It was particularly scorching on the day I planned to get my first skin check. I walked outside and felt the heat coat my skin, covering every limb in a soft wash of sweat. Mixed with the layer of SPF 50 I'd furiously applied that day, you know, for optics, I was drenched. And I was nervous. Skin checks are rightfully ubiquitous in 2019— so much so, I was met with concerned stares and animated jaw-drops each time I let it slip I'd never had one. And, as a beauty editor, that harsh reality felt even more humiliating.
According to Elizabeth Goldberg, MD, a board-certified dermatologist practicing in New York City and a spokesperson for The Skin Cancer Foundation, everyone is susceptible to skin cancer, regardless of age, gender, race, or skin tone. "One in five Americans will develop skin cancer by the age of 70," she told me, meaning almost everyone will know someone who has experienced the disease, even if they don’t get it themselves.
Rather than make a gratis appointment in a fancy office, I set out to have a different kind of experience that day. The Skin Cancer Foundation provides free screenings in an RV in approximately 17 different cities during the summer. Called Destination: Healthy Skin, the program allows for those without health insurance to get checked on their own time schedule. This season, the foundation hosted 34 screening events and reached 30,000 people. And I was one of them. I waited for about 15 minutes in a line that was far shorter than I expected.
The RV was stationed in Columbus Circle in New York City. After filling out a few pages of paperwork, I was whisked to the back to start my appointment. I met Dr. Goldberg, a woman so kind in the eyes I almost forgot the creeping fear I'd felt all morning. Almost. The fact is, I do know a few people who have been affected by skin cancer and I'd spent a lot of time lubing my body in baby oil as a teenager. I all but expected her to find something on my body.
I undressed and slid into one of those infamous blue gowns. It was backless and quite drafty, naturally. Goldberg inspected my body from the back first, having me reposition myself every few seconds so she could get a better look. Then, we swapped the opening of the gown to the front, and she began her meticulous check again. I kept taking long, calming breaths as to not show my accelerating panic. "You're good to go," she said after about 10 minutes, smiling up at me while the front half of my naked body was exposed.
I breathed a sigh of relief, finally revealing that this was, in fact, my first check. "You have three freckles on your entire body," she said, warmly, assuring me there was absolutely nothing to worry about. To be safe, I pointed out a mole on my thigh. I told her I'd had it for my entire life but that years ago I noticed the shape change a bit. "I saw that, she said. It's nothing to worry about." And with that, I got dressed. It was that easy. The entire experience was as comfortable as it could possibly be (for something that includes taking off all your clothes in front of a stranger).
I was thankful that I went and even more so that the results were so positive. Still, I wanted to know more about what she was looking for and what she'd have to do if she noticed something more concerning on my body. Below, find her thoughts.
On why she decided to get involved with the program...
"I’ve seen people of all ages with melanoma and non-melanoma, and catching it early can be live saving. That’s why programs like Destination: Healthy Skin are so important. Spreading information about sun protection and skin cancer warning signs really can save lives," Goldberg told me.
On what to expect when you come in...
"The skin cancer screenings are completely free to the public and anyone is welcome to show up when the RV is in their town," she says. "It is important to note, however, that the screenings are provided on a first-come, first-served basis, so it is best to arrive early. Upon arrival, the participant is given a brief patient form to fill out and bring into their exam with them. This helps the doctor mark down any findings," Goldberg explains. "After a thorough, head-to-toe exam, the doctor notes any findings on the form and makes recommendations for next steps, which may include a formal visit to a dermatologist for further treatment or a biopsy," she says.
Goldberg also suggests removing any nail polish and makeup in advance, making sure to let your doctor know if you have a personal or family history of skin cancer, and pointing out any spots that are new or have changed. The exam takes approximately 10 minutes.
On what doctors actually look for...
"Dermatologists participating in the Destination: Healthy Skin program screen patients to identify the most common type of skin cancers. This includes basal cell carcinoma (BCC), squamous cell carcinoma (SCC), melanoma and pre-cancer, actinic keratosis," explains Goldberg. "Dermatologists will also be looking for rare but dangerous types of skin cancer such as Merkel cell carcinoma and acral lentiginous melanoma. As board-certified dermatologists, we look for skin growths that increase in size or shape and appear pearly, translucent, tan, brown, black, or multicolored; spots or sores that continues to itch, hurt, crust, scab, erode, or bleed; open sores that haven't healed within three weeks, and changes in existing moles," she says.
On how often you should get checked...
"Skin cancer that is not caught or treated early can spread to other parts of the body, where it becomes hard to treat, leading to disfigurement and potentially death," Goldberg warns. "That’s why it’s so important to see a dermatologist once a year for a professional skin exam, and to check your skin once a month, head-to-toe, so you’re aware of any new or changing moles. If you notice anything new, changing, unusual, or you simply don’t like it, get it checked by a dermatologist immediately. If you’ve had skin cancer, your dermatologist may recommend you come in two to three times a year to monitor for potential recurrences."
On how to check yourself...
"The Skin Cancer Foundation recommends everyone practice monthly head-to-toe self-examinations, so they can find any new or changing lesions that might be cancerous or precancerous," Goldberg shares. "Performed regularly, self-examinations can alert you to changes in your skin and aid in the early detection of skin cancer. It should be done often enough to become a habit, but not so often as to feel like a bother." she says, adding, "For most people, once a month is ideal, but ask your doctor if you should do more frequent checks.
There are three main types of skin cancer: basal cell carcinoma, squamous cell carcinoma, and melanoma. Because each has many different appearances, it is important to know the early warning signs. Look especially for change of any kind. We often recommend the A.B.C.D.E. guideline (asymmetry, border, color, diameter, and evolving). Do not ignore a suspicious spot simply because it does not hurt. Skin cancers may be painless, but dangerous all the same. If you notice one or more of the warning signs mentioned previously, see a doctor right away, preferably a board-certified dermatologist."
On the best ways to prevent skin cancer in 2019...
"Skin cancer is highly preventable if you make sun protection a daily habit," laments Goldberg. "Clothing is the first line of defense against skin cancer, so cover up with long sleeve shirts and pants whenever possible. Wear a broad-brimmed hat to protect your scalp, neck and ears. Hats provide some protection for your eyes, but UV-blocking sunglasses provide the most effective protection. Choose a pair large enough to shield your eyes, eyelids, and surrounding areas. Wrap-around styles, with UV-protective side shields, are best," she says.
Goldberg continues: "Second, use a broad spectrum, SPF 15 or higher sunscreen every day. For extended time outdoors, choose a water-resistant sunscreen with an SPF of at least 30 or higher. It’s important that your sunscreen is labeled 'broad spectrum,' which means it protects against UVB and UVA rays. Finally, seek the shade, especially between 10 a.m. and 4 p.m. when the sun's rays are strongest."
FYI: The Skin Cancer Foundation has also launched a multiyear public service campaign called The Big See meant to empower people to take a proactive approach to skin cancer detection. Head to the link above to find out more about the initiative.