Skip to Main Content

INFORMATION FOR

Sun Safety

July 06, 2021
  • 00:00Funding for Yale Cancer Answers
  • 00:02is provided by Smilow Cancer
  • 00:04Hospital and AstraZeneca.
  • 00:08Welcome to Yale Cancer Answers with your
  • 00:10host, doctor Anees Chagpar. Yale Cancer
  • 00:13Answers features the latest information
  • 00:15on cancer care by welcoming oncologists
  • 00:17and specialists who are on the forefront
  • 00:20of the battle to fight cancer. This week
  • 00:22it's a conversation about skin cancer and
  • 00:24sun safety with Doctor Kathleen Suozzi.
  • 00:27Doctor Suozzi is an assistant professor
  • 00:29of dermatology and dermatologic surgery
  • 00:31at the Yale School of Medicine,
  • 00:33where Doctor Chagpar is a professor
  • 00:36of surgical oncology.
  • 00:39We've been waiting for this for a long time.
  • 00:42Tell us what we should know in
  • 00:45order to keep ourselves safe
  • 00:47during the summer.
  • 00:48Yes, I think as we're emerging
  • 00:51after this difficult COVID year,
  • 00:53people are really looking forward
  • 00:55to spending the summer outdoors and
  • 00:58doing activities that have been
  • 01:00really limited over the past year.
  • 01:02And I fully encourage that, but we
  • 01:05want to do it safely and there's a few tips
  • 01:09I think that will help people be sun safe
  • 01:12during their outdoor activities this summer.
  • 01:15The first thing to talk about is
  • 01:18sun protection and sun protection
  • 01:21comes in a couple forms.
  • 01:23So when we think about sun protection,
  • 01:26most people think about sunscreen and this
  • 01:29really is the main first line of defense.
  • 01:33But the key for sunscreen is using
  • 01:36it properly and what I think
  • 01:39people misuse is in terms of the
  • 01:42amount of sunscreen they use and the
  • 01:44frequency in which they apply it.
  • 01:47So in general,
  • 01:48when we're recommending
  • 01:49appropriate sunscreen use,
  • 01:50people want to look for an SPF.
  • 01:53This is sun protective factor
  • 01:55and is the amount of
  • 01:58increased protection the sunscreen
  • 02:00is giving you to prevent sunburns.
  • 02:03So, for example,
  • 02:04if you're using an SPF of 15,
  • 02:07that means it's going to
  • 02:09take 15 times longer
  • 02:11to cause a sunburn,
  • 02:12then it would without any sunscreen,
  • 02:15and so in general I recommend that patients
  • 02:19or people look for SPF of 30 or above.
  • 02:23This is going to be giving you
  • 02:26coverage for about 98% of UV rays,
  • 02:29so with application number one you
  • 02:31have to apply enough and so the general
  • 02:35recommendation is about 1 to 2 ounces.
  • 02:38So this is about a shot glass size
  • 02:41or a golf ball sized amount of
  • 02:44sunscreen to cover exposed skin
  • 02:46and this sunscreen needs to
  • 02:48be reapplied every two hours.
  • 02:50And so Katie, just a couple of
  • 02:53questions on that. The first is, is
  • 02:56the bigger the number for the SPF better?
  • 02:59So if you have a choice between 30 and
  • 03:0250 and maybe even 70 that you should
  • 03:05pick the higher number.
  • 03:07No, that's really not always the case.
  • 03:10So as I mentioned at an SPF of 30,
  • 03:13you're blocking approximately 98%
  • 03:15of the ultraviolet radiation,
  • 03:16and so at increasing numbers,
  • 03:18there's diminishing return.
  • 03:20And in order to
  • 03:21achieve higher sun
  • 03:22protective factor,
  • 03:24say your SPF is 100 or 70 or greater,
  • 03:27the consistency of the product changes.
  • 03:29It becomes more tacky, more opaque.
  • 03:31It's not as wearable,
  • 03:33and so in my experience my patients
  • 03:35aren't as likely
  • 03:37to use it as a more wearable,
  • 03:40say SPF 30, which goes on easier,
  • 03:42is more shear,
  • 03:43and they're more likely to keep
  • 03:45it on every day and reapply
  • 03:47every two hours as recommended.
  • 03:51So the next question I have is when
  • 03:53we're looking at the sunscreen bottle,
  • 03:56some of them will say broad spectrum.
  • 03:59Some of them will say UVA and UVB.
  • 04:02What do all of those terms mean and
  • 04:06how important or not are they?
