Melanoma and Skin Cancer Awareness 2022

Transcript

00:00 --> 00:02Funding for Yale Cancer Answers is
00:02 --> 00:04provided by Smilow Cancer Hospital.
00:06 --> 00:08Welcome to Yale Cancer Answers with
00:08 --> 00:10your host, doctor Anees Chagpar.
00:10 --> 00:12Yale Cancer Answers features the
00:12 --> 00:15latest information on cancer care by
00:15 --> 00:16welcoming oncologists and specialists
00:16 --> 00:18who are on the forefront of the
00:18 --> 00:20battle to fight cancer. This week,
00:20 --> 00:21it's a conversation about the
00:21 --> 00:23care of patients with Melanoma
00:23 --> 00:24with Doctor Jonathan Leventhal.
00:24 --> 00:27Dr Leventhal is an assistant professor
00:27 --> 00:29of dermatology at the Yale School
00:29 --> 00:31of Medicine where Doctor Chagpar is
00:31 --> 00:33a professor of surgical oncology.
00:35 --> 00:37So Jonathan, maybe we can start off
00:37 --> 00:40by you telling us a little bit more
00:40 --> 00:41about yourself and what it is you do.
00:42 --> 00:45I'm Jonathan Leventhal and I direct the
00:45 --> 00:46oncodermatology clinic.
00:46 --> 00:49So in this clinic I take care of
00:49 --> 00:51patients who develop all types of skin,
00:51 --> 00:53hair and nail problems from
00:53 --> 00:55all types of cancer treatment.
00:55 --> 00:56And I also perform skin checks for patients
00:56 --> 00:58who have a history of skin cancer.
00:59 --> 01:02So you know now that we're
01:02 --> 01:04emerging from the pandemic
01:04 --> 01:07and the weather is starting to get nicer,
01:07 --> 01:09many people start thinking
01:09 --> 01:11more about skin cancers,
01:11 --> 01:12so can you kind of give
01:12 --> 01:14us the lay of the land?
01:14 --> 01:16How common is skin cancer?
01:16 --> 01:18What are the different types and
01:18 --> 01:22what should people be aware of?
01:22 --> 01:24So skin cancer is actually the most
01:24 --> 01:26common type of cancer, just in general,
01:26 --> 01:28so there's three main types.
01:28 --> 01:30Basal cell, which is by far
01:30 --> 01:32the most common of all of them,
01:32 --> 01:35followed by squamous cell and then Melanoma,
01:35 --> 01:37which is only about 1% of skin cancers
01:37 --> 01:40but is the deadliest and so basal
01:41 --> 01:43cells can happen and up to 30% of
01:43 --> 01:45white individuals in their lifetime.
01:45 --> 01:47So it is so common it usually
01:47 --> 01:50presents in sun exposed areas,
01:50 --> 01:51often like a little pimple that
01:51 --> 01:53just doesn't seem to heal it.
01:53 --> 01:55Maybe a little sore or it can
01:55 --> 01:57bleed and it just persists.
01:57 --> 01:59Then there's squamous cells which are
01:59 --> 02:01the second most common type and these
02:01 --> 02:03also occur in areas of sun damage
02:03 --> 02:05and they usually present almost like
02:05 --> 02:09a painful wardy bump on the skin and
02:09 --> 02:11then finally Melanoma as I mentioned
02:12 --> 02:14which is the least carbon of the three.
02:14 --> 02:16But that's about a let's say an
02:16 --> 02:18incidence of about affecting one in 40
02:18 --> 02:20individuals in their lifetime that often
02:20 --> 02:23looks like an atypical appearing mall.
02:23 --> 02:24It's usually a pigmented lesion.
02:25 --> 02:27So you know, that's one thing
02:27 --> 02:30that I think a lot of people may
02:30 --> 02:32not be aware of is that some
02:32 --> 02:34skin cancers are not pigmented.
02:34 --> 02:37I think that so often people think about
02:37 --> 02:40skin cancer and they think Melanoma.
02:40 --> 02:41And when we think Melanoma,
02:41 --> 02:43we think of a pigmented lesion.
02:43 --> 02:45But basal cells and
02:45 --> 02:46squamous cells aren't right.
02:47 --> 02:48Yes, that is correct.
02:48 --> 02:50So basal cells, they often look pink
02:50 --> 02:53and pearly almost like a pimple and and
02:53 --> 02:55the same is true of squamous cells.
02:55 --> 02:58They're often pink in color and
02:58 --> 03:00wardian texture, so they don't
03:00 --> 03:02look like the classic Melanoma,
03:02 --> 03:04which is like an atypical looking dark
03:04 --> 03:08brown or black lesion which is asymmetrical,
03:08 --> 03:09and so I think it's really
03:09 --> 03:11important to know those differences
03:12 --> 03:15and so how can people tell the difference
03:15 --> 03:17between what could be a normal pimple
03:17 --> 03:19and what could be a basal cell?
03:20 --> 03:22Yeah, so normal pimples fortunately heal
03:22 --> 03:26and they self resolve within a matter of.
03:26 --> 03:27Weeks, whereas basal cells often
03:27 --> 03:30start as a small lesion and then it
03:30 --> 03:32becomes larger and it persists over
03:32 --> 03:34the course of months and months,
03:34 --> 03:38and so that's really the main way.
