About Skin Cancer

Deborah
This is weekly dose of wellness. Brought to you by Memorial Care Health System. Here's Deborah Howell. Welcome to the show. I'm Deborah Howell, and today we'll be talking about skin cancer symptoms causes and prevention. Our guest is Doctor Tanya Evans, a dermatologist at Memorial Care. Saddleback Medical Center and Southern California Skin and laser. Welcome, Doctor Evans.

Dr. Evans
Hi. How are you?

Deborah
Great. What a pleasure to have you today.

Dr. Evans
Thank you.

Deborah
Well, first of all, can you tell us a little bit about yourself and your background?

Dr. Evans
Sure. I'm a board certified dermatologist, and I went to medical school at Loma Linda University and I did my residency training in Chicago, University of Illinois. And then I came out here to Orange County.

Deborah
We have that in common. I went to northwestern and then came out here to LA.

Dr. Evans
Oh, wow.

Deborah
I guess we both got sick of those Chicago winters,

Dr. Evans
I know that's true. The city is great.

Deborah
Yeah, the city is fantastic. Not to mention the deep-dish pizza, but we digress. What I want to ask you is, who is at most risk for skin cancer?

Dr. Evans
Well, everyone is pretty much right now, so the ozone layer has been depleted so much and it continues to be depleted. So, everybody pretty much is at risk who spends a lot of time in the sun. The more fair skin you have, the more susceptible you are to skin cancer. However, even people that have a little bit more pigment in the skin are susceptible due to the depletion of the ozone layer.

Deborah
Okay. Fair enough. What are some signs and symptoms of skin cancer?

Dr. Evans
Well, I usually tell people it's a sport that appears that you notice and it doesn't heal. So a lot of times people will tell me, well, I had a pimple and the pimple lingered around for a month or six weeks, and it hasn't healed. Or it's a little spot that looks like a rash, like red scaly spot that looks like a rash that doesn't go away.

Dr. Evans
So those are the typical symptoms that people will tell me about.

Deborah
Is there any special size or shape?

Dr. Evans
It can be round. It can be oblong. It can have jagged edges. It can have different appearances. Now. Different skin cancers will have different appearances. For example. The most common skin cancer, basal cell carcinoma, will be more red and shiny in appearance. Squamous cell carcinoma is the second most common kind of skin cancer, and that one is typically red and scaly. Sometimes it can be a little crusty and it can be round. You can have jagged edges. It may not be perfectly round. And then the dreaded melanoma that everybody worries about and that one, we have certain criteria that we go by. So we go by the A, B, C, D, E, which I'm sure a lot of people have heard about. So typically, with melanoma, which is the worst kind of skin cancer, it can appear as a dark mole. Sometimes it can be pink, but usually there are dark mole. And we talk about the A, B, C, D, E meaning a is for asymmetry. So if you draw a line in the middle of the mole, one half looks a little different than the other B is border. So the border is usually jagged, not perfectly round. C is color if the mole changes color, or if it has different colors in it, and D's for diameter. If it starts to get larger or in large and is for evolution, meaning if the mole itches or bleeds, that's when we worry about it.

Deborah
Okay. Got it. And do you know what causes skin cancer?

Dr. Evans
Sure. So most of the time it's attributed to ultraviolet radiation, sun exposure basically. So there are some genetic factors involved. For example for basal cell carcinoma. There's a gene that can run in families that can give you a higher risk of developing basal cell carcinoma. For melanoma, there's also a familial history of melanoma that can put you at increased risk of developing melanoma. But typically it's UV radiation that causes skin cancers.

Deborah
And what are some of the signs and symptoms of skin cancer.

Dr. Evans
So typically, you'll have a spot that doesn't heal. And it could be red. It could be brown. It could be tan colored. Or it could even sometimes be flesh color. But it could be like crusty or scaly. And as it progresses, you'll just notice the spot will not go away and it gets larger. And sometimes the spots can become itchy or painful. And if you let em go far enough, they'll get bigger and the skin surface starts to open. And we call that ulceration. And then you can have bleeding and pain associated with that.

Deborah
Got it. Are there different types of skin cancer and are some more serious than others?

Dr. Evans
Yes. So, the three most common types of skin cancer that we talk about, there are other types of skin cancers, but they're more rare. But the three most common ones are basal cell, squamous cell, and melanoma. Basal cell is the most common. Squamous cell is the second most common. And melanoma is the next one. Down the line that we're seeing more of lately because people being more aware and getting skin checks. But those are the three types of skin cancers that we usually talk about.

Deborah
And at what point should people see a dermatologist?

Dr. Evans
If you have a spot that appears that you haven't noticed before, it could be a red spot. It could be a dark spot, it could be a crusty spot, or it could even be a pimple or something that looks like a pimple that appears, and it lingers past a month or six weeks. I would see a dermatologist for that.

Deborah
Okay. Fair enough. And how do we treat cancer these days?

Dr. Evans
Usually, the most important part is catching them early. So for basal cell carcinoma and squamous cell carcinoma, if they're caught early enough they're usually superficial. And with superficial treatment we have nonsurgical approaches meaning we can use treatments like light treatments like we could use creams. We can even use a method where we scrape the skin cancer off the skin. For skin cancers that are deeper, we usually cut them out. And also there's the option of radiation treatment for people who do not want to have surgery for their skin cancer. And that's a very good option as well. There are some also some newer medications that we can give for basal cell carcinoma. And there are some that are coming up for squamous cell carcinoma medication like pills that people take kind of like chemotherapy but only for basal cell. And there are some that are also used for squamous cell and melanoma. But usually when the skin cancers are caught, we typically like to cut 'em out unless they're superficial. Then we use some of the other treatments we have, right.

