Dr. Kevin Most: Melanoma Monday

Dr. Kevin Most

Today is the start of nurse week, it runs throgh Sunday the 12th, which is the birthday of Florence Nightingale, the founder of modern nursing.  Next year will be the 200th anniversary of her birth. Nightingale is also known as “ the Lady with the lamp” as she would round on injured soldiers with her lamp.

This is a week  for all of us to say Thank you to the outstanding nurses who care for us every day. They are often the unsung hero in healthcare.  Although this is a week to celebrate the great work they do, it should also be a reminder to thank them every day. We have 4 million nurses here in the US, so chances are you know a nurse, reach out this week and say “ Thank you !!” They are true heroes, they deliver care in many settings. We think of them in the hospitals and doctor’s offices but they have opportunities to do a lot more. Technology companies, insurance companies, schools, prisons, company health departments, travel clinics,….. the list goes on.

How about a few fun things about nurses.

  1.      Nurses are always ranked number 1 in the most trustworthy professions
  2.      By 2020 we will have a nursing shortage of close to 1,000,000
  3.      Nurses are more likely to suffer from a back injury than construction workers
  4.      Nurses have close to 100 different professions to choose from
  5.      The average hospital based nurse walks close to 5 miles
  6.      Only 3 out 5 nurses work in hospitals
  7.      President Nixon started nursing week and it always runs May 6-12, and always ends on Florence Nightingale’s birthday.

So if you know a nurse, give her a call this week and say Thanks. If you see a nurse this week, say Thank You. And remember we really should be thanking them every day, let’s just make this week special.

Melanoma Monday

Well, is spring finally here? Are we done with weekend snow storms?  Hopefully spring is here and summer is right behind. We take one Monday a year to educate everyone on Skin Cancer and more importantly Melanoma, the deadliest form of skin cancer. The American Academy of Dermatology takes the first Monday in May to remind us about Skin cancer and the importance of protection as well as identification. The academy always has a great way to highlight this message, last year it was “Protect Yourselfie” I play on selfie photos and protecting your skin. This year the saying is “The Sun is hot, Skin Cancer’s Not”

Everyone needs a quick reality check, we discuss a lot about cancer thru the year, but the mostimportant cancer for all of us may be the one that is the most common and is preventable. Skin cancer remains the number 1 cancer in the world. In the US, one out of 5 of us will have some form of skin cancer diagnosed, others say this number is actually much higher as some cancers go undiagnosed. To put it in perspective, add up everyone diagnosed with Breast, lung, prostate, colon, liver, Pancreatic and thyroid cancer last year, that total number does not come close to the number of patients diagnosed with skin cancer in the same time frame. Estimates are that almost 10,000 individuals are diagnosed with skin cancer every day !

Now today being Melanoma Monday, it is important to know why this type of skin cancer is highlighted. First it is the most deadly form of skin cancer.  We have almost 10,000 deaths a year from Melanoma and Melanoma rates doubled from 1982 to 2011. We lose a patient every hour who dies from melanoma. The scariest fact I think is that, Melanoma is the second most common form of cancer in females age 15-29. Unfortunately this is still the age group that feels that a tan is healthy, and that laying out at the beach is good for you. Even worse is the individual who wants that winter tan and goes to use a tanning bed.

Before we talk about how to identify skin cancer, let’s talk about prevention of skin cancer. 90% of skin cancers are associated with exposure of UV radiation from the sun. That simple piece of information should remind us how important it is to protect your skin from sun exposure. The goal is to minimize our skin from direct exposure to sunlight. This can obviously be done with clothing, hats and umbrellas. You will see now that many lines of clothing will have UV ratings on each piece of clothing. Now when it gets very hot, long sleeves and heavy clothing is not an option so we have to use other options.

Sunblock is the next option. Now there is always a little bit of confusion and questions about sun block, what SPF should I wear, UVA-UVB both, how often should I reapply, do I need water proof, is my sunblock from last year still good, when should I put on sunblock, what about children? Let’s take these and look at each one so we can understand the best way to minimize our chance of Skin Cancer.

SPF- what does it mean ? What should I wear. SPF is based on how bright the sun is and how long it would take you to burn your skin without any protection. A day with a bright sun, that would burn your skin in 10 minutes of unprotected time, the SPF is the multiplier for protection. If you were to use a SPF 30 in that situation, you would be protected for 10 x 30= 300 minutes.  This is a assuming the sunblock stays in place and is not washed off, sweated off or has worn off. Depending on your plan for activity, a minimum of 30 SPF is good for routine activities with minimal activity. Many dermatologists feel that we should all wear spf 30 minimum year round regardless of your sun exposure in the winter.