  • 04:09Broad spectrum is not just a marketing label,
  • 04:13it actually is really important and what
  • 04:16broad spectrum means is that the sunscreen
  • 04:19is blocking both UVA and UVB rays.
  • 04:22So UV radiation comes in a few forms.
  • 04:26The main ones that reach
  • 04:29the Earth are UVA and UVB.
  • 04:32UVB radiation is what causes sunburn
  • 04:34and is also associated with skin cancer.
  • 04:38UVA Is the ultraviolet radiation that
  • 04:42is associated with sun damage in the skin,
  • 04:46so the development of wrinkles,
  • 04:48sunspots, and is also associated
  • 04:51with skin cancer.
  • 04:53UVC really doesn't penetrate to
  • 04:55the earths surface,
  • 04:57so really talking about UVA and UVB
  • 04:59and so broad spectrum means that
  • 05:02that sunscreen product is going to
  • 05:05protect you from both UVB and UVA rays.
  • 05:08And so this is really important and
  • 05:10the type of sunscreen you will also
  • 05:13find on your sunscreen label and in
  • 05:16general sunscreens come in two forms so
  • 05:19we have our chemical based sunscreens
  • 05:22and our physical based sunscreens.
  • 05:24The physical base are also referred
  • 05:26to as mineral based sunscreens.
  • 05:28Mineral based sunscreens are the
  • 05:30ones that contain zinc or titanium.
  • 05:33That's why they get their name of
  • 05:35mineral based and the way mineral
  • 05:37based sunscreens work is they are
  • 05:39literally just reflecting the UV
  • 05:41radiation off the skin and this is
  • 05:43why you think about the traditional
  • 05:45zinc based sunscreens that were very
  • 05:47white and opaque because they would
  • 05:49go on and just reflect off the light.
  • 05:52Now we have a lot more elegant
  • 05:54formulations where the minerals are
  • 05:56micronized and they go on much more
  • 05:58shear on the skin and these are in
  • 06:01general my preferred forms of sunscreen
  • 06:03because they are not just reflecting UV,
  • 06:06they are by nature broad spectrum.
  • 06:09The main reason why I prefer the
  • 06:11mineral based to the chemical based
  • 06:14is that chemical based sunscreens
  • 06:16can cause skin irritation,
  • 06:18both irritant and allergic types of reactions.
  • 06:21Recently there has been
  • 06:23some controversies about some sunscreens.
  • 06:26The chemical variety causing cancer.
  • 06:28Is that true? And how much
  • 06:30stock should we put into that?
  • 06:34So we have a lot more research needed into
  • 06:38that to really determine
  • 06:41if there is any inherent harm in
  • 06:45these chemical based sunscreens.
  • 06:48So the initial concern came out when
  • 06:51it was found that the chemical based
  • 06:54sunscreens could be detected at very
  • 06:58very low levels in the bloodstream and
  • 07:01what does this mean?
  • 07:09Does this pose any health risk is still very,
  • 07:12very unknown.
  • 07:14It's very unlikely that these chemical
  • 07:17sunscreens pose any real risks to human
  • 07:20health because we would have seen a
  • 07:23signal come up over all of these years of use
  • 07:26and so the next question has to do
  • 07:29with sunscreens being waterproof.
  • 07:31Are sunscreens waterproof?
  • 07:33And if they say so on the label,
  • 07:37does that mean that you don't need to reapply
  • 07:39them necessarily after you get out of
  • 07:41the water?
  • 07:43Sunscreens can label themselves as water resistant,
  • 07:45but it's not perfect and
  • 07:47certainly it will wash off and
  • 07:49in general those water resistant
  • 07:51formulations tend to have a thicker,
  • 07:54more tacky feel to them,
  • 07:55so they're harder to apply,
  • 07:57so you know if someone is a
  • 08:00swimmer and going to be in
  • 08:03water for long periods of time,
  • 08:05I will say seek out these
  • 08:07water resistant formulations,
  • 08:08but in general I still recommend
  • 08:11that once you come out of the water
  • 08:14dry off and reapply.
  • 08:16What about if you are going outside but you're
  • 08:19going to be indoors for part of the time?
  • 08:23Do you still need to wear sunscreen,
  • 08:26or is that only when you're going
  • 08:29outside to the beach you're
  • 08:31going to be exposed to
  • 08:34the sun for a prolonged period of time?
  • 08:38So, interestingly,
  • 08:39you can even have UV exposure indoors,
  • 08:42and that is because UVA radiation
  • 08:44can penetrate through windows,
  • 08:46so our car windshields by law have to
  • 08:49have filters to protect against UVA,
  • 08:52but the side windows, sunroofs, back windows,
  • 08:55generally don't have UV protection.
