Tuesday, March 20, 2018

The essentials of skin cancer prevention: self-checks, sunscreen and covering up

Would you recognize skin cancer if you saw it?

The American Academy of Dermatology chose May, Skin Cancer Awareness Month, to launch a nationwide campaign it hopes will get you to check yourself and a loved one for suspicious skin spots that should be evaluated by a doctor.

The new awareness campaign, "Check Your Partner. Check Yourself," urges us to take self skin checks seriously. Anyone who sees you regularly — not necessarily a trained professional — might notice a spot, freckle, mole, bump or crusty patch that has changed or just doesn't look right. If they do, take action and have it checked. If you notice the same on someone else, speak up.

Women are especially good at noticing such things on others, and there's research to prove it.

A 2016 study in the Journal of the American Academy of Dermatology found that women are nine times more likely than men to notice a melanoma, the deadliest form of skin cancer. Melanoma likes to hide in difficult-to-see places like the scalp, between your toes, on the soles of your feet, in the middle of your back — areas that may not get a lot of sun or areas that you might miss, but which a partner might see when you change your shirt, put your feet up or wash your hair.

The American Academy of Dermatology's website (aad.org/public/spot-skin-cancer) offers tips on how to do a home skin check. It also displays photos of what suspicious moles look like and a short public service video that illustrates how men could miss a skin cancer.

Skin cancer found in its earliest stages is generally easier to treat and less likely to require disfiguring surgery. In some cases, early diagnosis may also save your life. (See box for tips on what to look for.)

Despite ongoing campaigns to educate the public about sun safety and skin cancer awareness, misconceptions persist. We wanted to know some of the most common ones and how to correct them. Here's what the experts we spoke with had to say:

You can still get cancer from tanning beds

Dr. Meryl Joerg, a New York City dermatologist who has been seeing adult and adolescent patients for 20 years, said most people still don't get an annual skin cancer screening. They also may not realize that people with a lot of moles or freckles may need more frequent skin exams.

"And don't let the doctor forget to check your scalp. I do it automatically with every patient, but not all doctors do," she said. "Be sure to ask for it."

Joerg is concerned about people who still think getting a tan in a booth or tanning salon is safer than sun exposure.

"That is simply not true," she said. "You can still get skin cancer from the UVA rays associated with tanning beds. Maybe not as often as with UVB rays from sunshine, but UVA rays can cause skin cancer."

Patients also tell her they believe they are ready for a full day in the sun if they've put on sunscreen in the morning. And, they think sunscreen alone is sufficient protection for a day at the beach or pool.

"First, putting on sunscreen once a day is not enough, especially if you sweat a lot or go in the water. I tell people to apply it every hour," said Joerg, noting that some experts say applying it every two hours is sufficient. "And, you still need to find some shade. Sit under an umbrella, wear a wide- brimmed hat, cover up. Sunscreen alone isn't enough to protect you from harmful sun exposure. Neither is shade. You need both."

Joerg also had this reminder: Be sure to choose a broad spectrum sunscreen, one that offers protection from UVA and UVB rays.

"UVA rays penetrate the skin more deeply and are responsible for wrinkles and other signs of aging. UVB rays are linked more to skin cancer," she said. "Be sure you're protected from both."

She tells patients to go with a broad spectrum product that has an SPF of 50 or higher.

Just a little sunscreen won't work

Dr. Kenneth Tsai is the physician who looks at your suspicious tissue samples and makes the diagnosis of skin cancer.

He's a dermatologist and dermatopathologist in the Department of Anatomic Pathology and Tumor Biology at Moffitt Cancer Center in Tampa. Before that he worked in a general dermatology practice in Houston, where he saw at least one or two cases of melanoma each week. At Moffitt, a specialty cancer referral center, he diagnoses five to 10 cases a week.

"These are the bad ones that are usually very deep and advanced," said Tsai, who also spends much of his time involved in skin cancer research. "Research has already proven that skin cancer prevention is rooted in sensible sun safety. Wear sunscreen, wear hats and long-sleeve shirts, avoid the midday sun. We know doing that works."

So does checking your skin for the early signs of skin cancer, which few people do.

"Look for spots that have changed color, darkened, those that itch, are raised, bleed or otherwise just bother you," said Tsai. "Patients who check themselves and know their skin are most likely to notice changes. Report those changes to your doctor."

According to Tsai, one of the most common mistakes people make regarding sun safety is not applying enough sunscreen. A little dab won't do ya.

"You need to put it on heavily every time you go out, and you have to put enough of it on each time to get the sun protection that's promised," said Tsai, noting that studies show people apply only about half the amount that's prescribed. The recommended amount is usually 1 ounce, enough to fill a shot glass. It should be applied at least every two hours, more frequently if you're sweating or get wet.

"I'm a sunscreen user and I know, it's not convenient to apply that much sunscreen and it's difficult to convince people to use that much. But that's what it takes to be protected." It's also important to reach all exposed skin, including the ears, behind the ears, the neck, front and back, between your fingers and toes and other often forgotten areas of the body.

Tsai also recommends a broad spectrum sunscreen with an SPF of at least 30. And he favors using sun blocks containing titanium dioxide or zinc oxide. "People don't like them because they give your skin a gray or white tinge and may make you look ghostlike. But they work," he said.

Tsai acknowledges that sun protection is about preventing cancers in the future, perhaps 10, 20, even 40 years from now, making it a hard sell, especially with younger people.

"But, one severe, blistering sunburn in childhood doubles your risk of melanoma later in life," said Tsai. "Imagine that. In one shot you've doubled your risk and you can't take that back."

That base tan: not a good thing

Dr. Sailesh Konda hears this one all the time: Getting a little color on your skin before heading out for a sun-drenched vacation or a day on the water will protect you from getting a sunburn and damaging your skin.

"A base tan does not protect you from burning," said Konda, who is co-director of Mohs Surgery and Surgical Dermatology and an assistant clinical professor in the division of dermatology at University of Florida Health in Gainesville.

While you're getting that base tan, you are damaging the DNA in your skin cells, he said. "That DNA damage is irreversible and places you at increased risk of skin cancer. Long story short, do not get a tan, base or otherwise."

Konda also hears the misconception that dark-skinned people don't get skin cancer, when in fact they do.

"All skin types are at risk," said Konda. "While the lighter your skin tone the greater your risk of developing skin cancer, those with a dark complexion are at particular risk for melanomas that tend to appear on parts of the body that don't get much sun exposure," making self- and partner-assisted skin checks even more important.

Konda echoes the warnings about tanning beds, citing research showing that more than 400,000 cases of skin cancer are linked to indoor tanning in the United States every year. At particular risk for melanoma are those individuals who use tanning beds before age 35.

"Use spray tans, skin bronzers or tinted moisturizers instead," Konda said.

Contact Irene Maher at [email protected]

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