03:38 --> 03:40I always tell my patients if there's
03:40 --> 03:42something on your skin that just doesn't
03:42 --> 03:44seem right, doesn't heal, persists,
03:44 --> 03:47or is painful definitely, you know,
03:47 --> 03:49tell me or tell your dermatologist
03:50 --> 03:52and so the other thing that you
03:52 --> 03:54mentioned is that basal cells happen
03:54 --> 03:57in about 30% of white patients.
03:57 --> 03:59And so when we think about
03:59 --> 04:00skin cancers in general,
04:00 --> 04:03is it true that these occur
04:03 --> 04:04primarily in white patients?
04:04 --> 04:09And do people who are of other races or
04:09 --> 04:11ethnicities get skin cancers as well?
04:12 --> 04:14That's a really great question,
04:14 --> 04:16and so the short answer is, yes.
04:16 --> 04:18Anybody can develop skin cancer.
04:18 --> 04:21It is true that these skin cancers,
04:21 --> 04:24basal cell squamous cells and
04:24 --> 04:26melanomas particularly occur in white
04:26 --> 04:28individuals who have had a lot of sun.
04:28 --> 04:31Damage, but we have seen all these types
04:31 --> 04:33of skin cancers in various ethnicities.
04:33 --> 04:34So interestingly, Melanoma,
04:34 --> 04:36which is in really important one
04:36 --> 04:39to talk about when it does happen
04:39 --> 04:41in patients who have skin of color.
04:41 --> 04:43It can occur in areas that we might
04:43 --> 04:44not think about for skin cancer,
04:44 --> 04:47so that includes on the palms and the soles,
04:47 --> 04:49or even under the toenails.
04:49 --> 04:51And so there seems to be some
04:51 --> 04:53sort of predisposition for that
04:53 --> 04:55with Melanoma and so definitely
04:55 --> 04:57important to know about and even
04:57 --> 04:59with basal cells and squamous cells.
04:59 --> 05:02I have plenty of patients who are
05:02 --> 05:04Hispanic or African American and and
05:04 --> 05:07they develop these skin cancers so it
05:07 --> 05:09doesn't only happen in white individuals.
05:09 --> 05:11Skin cancer can affect everyone.
05:12 --> 05:15When you think about skin
05:15 --> 05:17cancer occurring under toenails,
05:17 --> 05:18we've often heard about that.
05:18 --> 05:21But when we look at pictures,
05:21 --> 05:25so if anybody Googles.
05:25 --> 05:27You know Melanoma and looks at pictures
05:27 --> 05:30of of these occurring under the toenail.
05:30 --> 05:31It kind of looks like
05:31 --> 05:32somebody stubbed their toe.
05:32 --> 05:34It looks like they may have a bit
05:34 --> 05:36of a hematoma under their toenail.
05:36 --> 05:40How can you tell the difference between?
05:40 --> 05:41Stubbing your toe and getting
05:41 --> 05:44a a hematoma under a toenail.
05:44 --> 05:46Versus, you know a Melanoma that you
05:46 --> 05:49might need to be more concerned about.
05:49 --> 05:51Yet another really good point.
05:51 --> 05:53And so when dermatologist examined patients,
05:53 --> 05:55what we look for regarding the
05:55 --> 05:58fingers and the toes is a dark
05:58 --> 05:59pigmented streak that extends from
05:59 --> 06:02the nail fold up throughout the nail,
06:02 --> 06:04and so that's called melana nikkia.
06:04 --> 06:07So many Kate. Many times Melanoma
06:07 --> 06:10actually begins as kind of a.
06:10 --> 06:11Line and Nikki a streak.
06:11 --> 06:13A dark band under your nail,
06:13 --> 06:15and so if you see any new dark
06:15 --> 06:18bands under your nails that are
06:18 --> 06:21different than maybe some other
06:21 --> 06:23nails findings that you have,
06:23 --> 06:26you should definitely see the dermatologist.
06:26 --> 06:29Now regarding the question about trauma.
06:29 --> 06:30Fortunately only those really
06:30 --> 06:33advanced cases of Melanoma under
06:33 --> 06:35the nail bed really look like the
06:35 --> 06:38whole nails coming up and bleeding
06:38 --> 06:40and bloody and so those can be.
06:40 --> 06:41I'm very concerning,
06:41 --> 06:44so I would say if you do stub your
06:44 --> 06:46toe and you have a reason for
06:46 --> 06:48having a problem under your nail,
06:48 --> 06:50you can be a little. You know.
06:50 --> 06:51You can be reassured,
06:51 --> 06:53but if you don't recall any trauma and
06:53 --> 06:55now you see that your nail looks like
06:55 --> 06:57it might have some bleeding underneath
06:57 --> 06:59it or some dark discoloration.
06:59 --> 07:02Definitely something to show your doctor
07:02 --> 07:05all right so we know what to
07:05 --> 07:08kind of look for in terms of
07:08 --> 07:10basal cells and melanomas.
07:10 --> 07:11Squamous cells you mentioned?
07:11 --> 07:13They kind of look a little
07:13 --> 07:15bit more scaly, right?
07:15 --> 07:18Yes? Squamous cells can appear sometimes.
07:18 --> 07:19Similar to basal cells
07:19 --> 07:22they can be pink and scaly.
