In short. A whole-surface examination, a lens on any mark that has changed, a history of dose and medicines, and photographs that make the next visit a comparison.
Key points
- Burning in childhood and early adult life, years spent outdoors through work or sport, medicines that make skin light-sensitive, previous skin cancers, and whether a close relative has had one.
- These decide how closely the skin should be watched, and none of them can be read off the skin itself.
The assessment of sun-damaged skin is not a discussion in which a plan is offered. It is an examination with a sequence, and the sequence matters because each step decides something the next one needs. It takes minutes in person, and it cannot be replaced by a photograph, including a good one taken in the right light.
The whole surface, not the area of concern
The face is where the concern usually is, and it is rarely where the greatest cumulative dose has fallen. The examination therefore covers the scalp, the ears and the skin behind them, the neck, the upper back, the shoulders, the backs of the hands and the forearms. These are the sites that collect dose all year rather than on holiday, and they are also the sites people cannot see. Findings there are common, and they are found because somebody looked.
The lens, and what it settles
Any mark that looks irregular, that has changed, or that the patient is worried about is examined with a magnifying instrument carrying its own light. It shows the surface pattern and the vessels of the lesion at a level the eye cannot reach, and it is what allows a suspicious mark to be judged rather than removed on suspicion alone. It also allows an ordinary mark to be left alone, which is worth as much to the person carrying it.
The history is part of the examination
Burning in childhood and early adult life, years spent outdoors through work or sport, medicines that make skin light-sensitive, previous skin cancers, and whether a close relative has had one. These decide how closely the skin should be watched, and none of them can be read off the skin itself.
Photographs, so the next visit compares
Standardised photographs taken in the same light and from the same positions are a record rather than an illustration. For someone with many marks, or with change across a wide area, the comparison at the next visit is often more informative than the examination on the day, because it shows direction of travel.
What you should leave knowing
Three things: whether anything needs to be removed, watched or treated medically; what has changed and what has not; and which of the things you asked about treatment can improve, which it can only partly improve, and which it cannot reach at all. The assessment ends with a separation rather than a package.
Findings that shortcut the sequence
- A mark that has changed in size, shape, colour or height is examined before anything else.
- A lesion that bleeds, crusts, itches persistently or fails to heal is not treated as cosmetic.
- A new nodule on sun-exposed skin is assessed rather than treated off the surface.
Which findings need a doctor rather than a cosmetic plan is set out in when sun damage needs a doctor, and what the assessment leads to is described in what topicals can and cannot change.
Frequently asked questions
Why does the examination include skin I did not ask about?
Because the sites that collect the most dose over a lifetime are the ones a person cannot see: the scalp, the ears and the skin behind them, the neck, the upper back and the backs of the hands. Findings there are common, and they are found because they are looked for. Examining only the area of concern would answer the appearance question and miss the medical one.
What is the lens actually looking at?
The surface pattern and the vessels of a single lesion, at a level of detail the unaided eye cannot reach. It is what allows a suspicious mark to be judged rather than removed on suspicion alone, and it is equally what allows an ordinary mark to be left alone with confidence. Both outcomes depend on the same examination.
Why are photographs taken at an assessment?
So that the next visit can compare rather than remember. A recorded image taken in the same light and from the same position turns change over time into something that can be seen, which matters most for someone with many marks or with change across a wide area. Whether a mark has altered is often more informative than how it looks on any single day.
Risks & Limitations
- Damage already in the dermis is improved by treatment rather than removed by it, and the improvement fades while the exposure that produced it continues.
- Peels, light treatment and resurfacing can leave the treated skin darker or lighter than it was, and the risk is higher in darker skin tones.
- Resurfacing costs days to weeks of visible recovery, and redness often outlasts the healing.
- Skin with a large cumulative dose stays at raised risk of further lesions after treatment, which is why review continues rather than ends.
When to Seek Care
- A mole or patch that changes in size, shape, colour or height.
- A spot that bleeds without being knocked, crusts, itches persistently or fails to heal over a few weeks.
- A new lump or nodule on skin that has had a great deal of sun, particularly on the face, ear, scalp or lip.
- Persistent redness, scaling or roughness across an area of skin rather than in a single spot.
References & Further Reading
- American Society of Plastic Surgeons (ASPS) — procedure and safety guidance
- National Institute for Health and Care Excellence (NICE, UK) — relevant guidance
- Cochrane Library — systematic reviews
- Chinese Medical Association Plastic Surgery Branch — clinical guidance
This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.