Dr. Kevin Most: Skin Cancer
Each year we take a few minutes to remind us all about the most common cancer in the world and what we can do to prevent it or at least minimize our chances of getting it. That cancer is skin cancer. Skin is the largest organ in our body and is also the most important organ when it comes to prevention of infections. The American Academy of Dermatology website is a great resource and their program “Spot Skin Cancer” is the place to get great information.
We need to understand that Tanning is not healthy!! Yet even today we will see someone with a tan and comment how healthy they look when in fact it should be just the opposite. The individual with non-tanned skin is actually the one taking the best care of their skin.
How common is skin cancer? We talk about cancer on this show a few times a year, in the past year we have discussed Breast, Prostate, Lung and colon cancer. Well let’s take all of the individuals who are diagnosed with breast cancer, prostate cancer, lung cancer and colon cancer, add them up. That total number does not come close to the number of individuals who are diagnosed with skin cancer in the same time frame. So it is important for us to discuss. So how prevalent is it? In the United States each year over 5.4 million cases of skin cancer are treated, and this number does not include the most serious form of skin cancer which is melanoma. Unfortunately that number is increasing and there are a few reasons. Some of these reasons actually should make you think about both screening and prevention.
One of the biggest reasons is that we are seeing the Baby boomer generation hit an age where we see the highest incidence of skin cancer, over the age of 65. Now if you think about it, most of these individuals when growing up had never heard of sun block in fact many of them put oil on their body and laid in the sun. The importance and acknowledgement of the danger of skin cancer has really just been noted over the past 20- 25 years. Because of this we have many individuals who are now being diagnosed with skin cancer. Almost 50% of Americans over the age of 65 will be diagnosed with skin cancer at least once. The cost of treatment for skin cancer is over 8 Billion dollars a year.
Now we know that 90 % of skin cancers are associated with exposure to UV radiation from the sun. With that knowledge we should be aware and thinking of how can we protect our skin and prevent skin cancer. The most effective way is to minimize your time in direct sunlight, now this is easier said than done so other protective measures should be taken. The goal is to block sunrays from hitting the skin, we can do this with clothing, hats and umbrellas from a physical point of view. Probably one of the best and most effective ways is to wear appropriately applied sun screen materials along with protective clothing and to use the correct amount ( most people do not use nearly enough and it seems their goal is to make sure you can’t notice it)
So let’s talk a little bit about sun screens and what you need to know. First the type to buy, You will see numbers on each of the bottles so it is important to know what the number means and what to buy. The SPF number that you see on the bottles is a rating of the material in the bottle and how long it will work to protect you. Here is how it works, the SPF number is the multiplier for your protection. So let’s say the sun is so bright that you would normally have sunburn in 10 minutes without any protection. If you were to wear a sunscreen with SPF of 30, you would now be protected for 300 minutes. 10 minutes to burn with no protection x SPF 30 = 300 minutes. So if you know how long you will be outside and you know how fair your skin is you can predict what SPF you will need. There is a slight caveat, Sunscreen should never be placed on the first tee for golf, or as soon as you set your lane chair for a soccer game. Sunscreen is designed to be absorbed into the skin and this process takes 30 minutes. So those of you who put it on moments before the exposure or after the exposure you are not getting the protection you think you are. Most dermatologists will recommend that sunscreens are placed daily and immediately after taking a shower. This will allow you to place it with more diligence than rushing to do it, it allows you to be more inclusive of skin covered as it is easy to do after getting out of the shower. This practice will allow your skin to stay health and age gracefully.
More importantly is to protect young children. Children under the age of 2 should have minimal sun exposure and if they do they should have protective clothing and sunblock on. Studies have shown that individuals who had bad burns as an infant are more likely to go on to having bad skin cancer. So when out with a child, place a hat on them, Floppy hat that covers their ears and neck, long sleeved shirts and sunblock on all exposed skin. Reapply every 1-2 hours. If you have them in a pool consider keeping a shirt on them. Goal is to minimize and damage to the infants skin as they are developing
I am an advocate of reapplying every 1-2 hours and more frequently if you are swimming or sweating a lot. Most will forget but the simple task of asking Siri to set an alarm for 90 minutes is easy and a great reminder to you as well as others around you.