07:22 --> 07:24They can sometimes have a warty
07:24 --> 07:26texture and one thing that I find
07:26 --> 07:27is helpful with squamous cells,
07:27 --> 07:29as these tend to be painful.
07:29 --> 07:31And so if you have a lesion on
07:31 --> 07:32your skin when you touch it,
07:32 --> 07:33it's painful.
07:33 --> 07:35That's something that you should
07:35 --> 07:36definitely tell your doctor
07:36 --> 07:38dermatologist about because many times
07:38 --> 07:41that's how these squamous cells present.
07:41 --> 07:43It can also grow very rapidly,
07:43 --> 07:46usually a lot faster than a basal cell.
07:46 --> 07:49Let's suppose you have one of these
07:49 --> 07:52lesions you've listened to this show,
07:52 --> 07:54and you've discovered that you might
07:54 --> 07:58have one of these and you go and you see
07:58 --> 08:00your family doctor or your dermatologist.
08:00 --> 08:02What's generally the next step in
08:02 --> 08:04terms of making that diagnosis,
08:04 --> 08:06and how bad is the treatment?
08:08 --> 08:11So once there's a suspicious skin lesion,
08:11 --> 08:13the way that we diagnose the condition
08:13 --> 08:15is we perform a skin biopsy,
08:15 --> 08:16so this is a really simple procedure
08:16 --> 08:18that takes place in the office.
08:18 --> 08:21It only takes a few minutes to do locally.
08:21 --> 08:22The area is numbed up with
08:22 --> 08:24a little bit of lidocaine,
08:24 --> 08:26and then the area is either shaved
08:26 --> 08:29off or we use something called a
08:29 --> 08:31punch biopsy and we're able to get
08:31 --> 08:33the lesion into a bottle that was
08:33 --> 08:35sent to a pathologist who then
08:35 --> 08:37looks under the microscope and is
08:37 --> 08:38able to give us an answer.
08:39 --> 08:41Well, that's great for lesions
08:41 --> 08:43that are on the skin, but if
08:43 --> 08:45you've got one of those melanomas
08:45 --> 08:48that's on a toenail under the nail,
08:48 --> 08:50how do you do a biopsy of that?
08:50 --> 08:52Yeah, so those are a little
08:52 --> 08:53bit more complicated.
08:53 --> 08:55And so what's really important
08:55 --> 08:57about biopsying those lesions is
08:57 --> 08:59that a specialist who's familiar
08:59 --> 09:01with doing it performs it,
09:01 --> 09:02and so, for instance,
09:02 --> 09:04if we want to biopsy the nail,
09:04 --> 09:06and in particular we want to biopsy
09:06 --> 09:08what's called the nail matrix,
09:08 --> 09:09which is where.
09:09 --> 09:12Most of these cells, Melanoma cells form,
09:12 --> 09:15and then they expand upward into the nail.
09:15 --> 09:18We sometimes have to after we numb it up,
09:18 --> 09:20actually peel back some of the skin and
09:20 --> 09:23even remove the nail plate itself sometimes,
09:23 --> 09:25and so those procedures can be
09:25 --> 09:27a little bit more complicated.
09:28 --> 09:31Yeah, doesn't sound like fun.
09:31 --> 09:34OK, so so let's suppose a
09:34 --> 09:37diagnosis is made of a skin cancer.
09:37 --> 09:40Now you mentioned at the top of
09:40 --> 09:42the show that these are cells
09:42 --> 09:44and squamous cells are incredibly
09:44 --> 09:46common but not very lethal.
09:46 --> 09:48Unlike Melanoma, little less
09:48 --> 09:52common but far more lethal, so.
09:52 --> 09:54Does the treatment vary between these
09:54 --> 09:57different kinds of cancers as well?
09:57 --> 09:59Yeah, so. Fortunately,
09:59 --> 10:02in most cases of basal cell,
10:02 --> 10:04squamous cell, and even Melanoma,
10:04 --> 10:07these skin cancers are found relatively
10:07 --> 10:10early and very easily treated and cured,
10:10 --> 10:12and so the treatment for basal cells
10:12 --> 10:14and squamous cells which we can kind
10:14 --> 10:16of lump together is with surgical
10:16 --> 10:19removal and so usually a simple
10:19 --> 10:21excision is performed for these.
10:21 --> 10:23If they happen to occur on a more
10:23 --> 10:25sensitive area like let's say the face or
10:25 --> 10:27the hands of the feet or the genitals,
10:27 --> 10:30then they'll be removed by a technique.
10:30 --> 10:33Which is called Mohs surgery and this is
10:33 --> 10:36basically very similar to a simple excision.
10:37 --> 10:40It's just that a little bit of the skin
10:40 --> 10:42cancer is removed by a shave at a time,
10:42 --> 10:44and then the patient waits while the
10:44 --> 10:45doctor looks under the microscope
10:45 --> 10:47to make sure they got it all.
10:47 --> 10:49If there happens to be an area
10:49 --> 10:50that's remaining,
10:50 --> 10:52then the doctor will go back to
10:52 --> 10:54perform additional shave removal of it.
10:54 --> 10:58Now melanomas are removed as well by surgery.
10:58 --> 10:59However,
10:59 --> 11:01the procedures usually a little bit more.
