Are You Skipping Skin Checks? Sun Damage Timing, Radiated Skin, and the Vulnerability Women Face at the Dermatologist

Spencer Moore:

I was sitting in my dermatologist's office last October for a consultation for IPL laser treatment. I'd had a biopsy on my nose earlier that year that fortunately came back normal, but she had recommended annual laser maintenance to help with prevention. And after she examined my nose and said we were all good to go to schedule the IPL, she asked me, When was last time you had a full body skin check? And honestly, I didn't know.

I'd had so many doctor's appointments for so many different parts of my bodies over these years that skin checks just hadn't really been on my radar. But I was so grateful she asked because if she hadn't, I probably wouldn't have scheduled one anytime soon. And that skin checked changed so much for me. What she found that day led me down a path that taught me things about my body, about sun damage, melanoma risks.

Things that I wish I'd known years before.

Because here's what I learned. I have found three significant barriers stopping women from getting skin checks, and they all very much matter. First, most women don't understand what sun damage actually does or how long it takes to show up on their skin. Second, if a woman has had chest radiation for breast cancer, there's a specific risk they probably don't know about. And third, and this is the one not many people even talk about.

Is that there's a very real barrier of vulnerability and shame that keeps women from getting their skin checked at all. By the end of this episode, you're going to understand all three. And more importantly, you're going to feel like you have permission and a way forward as you take care of your skin. Now let's go back to the skin check for a minute with my dermatologist. She did the full body.

And she started examining my breasts and found a small discolored spot on the underside of my left breast. Now, this was the breast I'd had early stage breast cancer diagnosis on maybe two years before. The skin had been radiated for 15 sessions. And she asked me, Was that spot there before the radiation? And I said, I I really don't know. The truth is, look, I'm 43 years old, I have natural breasts, and in order to see this part of my breast,

I would have to lift it up and look at it in front of the mirror, which honestly I hadn't been doing. And here's the thing: I am a breast health educator for the Know Your Lemons Foundation. I teach women how to do self-breast exams. And in that moment, I thought, I can't believe I haven't been checking my breast. Because I do check for lumps in the shower. And sometimes when I'm in front of the mirror, I check for dimples and things like that.

But I wasn't really lifting and looking. I wasn't being as thorough as I teach my students to be in my sessions. And that kind of sat with me for a bit. But, anyways, she moved on and said, Well, maybe we can monitor it and I don't know, I'll I'll think about it. So we finished the exam, I got dressed, and we were sitting at her desk to schedule the IPL when it hit me.

That I'd taken photos of my breast after the lympectomy and during and after the radiation sessions. And look, I'm really happy I did this. And I really suggest doing this if you are going through chest radiation. Because at the time I didn't really know it, but I was actually making a record of what was happening to my skin. So I frantically started swiping up and up in my photos on my phone, and there they were.

The photos of my radiated chest. And I saw that I did not have that spot. It was new within the past two years. So when I showed her the photo, she said, Okay, with that information, we have to biopsy this. And that's when I first learned that I would need a biopsy, and also when I started learning about something that I had never known before.

If you've had chest radiation for breast cancer, there is a higher risk of melanoma in that radiated skin. Now, the studies say that when breast cancer patients are treated with radiation, they have about a 37% increased relative risk of melanoma compared with the general population. And that's a scary number, but I want to put that into context for a second because there is a difference between relative and absolute risk.

So if a person's lifetime melanoma risk was say two to three percent, then that 37% increase might raise that to around 2.724%. Now that doesn't make this more or less important, but it's a good thing to know, and it's something that I had no idea about. Now here's something else that I had never learned about my skin, and that was that sun damage doesn't really work the way most of us think it does.

And I do believe that this is a huge barrier to women staying on top of sun damage and getting their skin checks done. When a lot of us were younger, we were out in the sun. Some of us went to tanning buds, some used tanning oil perhaps, but then we started learning more about sun damage and sun protection. Wearing sunscreen, the strength of UV rays, all of that. And when we know better, we tend to do better. So a lot of us started really protecting our skin.

We started wearing sunscreen and hats, and that's all a very positive thing. But unfortunately, it doesn't change the cellular damage that was done in the past. What's really interesting is that sun damage can take anywhere from a few years to several decades to show up as precancerous or cancerous lesions.

And you may be thinking, well, I don't really have that high of a risk because for the past ten years I've been staying out of the sun and I wear my hat and I put sunscreen on every day. That's just unfortunately not the reality of how skin evolves. I believe there's a large percentage of women that don't think they're at risk for these types of skin cancers because they have changed their skin extended their sun exposure habits and they think, I'm too young for that, or I'm never really in the sun anymore.

But here's what matters, get checked anyways, regardless of what you think your risk is.

Now I want to go back to the biopsy for a second, so I'm not leaving you hanging about how this has all played out. The biopsy came back as a severely atypical compound nevus, which on a spectrum of skin lesions is the next stop before melanoma. So, similar to my DCIS this was found early and was inexcised for wider margins within a few weeks, and those came back clean. For that, I'm very fortunate.

Now, what my doctor recommended at that time was for me to follow up with another dermatologist in the clinic to be scanned by the Foto finder. I'd never heard about this before, but it is a new technology that scans the body. It takes a record of what it finds, and then it can compare that data with your next scan. For me, I was recommended to do this annually. Now, in this scan, which was about four months after.

My initial spot was found on my breast. It did pick up another lesion that was suspicious. It was on the upper back part of my thigh. Again, an area that I really wasn't checking out in the mirror on a daily basis. The doctor recommended for it to be biopsied, and it was done in that same appointment. The results came back the same as the lesion on my breast.