  • 08:57Same goes in office buildings.
  • 08:59So if you're working next
  • 09:01to a window every day,
  • 09:04you have significant UVA exposure and
  • 09:06so I do recommend to all of my patients
  • 09:10that they wear a daily facial sunscreen
  • 09:13and this is applied in the morning.
  • 09:17And you could have it in
  • 09:19your office to reapply.
  • 09:21Sometimes this becomes problematic,
  • 09:23especially for women who wear makeup and
  • 09:26just the practicality of reapplying
  • 09:29a cream based sunscreen multiple times
  • 09:31through the day is just not feasible.
  • 09:34So we do have some newer formulations
  • 09:37that help mitigate that problem.
  • 09:39For example,
  • 09:40there are powder based sunscreens that can
  • 09:43be used for reapplication during the day.
  • 09:47But if you're using a mineral based
  • 09:49sunscreen on your face in the morning,
  • 09:51that mineral composition is
  • 09:53really going to stay there until
  • 09:55you wash it off your face.
  • 09:57So it's better than nothing if you're
  • 09:59at least applying it every morning.
  • 10:02What about you know the reapplication
  • 10:04part seems to be one of the
  • 10:07issues that many people face.
  • 10:09I know that when I go out into
  • 10:11the sun I may start out the day
  • 10:14with all of the best intentions.
  • 10:17Put my sunscreen on,
  • 10:18but when you're outside and
  • 10:20you're having a good time,
  • 10:22you often forget to reapply
  • 10:24it every two hours.
  • 10:25How critical is it that you
  • 10:28reapply every two hours?
  • 10:29Can you up the SPF and then not reapply?
  • 10:34So upping the SPF and not reapplying
  • 10:36isn't going to be helpful,
  • 10:38because what is causing the sunscreen
  • 10:40to need reapplication is related
  • 10:42to what activities you're doing.
  • 10:44For example, if you're sweating,
  • 10:46if you're swimming,
  • 10:47which we already mentioned,
  • 10:49these are things that are
  • 10:51going to lead to the SPF
  • 10:53either washing off or breaking down.
  • 10:55Wiping down with a towel,
  • 10:58for example, and so yes,
  • 11:00it can be really hard to
  • 11:02continuously reapply while you're
  • 11:04outdoors, but I typically recommend
  • 11:07that before your outdoor activity,
  • 11:09give yourself a head to toe
  • 11:12cover in a broad spectrum,
  • 11:14cream based SPF, preferably a mineral,
  • 11:17but chemical is fine as well,
  • 11:20and then when you're out we
  • 11:22have to take a little bit more care
  • 11:28about convenience and so
  • 11:30the spray based sunscreens,
  • 11:32the aerosolized sunscreens,
  • 11:34which aren't perfect for initial
  • 11:36application because they don't
  • 11:37always go on fully evenly,
  • 11:39they're really easy to reapply to
  • 11:41spray it on your exposed skin,
  • 11:43and so those are a great option
  • 11:45to have in your purse or bag so
  • 11:48that when you're out and about
  • 11:50you can easily reapply without having to strip down.
  • 11:58The other thing which we haven't
  • 12:00touched on yet is protective clothing,
  • 12:02and so this is a great way to minimize
  • 12:05the need for reapplication because of
  • 12:07course if you have the clothing on it
  • 12:09will stay with you during your activity.
  • 12:13So all great tips and we're going to
  • 12:15pick up that conversation right after we
  • 12:18take a short break for medical minute.
  • 12:21Please stay tuned to learn more about
  • 12:24skin cancer and sun safety with
  • 12:26my guest doctor Kathleen Suozzi.
  • 12:28Funding for Yale Cancer Answers comes
  • 12:31from Smilow Cancer Hospital promoting
  • 12:33sun safety and skin cancer screening
  • 12:35in honor of UV Safety Month. For information
  • 12:38and to learn if you should be screened,
  • 12:41visit yalecancercenter.org/screening.
  • 12:44This is a medical minute
  • 12:46about smoking cessation.
  • 12:47There are many obstacles to
  • 12:49face when quitting smoking
  • 12:51as smoking involves the potent drug nicotine.
  • 12:54But it's a very important lifestyle change,
  • 12:57especially for patients
  • 12:58undergoing cancer treatment.
  • 12:59Quitting smoking has been shown to
  • 13:02positively impact response to treatments,
  • 13:04decrease the likelihood that patients
  • 13:06will develop second malignancies,
  • 13:08and increase rates of survival.