11:01 --> 11:03Tailed because the margins are
11:03 --> 11:04a little bit greater,
11:04 --> 11:06meaning the area around the skin
11:06 --> 11:08cancer is greater to ensure that
11:08 --> 11:10there no cells left behind and if
11:10 --> 11:12the Melanoma was a little bit thicker
11:12 --> 11:14then actually a lymph node is obtained
11:14 --> 11:17at the same time of the excision,
11:17 --> 11:19and that's called the Sentinel
11:19 --> 11:20lymph node removal,
11:20 --> 11:21and that's done usually by a
11:21 --> 11:23general or a plastic surgeon.
11:24 --> 11:26So now wait a minute when you were
11:26 --> 11:28talking about the basal cells and
11:28 --> 11:29the squamous cells and you were
11:29 --> 11:31talking about more sensitive areas.
11:31 --> 11:33You mentioned that these
11:33 --> 11:34could happen on the genitals,
11:34 --> 11:36so some of our listeners might
11:36 --> 11:38be very curious about that.
11:38 --> 11:40Thinking. How does somebody get a
11:40 --> 11:43cancer in that part of the skin?
11:43 --> 11:45We thought that most skin cancers
11:45 --> 11:47are due to sun exposure.
11:47 --> 11:48Was that?
11:48 --> 11:50Do those occur only in people
11:50 --> 11:51who go skinny dipping?
11:52 --> 11:53Or what's the deal with that?
11:54 --> 11:55So that's a really good question.
11:56 --> 11:58So in general, yes, like any cancer,
11:58 --> 11:59there's environmental and genetic
11:59 --> 12:02and other components that go into it.
12:02 --> 12:03O for most cases,
12:03 --> 12:05they do happen in areas that are sun exposed,
12:05 --> 12:08but for instance squamous cells.
12:08 --> 12:10There's some risk after
12:10 --> 12:12getting an HPV infection,
12:12 --> 12:15and so some patients can develop genital
12:15 --> 12:17lesions of squamous cell carcinoma,
12:17 --> 12:20and while not and while most skin cancers
12:20 --> 12:23do happen in areas that are sun exposed,
12:23 --> 12:25there are for some reasons some that
12:25 --> 12:27do develop in areas that have been
12:27 --> 12:29protected from the sun and these might
12:29 --> 12:32occur due to other genetic reasons.
12:32 --> 12:34And sometimes we don't fully
12:34 --> 12:35understand why these happen,
12:35 --> 12:36but they can,
12:36 --> 12:38so that's what makes a total body
12:38 --> 12:39skin exam particularly important
12:39 --> 12:42for patients who are at high risk.
12:42 --> 12:42Hmm,
12:42 --> 12:45interesting and so you know when you were
12:45 --> 12:48talking about the squamous cell carcinomas.
12:48 --> 12:51In particular, you did mention that they
12:51 --> 12:55can look wartlike and so is the pathway
12:55 --> 12:57to getting squamous cell carcinomas
12:57 --> 13:00and genital warts similar in the
13:00 --> 13:03sense that they're both caused by HPV.
13:04 --> 13:06So in some ways, yes,
13:06 --> 13:10but not all squamous cells are due to
13:10 --> 13:13that and so with HPV viral infection,
13:13 --> 13:15our body is immune.
13:15 --> 13:17System is often able to help to
13:17 --> 13:19help clear those infections but
13:19 --> 13:21with squamous cell carcinomas.
13:21 --> 13:23It's a bit more complicated because
13:23 --> 13:25it can involve HPV but can also
13:25 --> 13:27involve other changes in the DNA
13:27 --> 13:29of the skin called mutations
13:29 --> 13:30that happen from sun damage.
13:32 --> 13:34Now we're going to need to take a
13:34 --> 13:35short break for a medical minute,
13:35 --> 13:38but please stay tuned to learn more
13:38 --> 13:40about Melanoma and skin cancers with
13:40 --> 13:42my guest doctor Jonathan Leventhal,
13:42 --> 13:44funding for Yale Cancer Answers comes
13:44 --> 13:46from Smilow Cancer Hospital where the
13:46 --> 13:48bladder cancer team is at the forefront
13:48 --> 13:51of bladder cancer treatment and research.
13:51 --> 13:55Learn more at yalecancercenter.org.
13:55 --> 13:58The American Cancer Society estimates that
13:58 --> 14:01more than 65,000 Americans will be diagnosed
14:01 --> 14:04with head and neck cancer this year,
14:04 --> 14:07making up about 4% of all cancers
14:07 --> 14:08diagnosed when detected early.
14:08 --> 14:11However, head and neck cancers are
14:11 --> 14:13easily treated and highly curable.
14:13 --> 14:15Clinical trials are currently
14:15 --> 14:17underway at federally designated
14:17 --> 14:19Comprehensive cancer centers such as
14:19 --> 14:21Yale Cancer Center and its Smilow
14:21 --> 14:23Cancer Hospital to test innovative new
14:23 --> 14:26treatments for head and neck cancers.
14:26 --> 14:28Yale Cancer Center was recently
14:28 --> 14:30awarded grants from the National
14:30 --> 14:32Institutes of Health to fund the
14:32 --> 14:35Yale Head and neck Cancer Specialized
14:35 --> 14:37program of Research Excellence or
14:37 --> 14:40SPORE to address critical barriers to
14:40 --> 14:42treatment of head and neck squamous
14:42 --> 14:45cell carcinoma due to resistance to
14:45 --> 14:47immune DNA damaging and targeted therapy.