It was a severely atypical compound nevus. I then had wider margins excised, and those did come back clean. So it was a very fortunate situation for both of these areas and the timing for when they were found. I have to say there were a lot of feelings around these biopsies and the wider margins. I think the breast lesion felt emotional because that breast has been through a lot. It's had surgeries and radiation and scans.

And mammograms and a lot of stitches. And it has been seen and handled by so many people over the years. So I think having another biopsy there just felt surprisingly sad. But I was actually more shocked by the lesion on my leg because the breast lesion was inside the radiated area. And as I learned, radiation can increase melanoma risk or cellular changes. So part of me thought maybe this was just.

Me being inside of those statistics. But the lesion on my leg really caught me off guard because it wasn't in a radiated area at all. And that biopsy and that excision left me quite deflated. But this is also part of preventative health care. Sometimes you stay on top of things and everything comes back fine. And sometimes something needs further treatment. And that doesn't mean the screening failed.

It actually means the screening worked. And for me, I would always rather know early than find out later. The biopsy on my leg also forced me to think about how much time I spent in the sun growing up. As a kid, as a teenager, in my 20s, I was out in the sun, at the pool, at the beach, using tanning oils. I lived in southern Florida for a time.

And I just really wasn't thinking much about the long term consequences of sun exposure and especially sunburns. It's uncomfortable to look back and realize that choices you made years ago can affect your health later in life. But I also think it's important to remember the culture many of us grew up in regarding regarding the sun.

Tanning was normalized. A tan was considered healthy and attractive and desirable. And most of us just weren't thinking about skin cancer in our teens and 20s. And that's actually why I want to tell you about a woman named Belinda Shipman. She is an incredible advocate in Australia who has gone viral for documenting her treatment with 5FU chemotherapy cream after years of significant sun damage and tanning bed use.

She openly shares what skin cancer prevention, treatment, and recovery really look like. And what I appreciate most about her story is her honesty and how angry she is at the fact that she didn't take care of her skin when she was younger. Because now she's very much dealing with the consequences of those decisions. But look, she's being proactive now. She's educating others about her journey. She's having articles published and she's advocating for skincare.

And even though she's angry, she's also compassionate. And this for me is very important because you can't change what you didn't know then, but you can decide what you do now.

So up until this point, I've talked about getting your skin checks, having biopsies, being educated. But I want to go back to the beginning of the episode where I told you I was at the dermatologist following up about the eye pale laser. Because that is the most important part of all of this, is actually getting to that appointment. My appointment wasn't originally scheduled for a skin check, it was the consultation.

But it's still so important that I was there and that I got that skin check done. I'm so grateful for that doctor for advocating for me in that moment, asking me to do it, because the truth is, skin checks are not the most fun thing for me.

I've had a complicated relationship with my body, and I don't really love having it exposed. In the second episode of this season, I talked about body shame and vulnerability and how there's huge barriers for female health. In the survey I did that accompanied that episode, I share these mind-blowing percentages of women who said that they have delayed preventative screenings because of body shame and being uncomfortable in front of their doctor.

And that is a very valid reason why many women are not making dermatology appointments and not getting their skin checked. And here's what I've learned about this barrier. It looks different for everyone. For some women, it's about the gender of the doctor. They might feel more comfortable with a female dermatologist instead of a male one. For other women, it's about the actual experience of the exam itself.

And that can even look different depending on where you live. My experience here in Europe was quite different from what I've experienced in the United States. When I went for my skin check here, I was basically just quite naked in front of a handful of people. They were all women, but there was still an element of vulnerability. They were putting pictures of my body on a big screen TV, showing me where we needed to monitor, marking different spots from the photo finder. And I have to be honest, seeing myself on that big screen.

And being examined so thoroughly, that exposure was challenging. But here's what I realized in that moment. This was me taking care of my body that I love. And yes, it was uncomfortable, but it was necessary. Now I've talked about how skin checks can be so uncomfortable, but here's the good news. There are options, and we tend to have a lot more of them than most of us think.

Things that you can say are, I'd prefer to wear a robe. You can say, can you drape me while you check different areas? You can say I'd feel more comfortable with a female doctor. And if that doctor can't accommodate you, you can find a different one.

And here's another thing I want to say. Most doctors have seen it all. They've seen all kinds of bodies, and they're usually not the ones that are uncomfortable. It's the patient. But if you can express that,

If you can use your voice and tell them what you need, it can really help lower that barrier so you get the care you deserve.

I'll mention that there are amazing apps out there now.

To help patients monitor their skin. You can take a picture of a concerning spot, and the app or the AI can tell you your level of risk or if you need to be seen in person by a physician.

Now I wouldn't recommend that this replaces an in-person skin check by a dermatologist, but it is something that you can do to be proactive. Getting a skin check is an act of self-care. It's an act of loving your body. And truthfully, any sort of advocacy towards your health is an act of self-love. And you deserve to do that in a way that feels okay for you.

So, as I wrap up, I want to share the biggest takeaways from this episode. Remember that you have options, you have a voice, and you can ask for what you need. And also getting your skin checked is an important act of advocacy for your body and your health. Tomorrow in the Hairy Chin newsletter, I will be sharing more about Belinda's story. And in the future, we are hoping to be able to collaborate on an episode together. So please stay tuned for that. You can sign up in the show notes for the free weekly newsletter, which is where I share the backstories to these episodes.

and helpful resources and links that I love. Thank you for being here today. I'll see you next week.