First Light Healthcare


GP Dr Paddy McLisky answers commonly asked questions about what happens in a skin cancer check, how ofter we should have our skin checked…



My name is Paddy McCluskey and I’m a GP working at Cape Byron Medical Centre.
I run the Skin Clinic here, and we do skin cancer checks, we do a head-to-toe checkups looking for anything suspicious that might have grown on people’s skin.
We also take biopsies, excisions, flaps and skin grafts if needed in the clinic.

Is skin cancer becoming more common?

I think it’s hard to say whether the skin cancer per capita is becoming more common given that there are a host of factors which affect the incidence of skin cancer, such as migration, genetics, the ozone layer, people’s habits, the seasons, the development of new products such as there is new sunscreens and things like that. Certainly, skin cancer detection has been increasing over recent years and this may be because we’re getting better and more efficient looking for skin cancer, rather than an increase in the disease itself.

Can sunscreen cause vitamin D deficiency?

So there was it’s a good question. There was some research done in Nambour in Queensland on this question and what they found was that if individuals apply their own sunscreen in the normal kind
of casual way that people just slap it on, it was helpful in protecting against skin cancer but it did not lead to a vitamin D deficiency.
However, they found that if they put people in with the laboratory technicians and they properly applied sunscreen very thoroughly over the skin that those people’s vitamin D levels did drop over time. Over the weeks and months that they went out with their daily sunscreen if it was applied in the lab their levels did go down. So there’s a potential for sunscreen to decrease vitamin D levels, but it’s important to remember that vitamin D, it’s very a very important vitamin but at the end of the day if you’re at a high risk of skin cancer you can always take a vitamin D supplement, whereas there’s no there’s no substitute for looking after your skin.

Can a biopsy cause skin cancer to spread through the body?

So the short answer to that is no. Essentially when you take a biopsy you’re often taking a small portion of a skin cancer. Now, this would stand for basal cell carcinomas and squamous cell carcinomas. Doctors do not always initially excise the entire lesion because they probably want to confirm first that it is actually a cancer.
Whenever we suspect a melanoma, we always try to remove the lesion in total so we can have a 100% of the lesion at the laboratory to make a very definite diagnosis of what it is.
If we do partial biopsies of the other cancers – squamous cell carcinomas, basal cell carcinomas – often that means we will take the blade and when we cut through the cancer and take a piece away.
Now, people often ask ‘well what if those cancer cells get into the bloodstream what would happen then?’, and what we know about cancer is that cancer will sometimes invade the bloodstream, but it can only do that when it’s developed enough mutation and enough attributes that allow it to survive in the bloodstream.
So, initially skin cells they just live on the skin, they can’t really go anywhere else for them to gain those abilities they need to mutate adequately and if they haven’t mutated that far when you do the biopsy, well you’re not going to suddenly push them into the bloodstream. To further confirm this, if you think around Australia every day there are hundreds if not thousands of biopsies on early skin cancers and we do not see those things spreading through the body.

How often should we have our skin checked?

So, the frequency with which we recommend skin checks does vary by age. I don’t routinely do skin checks on children unless there is a request from the family. I recommend that parents keep a really close eye on their kids’ skin; if they see any moles that look hard or out of place, they can bring their child in for a skin check at any time.
Usually we would recommend coming in if you have a family history of melanoma or if you’re concerned, or if your child does spend a lot of time in the sun, maybe around the beginning of puberty, so around the age of 11 or 12 and around the end of the teen years, so 18 or 19, would be two times where it might be a good idea just to do a general check.
In terms of adults, we would screen people based on their family  history and their personal history, their skin type, their occupation and their exposure.
So, for a person who has a dark skin type who may have recently moved to Australia, has never had much sun exposure and has no family or personal history of cancer, we might check them once every five years opportunistically.
However, for somebody with red hair and blue eyes who’s had a melanoma, whose family has had a melanoma, and they work out in the sun, we might see them every six months, so it really does vary based on those factors.

What happens in a skin check?

If you’ve never had a skin check it hopefully is not an intimidating thing, we usually do a check in underwear, so you wouldn’t need to be naked. It’s coming in to have a quick chat about your risk factors, you lie up on the bed and we look over the front of you; you roll onto your front and we look over the back of you, checking your hair, in your eyelids, in your mouth, behind your ears and then we can take images if we need to. If there are any moles we need to watch, or skin lesions we need to monitor, or if we need to do a biopsy, we can do that either on the day or, if you prefer, we could defer that to a later date.
We do bulk billing for healthcare card holders and pensioners and we’d love to see you.

By Cape Byron Medical Centre Team