14:47 --> 14:50More information is available at
14:50 --> 14:52yalecancercenter.org you're listening
14:52 --> 14:53to Connecticut Public Radio.
14:55 --> 14:57Welcome back to Yale Cancer answers.
14:57 --> 14:59This is doctor Ennist Chappar
14:59 --> 15:01and I'm joined tonight by my
15:01 --> 15:03guest doctor Jonathan Leventhal.
15:03 --> 15:05We're here learning about the care
15:05 --> 15:07of patients with melanomas and
15:07 --> 15:09skin cancer in honor of Melanoma
15:09 --> 15:11and skin Cancer Awareness Month.
15:11 --> 15:14Now, right before the break Jonathan,
15:14 --> 15:16you were mentioning that some squamous
15:16 --> 15:19cell carcinoma is not all but some.
15:19 --> 15:22Can occur in the genital area and
15:22 --> 15:25may be related to HPV so I have
15:25 --> 15:28one follow up question to that.
15:28 --> 15:30Which is you know here are
15:30 --> 15:31on Yale Cancer answers.
15:31 --> 15:34We've talked a lot about the HPV vaccine
15:34 --> 15:37and it's benefit in terms of preventing
15:37 --> 15:40all kinds of different cancers,
15:40 --> 15:42cervical cancer, anal cancer,
15:42 --> 15:44head neck cancers.
15:44 --> 15:46Does it reduce your risk of
15:46 --> 15:49squamous cell carcinomas as well?
15:49 --> 15:52So not in the sense of the
15:52 --> 15:54squamous cell carcinomas that
15:54 --> 15:56happen from ultraviolet damage,
15:56 --> 15:57which is a large chunk.
15:57 --> 15:59The way to prevent those is to avoid
15:59 --> 16:01the sun and use sun protective measures,
16:01 --> 16:02which I'm sure we'll discuss,
16:02 --> 16:05but in a sense, reducing HPV related
16:05 --> 16:06squamous cell carcinomas that tend
16:06 --> 16:08to occur in the genitals? Yes,
16:09 --> 16:11well, let's segue into how
16:11 --> 16:14we can reduce our risk of.
16:14 --> 16:17Ultraviolet rays and how much that
16:17 --> 16:20really reduces our risk of cancer.
16:20 --> 16:22So when I talk to my patients about
16:22 --> 16:24protecting themselves in the sun,
16:24 --> 16:26especially those that are really high risk,
16:26 --> 16:28I mean obviously we have to be able to
16:28 --> 16:31go outside and enjoy ourselves and so
16:31 --> 16:33I think that just using a little bit
16:33 --> 16:35of common sense goes a very long way.
16:35 --> 16:37So first of all, when you're
16:37 --> 16:39outside for a long period of time,
16:39 --> 16:42wearing a hat and sunglasses is really
16:42 --> 16:44easy and something that's really important.
16:44 --> 16:46You know seeking shade rather
16:46 --> 16:48than lying out in tanning?
16:48 --> 16:50Also, something that's just an easy one,
16:50 --> 16:52but if you're going to be
16:52 --> 16:53outside then we have, you know,
16:53 --> 16:55protective measures with sunscreen.
16:55 --> 16:57And there's two main types of sunscreens.
16:57 --> 16:58There's physical blockers which
16:58 --> 17:00often look like those white, pasty,
17:00 --> 17:02zinc, or titanium dioxide and
17:02 --> 17:04those block the sun rays.
17:04 --> 17:06And then there's the chemical blockers.
17:06 --> 17:08Those are the ones that kind of
17:08 --> 17:10rub in a little bit more nicely,
17:10 --> 17:12and those basically absorb the ultraviolet
17:12 --> 17:14rays before they damage the skin.
17:14 --> 17:15So absolutely.
17:15 --> 17:19Using sunscreen, either type with an SPF.
17:19 --> 17:20That's usually, you know.
17:20 --> 17:22Dermatologists like to say 30
17:22 --> 17:24or higher is very protective.
17:24 --> 17:26It helps prevent sunburns,
17:26 --> 17:28which we know dramatically increase
17:28 --> 17:31the risk of all the major skin cancers
17:31 --> 17:33and and really have been shown in
17:33 --> 17:35studies to reduce the risk as well.
17:36 --> 17:38So let me ask you this,
17:38 --> 17:40if you're going to use sunscreen,
17:40 --> 17:43do you have to wear like long sleeves
17:43 --> 17:45and long pants and sit in the shade?
17:45 --> 17:47Or is the sunscreen sufficient
17:47 --> 17:49to block the sun rays?
17:50 --> 17:53So the best thing that works the best is
17:53 --> 17:56obviously avoiding direct sun exposure,
17:56 --> 17:58and so if you are going to be in
17:58 --> 18:00the shade wearing sun protective
18:00 --> 18:02clothing with long sleeve and pants,
18:02 --> 18:03you know you don't need to
18:03 --> 18:04have sunscreen underneath it.
18:04 --> 18:06You really want to apply sunscreen
18:06 --> 18:08to the areas that are uncovered,
18:08 --> 18:10but most of the time people want
18:10 --> 18:12to be outside and enjoy themselves,
18:12 --> 18:15and you know, including myself and so for me.
