› Forums › Cutaneous Melanoma Community › Follow up on MIS dx: Opinions on skin exams by dermatologist?
- This topic has 15 replies, 3 voices, and was last updated 9 years, 1 month ago by
ldub.
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- March 6, 2015 at 4:20 pm
I am newly diagnosed and will be having skin exams every three months for the time being. I am interested in opinions regarding your experiences and opinions regarding what constitutes an adequate/good/excellent skin examination by your dermatologist and whether I should seek out one who has additional training or expertise in melanoma skin cancer. Thanks!
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- March 6, 2015 at 5:52 pm
Honestly, I don't rely on my derm to find ANY cancer. I know my body best. I had baseline photos taken of my moles, and I can do my own checks comparing my moles against the pictures. I see a derm every 6 months (based on my 3 primaries), but I have found all my 3 primaries and expect to find any more if I get them. I know my body best. Anything that changes is removed. If it is stable, it stays.
So for you, I'd recommend photos for the "independent eye" they provide. As for the derm, I am not of the opinion that one is better than another. It's finding one who works WITH YOU that is the key. No derm can diagnose just from looking, and personally, that's not what I want anyway. I prefer someone who will utilize my photos. I'm not into unnecessary biopsies (neither is my melanoma specialist) so we only remove things that change verified by photo. My first two primaries were removed by a basic derm, I only moved to a specialist when I was sure I had a third. Many specialists don't even see those with in situ – so if it were me, I'd probably stay with the doc who worked with you and got that lesion removed. Again, I think pics are mandatory to peace of mind. WATCH FOR CHANGE, otherwise, live life!
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- March 6, 2015 at 7:15 pm
Hi Janner – I think this is great advice and agree. What I am wanting to know is exactly what constitutes a good general skin exam by a dermatologist? Does your doctor look at your photos, as well as do an close eyeball exam of your skin for things that you may have (though doubtfully because you are so diligent and experienced in monitoring your skin) accidentally missed? Does s/he use a dermoscope to minutely look at all of your skin even though you have your photographic evidence of no change? Is it cursory, looking for ugly ducklings that stand out even if no apparent "gross" change? The times I have been to my dermatologist, I have not gotten what I think is probably the "total" exam, meaning, looks between the toes, in areas where the sun doesn't shine, etc. I understand that I need to be on the front line, but I also think my doctor should be as vigilent as I am about looking at my skin surface – at a minimum as a backup – and I just dont know what the standard skin exam should include.
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- March 6, 2015 at 8:15 pm
My doctor doesn't use a dermatoscope unless we specifically point out a lesion as suspicious. He tends to wear a magnifying lens to get a good view (he is over 40 so would need reading glasses). He looks basically everywhere for ugly ducklings after asking me if I have any concerning lesions. All in all, it takes about 5 minutes for a complete exam when I have nothing of interest to report. I don't have a ton of moles but my back is a maze of dark freckles from years gone by before melanoma. It's the hardest area for me to monitor. Some docs are more thorough than others. Some docs won't check private areas unless you ask. My feeling is TELL YOUR DOC what you think is acceptable. Make sure you strip down so it makes things easier. I think most docs will look at anything and everything if you express that this is what you want for YOUR exam. I've had different docs and everyone has their own method. I just make sure I point out my areas of concern first, then let them have a looksy in case I have missed something. TALK TO YOUR DOC and make your wishes known. That's the best relationship you can have — and most docs will work with you if they understand what you want.
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- March 6, 2015 at 8:15 pm
My doctor doesn't use a dermatoscope unless we specifically point out a lesion as suspicious. He tends to wear a magnifying lens to get a good view (he is over 40 so would need reading glasses). He looks basically everywhere for ugly ducklings after asking me if I have any concerning lesions. All in all, it takes about 5 minutes for a complete exam when I have nothing of interest to report. I don't have a ton of moles but my back is a maze of dark freckles from years gone by before melanoma. It's the hardest area for me to monitor. Some docs are more thorough than others. Some docs won't check private areas unless you ask. My feeling is TELL YOUR DOC what you think is acceptable. Make sure you strip down so it makes things easier. I think most docs will look at anything and everything if you express that this is what you want for YOUR exam. I've had different docs and everyone has their own method. I just make sure I point out my areas of concern first, then let them have a looksy in case I have missed something. TALK TO YOUR DOC and make your wishes known. That's the best relationship you can have — and most docs will work with you if they understand what you want.
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- March 6, 2015 at 8:15 pm
My doctor doesn't use a dermatoscope unless we specifically point out a lesion as suspicious. He tends to wear a magnifying lens to get a good view (he is over 40 so would need reading glasses). He looks basically everywhere for ugly ducklings after asking me if I have any concerning lesions. All in all, it takes about 5 minutes for a complete exam when I have nothing of interest to report. I don't have a ton of moles but my back is a maze of dark freckles from years gone by before melanoma. It's the hardest area for me to monitor. Some docs are more thorough than others. Some docs won't check private areas unless you ask. My feeling is TELL YOUR DOC what you think is acceptable. Make sure you strip down so it makes things easier. I think most docs will look at anything and everything if you express that this is what you want for YOUR exam. I've had different docs and everyone has their own method. I just make sure I point out my areas of concern first, then let them have a looksy in case I have missed something. TALK TO YOUR DOC and make your wishes known. That's the best relationship you can have — and most docs will work with you if they understand what you want.