  • 13:10Tobacco treatment programs are
  • 13:11currently being offered at federally
  • 13:14designated Comprehensive Cancer Centers
  • 13:16and operate on the principles
  • 13:17of the US Public Health service
  • 13:20clinical practice guidelines.
  • 13:21All treatment components are
  • 13:23evidence based and therefore all
  • 13:25patients are treated with FDA
  • 13:27approved first line medications
  • 13:29for smoking cessation as well as
  • 13:31smoking cessation counseling that
  • 13:33stresses appropriate coping skills.
  • 13:35More information is available at
  • 13:37yalecancercenter.org. You're listening
  • 13:39to Connecticut Public Radio.
  • 13:41Welcome back to Yale Cancer Answers.
  • 13:44This is doctor Anees Chagpar
  • 13:46and I'm joined tonight by my
  • 13:48guest doctor Kathleen Suozzi.
  • 13:50We're talking about skin cancer and
  • 13:52sun safety and right before the break,
  • 13:55Katie you were starting to talk
  • 13:57about protective clothing.
  • 13:59So when I think about going outside,
  • 14:01you know part of the reason is
  • 14:04that it's warm and it's beautiful
  • 14:06and nobody really wants to wear a
  • 14:09long sleeve shirt and full length
  • 14:11pants and a hat.
  • 14:13How important is it to keep
  • 14:16really covered up?
  • 14:18Well, the great thing about protective
  • 14:21clothing is the convenience factor that
  • 14:23you put it on and don't need to reapply.
  • 14:26And so for example,
  • 14:28a regular white T shirt.
  • 14:30So when we talk about protective clothing
  • 14:32instead of SPF, we talk about UPF.
  • 14:35UPF measures the transmission of ultraviolet,
  • 14:38so it's ultraviolet protective factor
  • 14:40and so a regular white T shirt has a
  • 14:43UPF somewhere on the order of five to seven,
  • 14:46whereas the Sun protective clothing,
  • 14:49the UPF factor is around 50,
  • 14:51so it doesn't mean that you don't need
  • 14:54sunscreen in the areas of exposed skin,
  • 14:56but by choosing that specific sun
  • 14:58protective clothing instead of the
  • 15:00normal clothing you would wear,
  • 15:02you're better protected in the
  • 15:04areas that are covered.
  • 15:05So tell us
  • 15:06more about Sun Protective clothing
  • 15:08because I think a lot of people,
  • 15:10when they think about
  • 15:12wearing protective clothing from the
  • 15:14sun are thinking well instead of a T shirt,
  • 15:17I'll grab a long sleeve shirt.
  • 15:19Or instead of short shorts,
  • 15:22I will grab cotton pants,
  • 15:25but I think what you are talking about
  • 15:27is really clothing that is specially
  • 15:30designed to protect against UV rays.
  • 15:32Can you tell us more
  • 15:34about where we find that?
  • 15:36How are they labeled?
  • 15:37Can we see how much protective
  • 15:40factor we're getting and what
  • 15:42should we be aiming for?
  • 15:44Yeah, so the market for some protective
  • 15:47clothing has really grown in recent years.
  • 15:50There used to be limited brands that
  • 15:53had this technology that has to do
  • 15:55with the weaving and the material,
  • 15:58the type of material that they use,
  • 16:01but now even more mainstream brands
  • 16:04are carrying clothing that are
  • 16:06specifically UPF rated and that
  • 16:08UPF is what you want to look for.
  • 16:10So on the label it will say
  • 16:13that this garment
  • 16:14is UPF X and usually they'll carry
  • 16:17around a UPF of 30 to 50 and
  • 16:21UPF 50 that's corresponding to
  • 16:23blocking 98% of UV transmission,
  • 16:25which is about equal to what
  • 16:28I said at SPF 30 is doing,
  • 16:30so that's what you want to look for
  • 16:33when you're looking for clothing.
  • 16:36So the
  • 16:37next question I have,
  • 16:38Katie is with regards to when you
  • 16:41say covering up and applying
  • 16:43sunscreen head to toe.
  • 16:46Let's talk about toes.
  • 16:48You know we generally
  • 16:50speaking do not wear socks,
  • 16:52and you know covered shoes
  • 16:54when we go to the beach.
  • 16:57And yet we know that some
  • 16:59skin cancers can occur on
  • 17:01peoples feet and peoples toes.
  • 17:03Can you talk about
  • 17:05how we protect our feet?
  • 17:07Yeah, so this is actually
  • 17:09an interesting discussion.
