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Wednesday November 26th 2014

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An Ounce of Prevention

By Jessica Forbes

For most Floridians, days spent boating, lazing on the beach, or playing in the yard are a regular and time-honored tradition—we live in The Sunshine State, after all.

As warm and comforting as basking in the sun can sometimes feel, the verdict has long been in that sun exposure can have serious affects on our health. Over the past decade, steadily increasing rates of skin cancer among both women and men—the highest increases being among Caucasian women in their late 20s and early 30s—signal the importance of protecting our skin from the sun’s rays cannot be overemphasized.

With the summer season officially in full swing, we at the IN decided to review the basics about skin cancer and its prevention. We spoke to experts to learn important pointers like what strength of sunscreen to buy, how bad tanning beds may actually be, plus how often skin cancer screenings are necessary and what a first-timer can expect during the exam.

The Basics
Thinking back to science class, you might remember that the skin is the largest organ of the body. Three main types of cells make up the epidermis, or top layer of our skin (squamous cells, basal cells and melanocytes), from which each of the three types of skin cancer take their names. Cancer can develop in any of those cells and often does. According to the American Cancer Society (ACS), skin cancer accounts for almost half of all cancers in the U.S. and shows no signs of slowing.

The two types of non-melanoma skin cancers—basal cell carcinoma and squamous cell carcinoma— account for over 3.5 million skin cancer diagnosis each year in the U.S. The ACS predicts that over 76,000 cases of melanoma will be diagnosed in 2014. While its rate of occurrence is the lowest of the three, melanoma is more aggressive, accounting for between 75 and 80 percent of all deaths attributed to skin cancer each year.

“As far as basal cell and squamous cell, we usually see them if they’re more advanced cases. We treat melanoma that is more advanced because they might need chemotherapy,” said Dr. Dee McLeod, an oncologist with Sacred Heart Medical Oncology. McLeod treats patients who are referred to the practice after skin cancer is diagnosed and also counsels patients with other forms of cancer on sun protection.

“Skin cancer is very common, but it also depends, as does anything,” McLeod said, cautioning against neglecting to have a spot examined, as time will only compound the risk of an unchecked growth developing into something serious. “I’ve seen people who’ve had a regular squamous cell skin cancer, which is one of the more common skin cancers, and it’s been neglected and people have lost their eye. They have had to have aggressive surgery done and even undergo radiation and chemotherapy.”

Experts recommend conducting a self-exam of your skin once a month and having a screening exam performed by a physician once a year.

“If there is a spot on your skin, a mole of any type, it needs to be evaluated by a dermatologist,” McLeod said, emphasizing that anything asymmetrical or that has had a change in color or diameter should be a priority to mention in an exam. “It can be serious. You don’t know what it is when it’s on your skin, so it needs to be evaluated.”

As far as those more likely to develop skin cancer, genetics play a factor in increasing a person’s risk, but behavior and habits—like having bad sunburns in the past and/or not using sunscreen consistently—also play a role.

“Some families can have a genetic predisposition to develop melanoma in particular,” McLeod said. Adding sun exposure is a key factor that increases the risk for anyone, particularly those who are prone to developing freckles. “If you’re fair skinned, you’re more likely to be at an increased risk, but anybody can have a risk for any type of skin cancer.”

What to Put on Your Skin
It is pretty common knowledge that if you’re heading outdoors, applying sunscreen should be a priority, and the old adage, “An ounce of prevention is better than a pound of cure,” is particularly appropriate when it comes to sunscreen usage.

The Skin Cancer Foundation reports that 90 percent of non-melanoma skin cancers and 65 percent of melanoma cases are attributed to exposure to ultraviolet (UV) radiation from the sun. When it comes to shielding skin from that radiation, medical sources say sun protection factor (SPF) 30 is a minimum for periods of prolonged exposure, and many recommend SPF 15 for everyday use, as UV rays that hit the skin while walking, driving, et cetera can have cumulative effects over the long term.

Two types of UV radiation—UVA and UVB—damage different layers of the skin, and sources suggest purchasing sunscreen labeled as “broad spectrum,” which, under new Federal Drug Administration (FDA) guidelines, means a product protects against both UVB and UVA rays. Even on cloudy days, UV rays can penetrate the skin, and it’s important to remember that sand, water, concrete and snow act as reflectors. This means on most days and in most environments, there will be UV rays coming at you from a number of directions—all the more reason to sunscreen up.

As of 2013, labels also specify whether a sunscreen becomes ineffective after 40 minutes or 80 minutes, a good reminder for those of us who are prone to forgetting to reapply. Whatever the labels say, experts recommend applying at least one ounce (or approximately two tablespoons) of sunscreen 30 minutes before heading outdoors and reapplying at least every two hours. They also suggest reapplying more frequently if you are swimming or sweating.

Getting Checked Out: What to Expect During an Exam
Some screening exams held in public venues are different than full-body exams performed in a physician’s office. If you’ve made an appointment with either a general practitioner or dermatologist for an exam, there are a few things to keep in mind as you prepare for the appointment.

Screening exam first-timers can sometimes be surprised to find out the exam will require them to strip almost totally down to their underwear. As it is possible for melanoma to develop in places on your body where the sun literally doesn’t shine, your doctor will need to take a glance at the full surface of your skin. Your scalp, behind your ears, and between your toes are all locations a physician will look over during an exam.

“You can probably leave your undergarments on, but plan accordingly,” said Dr. Kevin Welch, a board-certified dermatologist. Welch also suggests patients bring a list of all current medications as part of their pre-exam preparation. “Clean, fresh skin is always preferable, but not always possible with work, weather and time of day. It is best not to wear makeup if possible, or perhaps plan to remove in the office.”

All sources recommend conducting monthly self-exams of your skin as the best way to learn of any new spots or any spots that have demonstrated changes in their color, boundary definition or symmetry. If you’d like a point of reference for self-exams, the Skin Cancer Foundation provides guidance and body maps to aid in documenting what you observe. They can be found by visiting skincancer.org.

“Be familiar with skin lesions and birthmarks. Pay special attention to lesions that are new or changing,” Welch advised, adding if you have help at home, accept it. “Have a spouse or significant other circle spots on hard to see places like the back.”

Also, be prepared for a doctor to possibly perform a biopsy if they note something questionable—it is a very common occurrence in screenings, Welch said. “During a skin cancer screening, biopsies are routinely performed if suspicious lesions are noted. It is usually a simple procedure with minimal pain and requiring less than 5 minutes,” he explained.

Dr. Kevin Welch
Medical Center Clinic
Welch Skin Care Center
8333 N. Davis Highway
474-8386
kevinwelchmd.com

Dr. Dee McLeod 
Sacred Heart Medical Oncology Group
1545 Airport Blvd., Ste. 2000  
416-6933 
sacred-heart.org/cancercenter