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- March 6, 2015 at 7:15 pm
Hi Janner – I think this is great advice and agree. What I am wanting to know is exactly what constitutes a good general skin exam by a dermatologist? Does your doctor look at your photos, as well as do an close eyeball exam of your skin for things that you may have (though doubtfully because you are so diligent and experienced in monitoring your skin) accidentally missed? Does s/he use a dermoscope to minutely look at all of your skin even though you have your photographic evidence of no change? Is it cursory, looking for ugly ducklings that stand out even if no apparent "gross" change? The times I have been to my dermatologist, I have not gotten what I think is probably the "total" exam, meaning, looks between the toes, in areas where the sun doesn't shine, etc. I understand that I need to be on the front line, but I also think my doctor should be as vigilent as I am about looking at my skin surface – at a minimum as a backup – and I just dont know what the standard skin exam should include.
-
- March 6, 2015 at 7:15 pm
Hi Janner – I think this is great advice and agree. What I am wanting to know is exactly what constitutes a good general skin exam by a dermatologist? Does your doctor look at your photos, as well as do an close eyeball exam of your skin for things that you may have (though doubtfully because you are so diligent and experienced in monitoring your skin) accidentally missed? Does s/he use a dermoscope to minutely look at all of your skin even though you have your photographic evidence of no change? Is it cursory, looking for ugly ducklings that stand out even if no apparent "gross" change? The times I have been to my dermatologist, I have not gotten what I think is probably the "total" exam, meaning, looks between the toes, in areas where the sun doesn't shine, etc. I understand that I need to be on the front line, but I also think my doctor should be as vigilent as I am about looking at my skin surface – at a minimum as a backup – and I just dont know what the standard skin exam should include.
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- March 6, 2015 at 5:52 pm
Honestly, I don't rely on my derm to find ANY cancer. I know my body best. I had baseline photos taken of my moles, and I can do my own checks comparing my moles against the pictures. I see a derm every 6 months (based on my 3 primaries), but I have found all my 3 primaries and expect to find any more if I get them. I know my body best. Anything that changes is removed. If it is stable, it stays.
So for you, I'd recommend photos for the "independent eye" they provide. As for the derm, I am not of the opinion that one is better than another. It's finding one who works WITH YOU that is the key. No derm can diagnose just from looking, and personally, that's not what I want anyway. I prefer someone who will utilize my photos. I'm not into unnecessary biopsies (neither is my melanoma specialist) so we only remove things that change verified by photo. My first two primaries were removed by a basic derm, I only moved to a specialist when I was sure I had a third. Many specialists don't even see those with in situ – so if it were me, I'd probably stay with the doc who worked with you and got that lesion removed. Again, I think pics are mandatory to peace of mind. WATCH FOR CHANGE, otherwise, live life!
-
- March 6, 2015 at 5:52 pm
Honestly, I don't rely on my derm to find ANY cancer. I know my body best. I had baseline photos taken of my moles, and I can do my own checks comparing my moles against the pictures. I see a derm every 6 months (based on my 3 primaries), but I have found all my 3 primaries and expect to find any more if I get them. I know my body best. Anything that changes is removed. If it is stable, it stays.
So for you, I'd recommend photos for the "independent eye" they provide. As for the derm, I am not of the opinion that one is better than another. It's finding one who works WITH YOU that is the key. No derm can diagnose just from looking, and personally, that's not what I want anyway. I prefer someone who will utilize my photos. I'm not into unnecessary biopsies (neither is my melanoma specialist) so we only remove things that change verified by photo. My first two primaries were removed by a basic derm, I only moved to a specialist when I was sure I had a third. Many specialists don't even see those with in situ – so if it were me, I'd probably stay with the doc who worked with you and got that lesion removed. Again, I think pics are mandatory to peace of mind. WATCH FOR CHANGE, otherwise, live life!
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- March 7, 2015 at 4:50 pm
My first derm was veru superficial. Even though he was the one that biopsied my primary (telling me it was nothing), he would spend perhaps a minute looking at my upper body only. I quickly realized I needed a new one.
My new derm is much more thorough. I asked him early on about grid photography (which I first heard about here on this board) and he thought it would be a good idea. I am covered in moles. I hvae hundreds of them.
His exams take about 10 to 15 minutes. He always has the stack of photos handy and I think he goes through them all. He looks where the sun don't shine.
The grid photos did not include the top of my head (not sure why) which is the location of my primary. My derm found a recurrence up there in the form of two new small nevi which proved to be melanoma.
I trust my derm and I feel very lucky to have found him. This is very important to my peace of mind.
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- March 7, 2015 at 4:50 pm
My first derm was veru superficial. Even though he was the one that biopsied my primary (telling me it was nothing), he would spend perhaps a minute looking at my upper body only. I quickly realized I needed a new one.
My new derm is much more thorough. I asked him early on about grid photography (which I first heard about here on this board) and he thought it would be a good idea. I am covered in moles. I hvae hundreds of them.
His exams take about 10 to 15 minutes. He always has the stack of photos handy and I think he goes through them all. He looks where the sun don't shine.
The grid photos did not include the top of my head (not sure why) which is the location of my primary. My derm found a recurrence up there in the form of two new small nevi which proved to be melanoma.
I trust my derm and I feel very lucky to have found him. This is very important to my peace of mind.
-
- March 7, 2015 at 4:50 pm
My first derm was veru superficial. Even though he was the one that biopsied my primary (telling me it was nothing), he would spend perhaps a minute looking at my upper body only. I quickly realized I needed a new one.
My new derm is much more thorough. I asked him early on about grid photography (which I first heard about here on this board) and he thought it would be a good idea. I am covered in moles. I hvae hundreds of them.
His exams take about 10 to 15 minutes. He always has the stack of photos handy and I think he goes through them all. He looks where the sun don't shine.
The grid photos did not include the top of my head (not sure why) which is the location of my primary. My derm found a recurrence up there in the form of two new small nevi which proved to be melanoma.
I trust my derm and I feel very lucky to have found him. This is very important to my peace of mind.
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Tagged: cutaneous melanoma
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