Deborah
Better to be safe than sorry, right?

Dr. Evans
Correct.

Deborah
Now, doctor, is skin protection more important during the summer than at other times of the year?

Dr. Evans
Well, we're fortunate to be in California. So, you know, sun protection is pretty much all year round when you're in other areas where the sun isn't as strong, then typically you want to protect more so in the summertime. But I would say all year round, because the sun is out all year round, may not be as strong during wintertime in some areas, but it's still out there. The UV light is out there, and actually, even when you don't see the beautiful sunshine, you have, even when it's overcast, you still get UV rays and so you still have to protect yourself. So I would say all year round is important.

Deborah
Okay. And then what SPF do you recommend in. Is higher SPF always better?

Dr. Evans
Yes, absolutely. So the SPF that typically people will look. And if you go Google on the internet they say the SPF of 15 and above is enough. However, most of us do not apply enough sunscreen on to make it an SPF of 15. For example, if you get a tube of SPF 15 and you put a little dollop in your hand and you try to protect your face and your hands and your arms, you're not going to get that SPF 15 protection. You're going to get lower than that. So usually we say SPF 30 and above or even 50 and above because we need to put enough of it on to make it a 30 or a 50. And sometimes when we don't put enough on, we're reducing the SPF number that's protecting us. So I typically recommend an SPF of at least 30. And we need to apply a shot glass amount, which is about 1.5oz on sun exposed area. Every time we apply sunscreen.

Deborah
That is a lot of sunscreen. I'm a little shocked by that.

Dr. Evans
Yeah, and that's why the SPF number, the higher the number, the better, because most of us don't apply that much. So when you're doing an SPF, let's say 50 or 70, or 75 even, you're not going to use that 1.5oz. So, when you're using less, you're knocking down the SPF because you're putting less on.

Deborah
You know, it's such an interesting dichotomy because, you know, at one point the doctor say you really need to get sunshine. You really need the vitamin D. If we put on 50 sunblock, are we getting that vitamin D our doctors recommend?

Dr. Evans
Probably not as much. Of course, the sunscreens are not 100%. That's why sometimes you'll see people that say, well, I applied my sunscreen, you know, all day, or I applied it, you know, half a day and I still got some color or I still got burned. Typically, most people will put on sunscreen in the morning and they'll go about their day. So usually what we tell patients is when you're out there, use your sunscreen, apply it 20 minutes before you go out for the day. And when you're out on day, you're supposed to reapply every one and a half to two hours. Now, if you're indoors and let's say you've applied it in the morning, we usually recommend that you reapply when you go out during the day. But most people don't do that. So even though you're using your sunscreen, you're still getting some sunshine and you're getting your vitamin D. But we also have to be conscientious. The way that vitamin D is made is in a perfect environment where you're getting the UV light to comfort in on your skin to make the vitamin D, but there are other factors that diminish that. For example, if if there's pollution in the air, you're not going to be able to do that. And so there are other things in the environment that can diminish your ability of making vitamin D. So, we always recommend that you take vitamin D in an oral form or a pill form, because you know exactly how much vitamin D you're getting that way, and then your body will use it.

Deborah
Okay. So, you're not going to get an excess of vitamin D if you run every day and you take it.

Dr. Evans
Correct. No. There are levels that you can check for vitamin D. So typically, the recommendation is 50 for the level of vitamin D one on a blood test. So most of the patients that I check and I check a lot of vitamin D because they can be associated with with other types of skin conditions. And most of the people are deficient in vitamin D. And what's interesting is I've had patients that are actually avid gardeners and they're outdoor outdoorsy people. And when I check their vitamin D, it's on the lower end switch. Yeah. So it's really interesting. So I always recommend for people to take vitamin D and you can get your vitamin D levels checked because vitamin D is important.

Deborah
Very good doctor. What else can people do to help prevent skin cancer.

Dr. Evans
Well, there are other things we can do. There are UPF protective clothing and that's ultraviolet protective factor. And then they have numbers on those UPF clothing for example. Typically, they're 50. But sometimes you can have some that are 25 or 30. So we can wear those on top of, you know, when we're out and about, we can wear those type of clothing that will protect us. There are also hats that we can wear, like if we go out to the beach, or even if we're out all day at the park or an amusement park. We can wear those hats and those protect as well. We can sit in the shade when we're out as much as we can. And of course, those are in addition to using sunscreen, but we could use all those other factors. There is also a pill that's out there to herbal supplement for the skin. It's called Healio care. And it actually people call it an oral sunscreen, but it's not a sunscreen. It protects your skin from the damage that occurs from the sun. So when you take it, it's like an extra protection for your skin. The vitamin niacinamide or vitamin B3 has been also shown to decrease the risk of developing skin cancers. So in people who have had skin cancers, that's a great supplement to take.

Deborah
Healio care and vitamin B, something I never heard of before today. And that's why we have you on Doctor Evans. Thank you so much for your time and expertise today.

Dr. Evans
Thank you. Thank you very much.

Deborah
We really enjoyed having you on the show. And if you want to learn more, you can go to Memorial Coorg and to listen to a podcast of this show, please visit Memorial Coorg slash podcasts. That's all for this time. I'm Deborah how to protect yourself and have a great day.