For those of you going to sporting events, hats and sunscreen are a must. Often you will not have the opportunity to get out of the sun for protection. Bring a small bottle of sunscreen to reapply as it may be a long walk back to the car. For those of you in cars, especially those with thinning hairlines, wear a hat or apply sunscreen to your scalp. We all love driving with the sunroof open, however that is allowing UV rays to be striking our scalp for hours at a time while we are not even thinking about it.
So knowing the SPF number is one part, the other is to make sure that your sunscreen protects from both UVA and UVB radiation. Although we know sunblock’s will protect from UVB and many sunscreens will protect from UVA, you want to find sunscreen that protects from both UVA and UVB as both can be damaging to the skin. Also I feel that getting a waterproof sunscreen is good but realize that it is really not totally waterproof and sweat and swimming should be prompts to reapply sooner regardless of the waterproof claim.
What else can we do to prevent skin cancer? Push to have tanning beds and salons outlawed. Tanning beds are the equivalent to tobacco for lung cancer. Currently in Illinois use of tanning salons is prohibited for those under the age of 18, Only a few states have no restrictions on tanning beds, unfortunately Iowa is one of those states. Many countries have the age 18 limitation in place, others including Australia have totally banned tanning salons. Another thing to know is that the spray on tans that you see in salons now do not offer much if any protection from UV rays, so even if you get a spray on tan, you need to use sunscreen as well to protect the skin.
Enough about prevention, let’s take a couple of minutes on identification of skin cancers. First, you don’t need to be an expert, but having some basic knowledge is great. Basic knowledge will keep you aware and push you to have your primary care doctor look at any areas of concern. Seeing a dermatologist once a year would be a great ida, however we have problems getting individuals to see their primary care doc once a year nonetheless a specialist. So what are we concerned about? We don’t like rashes or moles that change. The change may be color, shape or size, we just don’t like change period. So any of these that are noted should be followed up. This is sometimes noted in photos or by a friend as we often miss subtle changes as they occur.
We also do not like rashes that bleed, these should be followed up as well. Physicians advocate that you do a good skin exam at least once a year, do it on your birthday to remember
Let’s take a moment to review what to look for with the deadliest skin cancer, melanoma. We have talked in the past about the simple acronym ABCDE for this type of cancer. Let’s go over them again.
A- Is for asymmetry, we like moles that are uniform and if cut in half would look similar in both pieces. Melanoma moles however are often asymmetric
B- Is for borders- for benign moles we like to see smooth borders, for melanoma we will see irregular borders
C- Is for color, we like moles that have uniform color and do not change for many melanomas the mole is different colors and may change colors, some melanomas can even be red or blue
D- Is for diameter, we like moles that are smaller than a pencil eraser , if they are bigger than a pencil eraser we start to get concerned
E- Is for evolving, as I said earlier we don’t like change so any change whether it is size shape or color should get our attention
A somewhat unique thing about melanomas is that in people of color it is often found on the palms of the hands , soles of the feet , fingernail bed or on mucous membranes like the inside of the mouth. Remember melanoma does not have to be found on sun exposed areas only. This cancer can spread early on thru the blood or lymphatic system pushing the cancer to areas that are not sun exposed. Unfortunately many African Americans think that melanoma is only found in caucasians and when diagnosed it has often advanced. The big message here is that this is a cancer that can be found in anyone and we all need to know what to look for.
Treatment for skin cancer varies on the type and location of the cancer. For some cancer surgery is needed to remove the cancerous cells, often these cancers are more extensive under the skin than what is visible on the surface. Melanomas need to be surgical removed with wide margins to prevent spreading. Some cancers may be treated with cryotherapy where the cancer is “burned off or frozen off” Cancers that have spread may need chemotherapy or radiation as well.
The biggest message is, Do what you can to prevent damage to the skin, wear protective clothing, wear sunblock, minimize your time in the direct sun and stop telling people they look healthy when they have a tan. Sunblock everyday, especially for individuals who are fair skinned and burn easily.
A great resource is the American Academy of Dermatology, aad.org.