18:15 --> 18:17You know, putting hat sunglasses and
18:17 --> 18:19sunscreen on anywhere that's exposed
18:19 --> 18:21like my arms if I'm wearing AT shirt,
18:21 --> 18:25my neck not forgetting my ears
18:25 --> 18:26really important.
18:26 --> 18:27Something else that a lot of
18:27 --> 18:29my patients seem to tell me is
18:29 --> 18:30that they put on sunscreen,
18:30 --> 18:32but yet they still get burned.
18:32 --> 18:34And so when I talk to them a little bit more,
18:34 --> 18:35it turns out that maybe they
18:35 --> 18:37applied it in the morning,
18:37 --> 18:38but then they were playing
18:38 --> 18:39basketball or tennis,
18:39 --> 18:41or were out playing golf all day
18:41 --> 18:42and they never reapplied it.
18:42 --> 18:44So after several hours you really
18:44 --> 18:46need to reapply the sunscreen,
18:46 --> 18:48especially if you're going to be sweating or,
18:48 --> 18:49you know,
18:49 --> 18:51jumping into the pool when coming out.
18:51 --> 18:53The sunscreen will not work all day long.
18:53 --> 18:55How do we get the sunscreen
18:55 --> 18:57underneath those nail beds?
18:57 --> 19:00If Melanoma can occur under your nail, so
19:00 --> 19:02that's a good question, so the nails and
19:02 --> 19:05you know the fingers you know you want
19:05 --> 19:07to apply sunscreen to the skin itself.
19:07 --> 19:09Regarding the nail beds, those types
19:09 --> 19:12of melanomas likely are not solely
19:12 --> 19:15driven by the sun rays and ultraviolet.
19:15 --> 19:17You know, especially in patients
19:17 --> 19:18with darker skin types,
19:18 --> 19:21there seems to be more of genetic
19:21 --> 19:23risk factors at play there,
19:23 --> 19:25and so I don't think people need to
19:25 --> 19:27drive themselves a little crazy.
19:27 --> 19:28By applying sunscreen under,
19:28 --> 19:31you know under and around their their nails.
19:31 --> 19:32I think really the focus should be
19:32 --> 19:34on on exposed areas of the skin.
19:35 --> 19:36Next question. We have hair
19:36 --> 19:39on the top of our heads,
19:39 --> 19:41some more than others,
19:41 --> 19:44so if you aren't bald,
19:44 --> 19:45do you still need to wear a hat?
19:46 --> 19:48So the answer is yes.
19:48 --> 19:51Even in patients who have a lot of hair,
19:51 --> 19:54you still can find sun damage,
19:54 --> 19:57precancers and skin cancers develop.
19:57 --> 19:59And so the ultraviolet rays
19:59 --> 20:01can still cause skin damage,
20:01 --> 20:03especially in the areas of the
20:03 --> 20:05midline part or in patients
20:05 --> 20:07who maybe have some thinning.
20:07 --> 20:09Others may be a little bit more bald.
20:09 --> 20:11You can certainly get skin cancers there.
20:11 --> 20:14That's actually a really common place
20:14 --> 20:17for men to develop skin cancers,
20:17 --> 20:21and that's on areas of thin hair scalp.
20:21 --> 20:24OK, let's suppose there are some men
20:24 --> 20:26who are listening who may be bold,
20:26 --> 20:28but they don't particularly
20:28 --> 20:30enjoy wearing a hat.
20:30 --> 20:32Could they just use sunscreen on the
20:32 --> 20:35top of their head instead of wearing a hat,
20:35 --> 20:36just like you would on your arms
20:36 --> 20:38and legs if you didn't want to
20:38 --> 20:40wear long sleeves and long pants,
20:41 --> 20:44sure, so hat is clearly more protective,
20:44 --> 20:46but if someone does not wish to wear a hat,
20:46 --> 20:48then absolutely applying sunscreen
20:48 --> 20:52onto the the scalp is is very helpful.
20:52 --> 20:53And you know this really
20:53 --> 20:55different types of sunscreen too.
20:55 --> 20:57Some lotions that seem to rub in better,
20:57 --> 20:59some are creams,
20:59 --> 21:01others are actually sprays.
21:01 --> 21:02Which some people actually prefer
21:02 --> 21:04if they have thinning on the hair,
21:04 --> 21:06they just spray on some sunscreen.
21:06 --> 21:08So there's really different types.
21:08 --> 21:10And what I tell patients is find
21:10 --> 21:12a type that works best for you.
21:12 --> 21:14Don't just ask well what's the best one.
21:14 --> 21:17You want a sunscreen that blocks
21:17 --> 21:19both ultraviolet and ultraviolet B,
21:19 --> 21:21and most of the sunscreens on the shelf.
21:21 --> 21:23Do that now and you want a sunscreen
21:23 --> 21:25that you actually like and use
21:26 --> 21:31so the spray is a cool idea for.
21:31 --> 21:33Those of us who really
21:33 --> 21:34don't enjoy wearing hats.
21:34 --> 21:37Could we just spray over our hair?
21:37 --> 21:38Does that work?
21:38 --> 21:40Would that prevent skin cancer
21:40 --> 21:42and would it wreck our hair?
21:44 --> 21:45So I don't wanna be blamed
21:45 --> 21:47for some right hairstyles,
21:47 --> 21:48but here's what I would say.
