Life is busy. We all have commitments that dominate our time: project deadlines, work meetings, social outings, PTA, orthodontic appointments for the kids, vet visits for the pets… the list goes on and on. A skin check just feels like one more thing to add to the list. Is it really worth the interruption to the scheduling chaos?
Patients often are torn between desiring a quick appointment and wanting to make sure that I am thorough. How long should a complete skin examination really take anyway?
One of my mentors used to say that it takes him 90 seconds. That sounded pretty fast, so I did some research and found out that the time required to complete a full body skin exam has actually been studied. In 8 different melanoma clinics around the world, dermatologists were timed doing over 1500 exams. When doing a head to toe uninterrupted exam, it took just over a minute. When dermoscopy was added (a special type of skin microscopy that I routinely use), the time doubled. It is important to note that the genital areas and scalp were not included unless requested by the patient.
So I started trying to keep track of the time it takes me. Given that the whole exam takes just a few minutes, I also decided to see how much extra time it takes to include the scalp (I still only examine the genital areas if a patient requests it).
About 3 minutes. It really does just take about 3 minutes to do the exam. You don’t have to be a speed demon either, my pace was still rather leisurely. I can’t really do it in the 2 minutes that was reported in these melanoma clinics, but I think that the reason is because these clinics will see 100 patients with history of melanoma in a single day, and usually ONLY see melanoma patients that day so you do get quite speedy doing the same thing over and over again.
It still seems like a short amount of time, but this is what years of training and experience gives you. A good dermatologist ought to be able to do this in just a few minutes. It made me think: It takes me about 30 minutes to change my own oil, but Jiffy Lube can do it in about 5. Is my 30 minute oil change better or more thorough? Not at all. I usually stain my clothes, leave an oil stain on the driveway, and hopefully don’t burn myself reaching around the exhaust manifold to get to the oil filter. Even in my own world of medicine, if you came to me to have your annual physical done, I would take twice as long and still be not as good as my neighbors in the building who practice family medicine because as a specialist I focus on the skin whereas they listen to heart and lungs and palpate the liver the spleen on many patients each day. So I can do a much better skin exam than they can, and it will take me a fraction of the time it will take him. But if you ask me to do their job, I will be slower and less good. It would be even worse if you asked me to do your job.
But 3 minutes of focused time to look at your skin is all I need to find a cancer that could potentially kill you.