The recommended frequency for a professional skin cancer screening is not universal; it is a personalized schedule determined by an individual’s specific risk factors. For the average adult with no history of skin cancer and minimal risk factors, a professional Total Body Skin Exam once per year is advised. This annual check establishes a baseline for the skin and allows tracking any changes over time.
A higher frequency is often recommended for individuals who possess certain risk factors that increase their susceptibility to skin cancer. A personal history of any type of skin cancer (including basal cell carcinoma, squamous cell carcinoma, or melanoma) necessitates a screening every three to six months. Similarly, a strong family history of melanoma in a first-degree relative prompts more frequent monitoring.
Other physical characteristics and exposure history also influence the schedule. These include:
Risk Factors Influencing Screening Frequency
- Fair skin that burns easily.
- Light-colored eyes, red, or blonde hair.
- A high number of moles (over 50).
- History of excessive sun exposure or blistering sunburns.
- Past use of tanning beds.
Individuals with these factors may be advised to have a professional exam every six months. The dermatologist uses this data to tailor a surveillance strategy for early detection.