21:48 --> 21:49The hats the best.
21:49 --> 21:51If someone is balding and there's
21:51 --> 21:53a lot of exposed skin, then yeah,
21:53 --> 21:55I think spraying it's a really good idea.
21:55 --> 21:57I don't think that you just want
21:57 --> 21:58to go spraying sunscreen throughout
21:58 --> 22:00your your hair because that's not
22:00 --> 22:01going to be particularly helpful.
22:01 --> 22:04You really want to get it on exposed
22:04 --> 22:06skin and so for all those men out there
22:06 --> 22:09who don't like to wear a hat but do
22:09 --> 22:11have a bald scalp or hair thinning.
22:11 --> 22:13Absolutely protecting it with sunscreen.
22:13 --> 22:16It's very important and will reduce sunburns,
22:16 --> 22:17will reduce ultraviolet damage
22:17 --> 22:19to your skin and will therefore
22:20 --> 22:21reduce you getting skin cancer.
22:22 --> 22:24OK then the next thing
22:24 --> 22:26you said was sunglasses.
22:26 --> 22:29So is there a particular type of
22:29 --> 22:31sunglasses that you should be wearing?
22:31 --> 22:34Or are dark shades good enough
22:34 --> 22:37or how does that kind of work?
22:37 --> 22:39Yeah, so you actually can develop
22:39 --> 22:42a Melanoma in in the eye.
22:42 --> 22:44And while there's many different
22:44 --> 22:46genetic and environmental risk
22:46 --> 22:48factors that are important there,
22:48 --> 22:49getting ultraviolet damage
22:49 --> 22:51is clearly one of them.
22:51 --> 22:52And so I just tell patients
22:52 --> 22:54to find a pair of sunglasses,
22:54 --> 22:56especially those that have UV protection,
22:56 --> 22:58which many of the nicer brands do.
22:58 --> 23:00And that's that's something that's
23:00 --> 23:03important in addition to the eyes.
23:03 --> 23:05Another area that's sometimes
23:05 --> 23:06forgotten are the lips,
23:06 --> 23:08and so I do tell patients also
23:08 --> 23:10to don't forget about applying
23:10 --> 23:11sunscreen to the lips,
23:11 --> 23:14and so they're actually are special.
23:14 --> 23:16Lip balms that have sunscreen in them,
23:16 --> 23:17which patients can buy
23:18 --> 23:21that's interesting. I didn't know that.
23:21 --> 23:24What about getting back to the glasses part?
23:24 --> 23:27UM, OK, fine, you can wear shades
23:27 --> 23:30when you're not in the pool,
23:30 --> 23:31but if you're jumping into a
23:31 --> 23:34pool or a lake, let me tell you.
23:34 --> 23:35Swimming with glasses on
23:35 --> 23:37is a little bit tricky.
23:37 --> 23:39So what do you do then?
23:41 --> 23:44If you are not going to wear sunglasses,
23:44 --> 23:46then you know applying sunscreen
23:46 --> 23:48to your face, and again,
23:48 --> 23:51you know you can totally go in the pool
23:51 --> 23:54with a really nice hat and you know if
23:55 --> 23:57you're worried about it getting wet,
23:58 --> 24:01you can totally take it off.
24:01 --> 24:03Apply sunscreen and then reapply it,
24:03 --> 24:04but I told my patients we
24:04 --> 24:06have to do the best we can.
24:06 --> 24:07You want to protect your skin.
24:07 --> 24:09We have so many different strategies
24:09 --> 24:11that we can use sunscreen.
24:11 --> 24:12Had some protective clothes
24:12 --> 24:14and a lot of my patients.
24:14 --> 24:16Once they develop a skin cancer,
24:16 --> 24:18they're saying to themselves, well,
24:18 --> 24:19that's it. I don't want anymore.
24:19 --> 24:21And so when they go in the
24:21 --> 24:22pool you better believe it.
24:22 --> 24:23They have a hat on.
24:23 --> 24:25They have a sun protective clothing
24:25 --> 24:27on they look like scuba divers
24:27 --> 24:29and and I think that's great
24:30 --> 24:32so you know in terms of
24:32 --> 24:34really protecting yourself,
24:34 --> 24:36there are now some clothing brands
24:36 --> 24:39that claim to have UV protection
24:39 --> 24:42or they're kind of sun repellent.
24:42 --> 24:45That clothing they're a little bit
24:45 --> 24:47hard to find, but they are available.
24:47 --> 24:49Is that worth it or is
24:49 --> 24:51that just over the top?
24:52 --> 24:54So I would never say it's over the top.
24:54 --> 24:57If somebody's really worried about, you know,
24:57 --> 24:59let's say they have had skin cancers,
24:59 --> 25:01they really don't want to get anymore
25:01 --> 25:03skin cancer and so clothing that has
25:03 --> 25:05UPF ultraviolet protective factor.
25:05 --> 25:07Those are great and you
25:07 --> 25:08can order those online.
25:08 --> 25:10You can find them at many different stores,
25:10 --> 25:13but in general, if you're wearing clothing,
25:13 --> 25:14you're wearing a hat.
25:14 --> 25:15If you're wearing,
25:15 --> 25:17you know long sleeve shirt and
25:17 --> 25:20pants that tends to be a very
25:20 --> 25:21good strategy to prevent.