UVA- UVB protection- the sun emits both UVA and UVB rays. 95% of the rays are UVA that reach our skin, they are there every day even when it is cloudy. UVA rays go deeper into the skin and are the leading cause of wrinkles, as UVA impacts the layers of our skin that gives firmness. UVA also will penetrate glass were UVB will not. UVB does not go as deep into the skin but is responsible for sunburn and other discolorations on the skin and thus causes some forms of skin cancer. UVB is also in higher intensity the high altitude you are at. The simple big message is your sunscreen should be protective against UVA and UVB rays.

How often do I need to apply?-  Most dermatologists will recommend that sunblock is reapplied every 2 hours and possibly every hour if you are physically active and sweating a lot. The SPF number does not take into consideration activity and the removal of lotion from friction or sweat. The best option is to reapply every 2 hours on a regular basis. If playing golf, do it at the turn, if just out, set your alarm on your phone to remind you to reapply.

Do I need waterproof sunblock- this is a great question with a not so great answer. If you are going to be in and out of a pool, yes you should use waterproof SPF lotion but also it should be reapplied more frequently as the swimming and water time as well as using a towel to dry off will remove the impact quicker.  Swimmers, apply each time you go in the pool, or each hour at a minimum.

Is my sunblock from last year good?  Sunblock’s are designed to remain at their full strength for up to three years. That being said it is also with the caveat that it is stored properly. Many sunscreens now have an expiration date on them, so look to see. If you have any doubts, replace it with a new one this season.

Best time to put on sunblock?  Most people do this wrong, you will see them get to the beach and put on the sunblock, you will see them placing it on the first tee when golfing. You are too late at this point for it to work the way it was designed. Sunscreen should be placed 30 minutes before your sun exposure. Most dermatologists will recommend that sunscreen is placed immediately after your shower. This allows for sunscreen to be placed without clothes blocking the area and allows for liberal placement of the lotion. So, keep a bottle of sunscreen lotion in your bathroom and put it on after each shower every day.

What about children- Children need to be protected!!  Children under the age of 2 should have very minimal sun exposure and if they have sun exposure they need to be protected with clothing as well as sunscreen. Studies have shown that children who had bad burns as a child have a higher incidence of melanoma later in life. Protect your child, floppy hats that cover their ears and neck are great. Reapply sunscreen every 1-2 hours. Children in the pool should wear tee shirts, preferably long tee

Going to watch a soccer/ baseball/ band concert- make sure you place sunblock before you leave for the event and don’t forget to bring a small bottle to reapply during the event when needed. Often we will apply and then forget to bring it with us for the reapplication and end up with a burn.

Technology is now getting into the sun exposure game. There are now wearable devices that actually measure our UV exposure and tell us to reapply sunscreen or get out of the sun when we have reached our exposure limits. This technology will send a reminder to your phone, which will signal you to reapply sunscreen or seek shelter from the sun. Some of these are worn on your clothes, others are so small that they can fit on a finger nail, one of these was actually designed here in Chicago at Northwestern. Again this is technology that is used to measure and remind you to protect yourself, it will not protect you.

Now that we know how to protect ourselves, what can we do to identify skin cancer. Some simple things are anything that goes not look normal or bleeds easily should be seen by a dermatologist.

We should know about the ABC’s of melanoma as it is very important to catch and Identify this early as it can be lifesaving. We have ABCDE as a simple acronym for melanoma.

A = Asymmetry

One half is unlike the other half. If we were to cut it in half would both pieces match? Melanoma is often asymmetric

B = Border

An irregular, scalloped or poorly defined border. For normal moles we like to see smooth edges, melanoma will have irregular borders

C = Color

Is varied from one area to another; has shades of tan, brown or black, or is sometimes white, red, or blue. Regular moles are uniform in color, melanoma have varying colors and will change often

D = Diameter

Melanomas are usually greater than 6mm (the size of a pencil eraser) when diagnosed, but they can be smaller. Moles bigger than a pencil eraser concern us

E = Evolving

A mole or skin lesion that looks different from the rest or is changing in size, shape or color. We don’t like moles that change in size, shape, or color

If you notice a spot that is different from others, or that changes, itches or bleeds, you should make an appointment to see a board-certified dermatologist.

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