Q: I have a bone to pick with dermatologists. Why do skin doctors tell women to leave their underwear on during an exam for skin cancer? When I went to have my moles checked, I was told to leave my bra and panties on. I asked about this and was told that the doctor would pull the undergarments up and look underneath. I questioned the thoroughness of this and was told it was standard practice and was good enough. Well, it wasn’t. The doctor who checked me missed the mole under my bra which turned out to be melanoma. If I hadn’t examined my own skin before the appointment and mentioned my concern over that particular mole, the diagnosis would have been missed and I would have been left with a deadly cancer. Needless to say I changed to a skin doctor who’s not uncomfortable examining skin. Yes, it’s embarrassing to have someone look you over so closely, but I’d rather be embarrassed than dead. I’ve talked to other women who share this concern with their dermatologists. At the very least, a doctor should give a woman the option to fully undress or not. For me, when I leave the doctor’s office, I want to feel as if no mole has been left unseen. What are you’re thoughts on this?
A: I agree with you completely. A skin exam cannot be complete unless the patient is undressed. Yes, it can be uncomfortable to be nude in front someone other than a significant other or spouse, but if the physician is both respectful and competent with good bedside manner, the discomfort can be kept to a minimum.
I believe that in an effort to ease the embarrassment or discomfort that nakedness can cause, physicians agree and usually recommend that their female patients remain at least partially clothed during the exam. There is also the issue of inappropriate conduct or the accusation of inappropriate conduct that may arise. This is often why male doctors often ask female staff (usually a nurse) to remain present in the room whenever there are intimate examinations, such as at the gynecologist’s or dermatologist’s office. It can also ease the female patient’s tension by having a fellow female in the room.
That said, your suggestion of giving the patient the option is very fair. As you experienced, clothing can obscure skin lesions, making them easily missed. This can have potentially serious consequences such as your nearly undiagnosed melanoma.
In my opinion, you did the right thing in performing a prior self-examination, bringing up your concerns to the physician, and later finding a physician who was comfortable with your request. Open communication between patient and physician is vital.