25:21 --> 25:24To protect your skin from UV damage,
25:25 --> 25:28now the other thing while people are
25:28 --> 25:31getting ready to hit the beach this summer,
25:31 --> 25:34some people try to get kind of a head
25:34 --> 25:37start on tanning by visiting their
25:37 --> 25:40local tanning salon. OK or not? OK,
25:40 --> 25:41definitely not. OK,
25:41 --> 25:44so for some reason a lot of my patients
25:44 --> 25:46would tell me that before going on a
25:47 --> 25:49vacation they would get a head start.
25:49 --> 25:51They would get a baseline tan,
25:51 --> 25:52so we absolutely know.
25:52 --> 25:54That especially for young women
25:54 --> 25:56who seem to do this more than
25:56 --> 25:59young men that using tanning beds,
25:59 --> 26:00significantly increases your
26:00 --> 26:02risk of getting Melanoma,
26:02 --> 26:04and so absolutely no.
26:04 --> 26:06No to tanning beds.
26:06 --> 26:08If you want your skin to look tan,
26:08 --> 26:10there's no harm in using
26:10 --> 26:12an artificial Tanner.
26:12 --> 26:14You just don't want to look like Ross from
26:14 --> 26:15friends when he was all orange like a carrot.
26:16 --> 26:17But there's no harm at all for
26:17 --> 26:19using an artificial Tanner.
26:19 --> 26:23OK, so?
26:23 --> 26:25So we've gotten some tips now on
26:25 --> 26:28kind of how to protect ourself and
26:28 --> 26:31and protect ourselves from the sun.
26:31 --> 26:33And we know what to look
26:33 --> 26:36for in terms of Melanoma,
26:36 --> 26:39squamous cell and basal cell cancers.
26:39 --> 26:41But in terms of skin cancer you
26:41 --> 26:43you also mentioned that there
26:43 --> 26:45are things that are a little
26:45 --> 26:46bit outside of our control,
26:46 --> 26:50so genetic factors and so on and so forth.
26:50 --> 26:52How do we know how much baseline
26:52 --> 26:53risk we have?
26:53 --> 26:54And the things that we can't control.
26:56 --> 26:57That's a really great question.
26:57 --> 27:00And so some of the genetic factors
27:00 --> 27:02include our the type of skin,
27:02 --> 27:05hair and nails and eye color that we have.
27:05 --> 27:06So for instance,
27:06 --> 27:09patients that have very white skin,
27:09 --> 27:11lots of freckles, light hair like
27:11 --> 27:14blonde or red hair, light eyes.
27:14 --> 27:16Those are patients that we know
27:16 --> 27:19have a far greater risk of burning.
27:19 --> 27:20And these are also the patients that have
27:20 --> 27:23a far greater risk of getting skin cancer.
27:23 --> 27:25If a patient has many moles on their body,
27:25 --> 27:28we also know that having over 100 moles
27:28 --> 27:30and atypical appearing malls can increase
27:30 --> 27:33your risk for developing Melanoma.
27:33 --> 27:34So those are some of the things
27:34 --> 27:36that we really can't control.
27:36 --> 27:36In addition,
27:36 --> 27:38we also know that genetics
27:38 --> 27:40is important here as well.
27:40 --> 27:43So if we have a strong genetic history
27:43 --> 27:45of others who have skin cancer,
27:45 --> 27:46that could also increase your risk.
27:47 --> 27:49Great one last question.
27:49 --> 27:53You did mention that one of the things.
27:53 --> 27:55That we should be thinking about
27:55 --> 27:57is getting regular skin checks.
27:57 --> 28:00So how do we know whether we should
28:00 --> 28:02get a skin check who we should
28:02 --> 28:05go and see about that and how
28:05 --> 28:07often that should be done? Advice?
28:08 --> 28:10Yes, so in general not everybody
28:10 --> 28:12needs to get his skin check.
28:12 --> 28:14Get his skin, check a total body skin
28:14 --> 28:16check by a board certified dermatologist.
28:16 --> 28:18If you're somebody who has a person
28:18 --> 28:20or family history of skin cancer.
28:20 --> 28:22If you think that you're someone
28:22 --> 28:25who has these genetic or phenotypic
28:25 --> 28:27risks of developing skin cancer.
28:27 --> 28:29And if you have something on your
28:29 --> 28:31skin that you're concerned about,
28:31 --> 28:32definitely see a dermatologist.
28:33 --> 28:35Doctor Jonathan Leventhal is an
28:35 --> 28:37assistant professor of dermatology
28:37 --> 28:39at the Yale School of Medicine.
28:39 --> 28:41If you have questions,
28:41 --> 28:43the address is canceranswers@yale.edu
28:43 --> 28:45and passed editions of the program
28:45 --> 28:48are available in audio and written
28:48 --> 28:49form at yalecancercenter.org.
28:49 --> 28:51We hope you'll join us next week to
28:51 --> 28:53learn more about the fight against
28:53 --> 28:54cancer here on Connecticut Public
28:54 --> 28:57radio funding for Yale Cancer Answers
28:57 --> 29:00is provided by Smilow Cancer Hospital.

Information

Melanoma and Skin Cancer Awareness 2022 with guest Dr. Jonathan Leventhal May 22, 2022 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095