  • 17:10So when we think about skin
  • 17:13cancers that occur on the feet,
  • 17:15there are the non Melanoma
  • 17:17type of skin cancers which we could
  • 17:19get into a little more detail,
  • 17:21but these are the basal cell and
  • 17:24squamous cell type of skin cancers
  • 17:26and as a skin cancer surgeon
  • 17:28often I'm treating these types
  • 17:30of skin cancers on the back of a
  • 17:32person's foot and just as you said,
  • 17:34I think that's related to the increased
  • 17:36sun exposure that these areas are getting.
  • 17:39And probably many people could remember
  • 17:41getting a bad sunburn on their feet
  • 17:43at one point in the summer months.
  • 17:45But then there's also the
  • 17:47type of skin cancers
  • 17:48that occur in and around the nail,
  • 17:51and these include both Melanoma and
  • 17:53squamous cell type of skin cancers and
  • 17:56the ones that occur around the nail
  • 17:58they have drivers that aren't just
  • 18:01sun related and this might be outside
  • 18:04of the scope of our talk today,
  • 18:06but they have different genetic
  • 18:08causes for the squamous cell type.
  • 18:10They can be virally related and for
  • 18:13the Melanoma type these are the type of
  • 18:15melanomas that we see in increased frequency
  • 18:19in African American patients,
  • 18:20Bob Marley is the
  • 18:23famous person who died from
  • 18:25a subungal Melanoma,
  • 18:26and so these are not necessarily sun related.
  • 18:29But one thing that is interesting and
  • 18:32is an area of active research is if UV
  • 18:36light that is used in nail salons to harden,
  • 18:39nail polish,
  • 18:40or help dry nail polish,
  • 18:42particularly for these longer wear,
  • 18:44nail polishes might have any meaningful
  • 18:46increased risk for skin cancers
  • 18:49in and around the toes and hands so
  • 18:51does that mean that we should be wearing
  • 18:54sunscreen on our hands before we go
  • 18:57to a nail salon?
  • 18:58I think we need some more data,
  • 19:01but there are these great gloves that
  • 19:04you can get that cover the
  • 19:06skin on the hands while your hands
  • 19:09are under those light beds, but again,
  • 19:11that's not protecting the nail unit.
  • 19:13So in general, what I recommend is if
  • 19:16patients are getting these type of manicures
  • 19:19rarely or infrequently,
  • 19:20it's probably not increasing their risk,
  • 19:22but for those people who get these
  • 19:24type of manicures every single month,
  • 19:26we may find that their risk of skin cancer
  • 19:29in and around the nail is increased.
  • 19:31But we don't quite have that data yet.
  • 19:35My next question has to do with hats.
  • 19:37Back in the day when we used to talk
  • 19:40about slap on some sunscreen and
  • 19:42slap on a shirt and slap on a hat.
  • 19:45But the truth of the matter is,
  • 19:48how much benefit
  • 19:50do we get from a wide brimmed
  • 19:52hat when we go outside.
  • 19:53Clearly, unless we don't have hair
  • 19:56we can't use sunscreen there.
  • 19:57And certainly skin cancers
  • 19:59can occur on the scalp.
  • 20:01But how frequent is that and how much
  • 20:04does a hat really help us?
  • 20:06Skin cancers on the scalp are
  • 20:08actually quite frequent.
  • 20:09You can imagine in patients
  • 20:11like you said, who are bald,
  • 20:13that's going to be a very common
  • 20:15site where we see skin cancers,
  • 20:18but I treat many women
  • 20:20with full heads of hair that developed
  • 20:22skin cancers on the scalp and again
  • 20:25this harkens back to childhood
  • 20:26where you can probably remember
  • 20:28getting a bad burn within the part
  • 20:31of your scalp 'cause it wasn't
  • 20:33protected and so hats are actually
  • 20:35very effective for this purpose and
  • 20:37the type of hat you wear matters.
  • 20:39So you mentioned a wide brim hat,
  • 20:42so this is something that is
  • 20:45different than just a baseball cap.
  • 20:47A baseball cap, for example,
  • 20:49doesn't even give you full coverage
  • 20:51down to the tip of your nose
  • 20:53so it is effective for
  • 20:55the top of the scalp but is
  • 20:58not going to protect the lower face.
  • 21:01And again,
  • 21:01they're now making hats that
  • 21:03have UPF rated factors,
  • 21:04so look for ones that have a UPF
  • 21:07rating that was going to be better
  • 21:09than a white baseball cap,
  • 21:12which is not going to give
  • 21:14you full protection.
  • 21:15So the other thing to know though,
  • 21:17is that you can have reflected UV off
  • 21:20the ground, particularly on the water.
  • 21:22And I see this in boaters all
  • 21:25the time that have a hat on,
  • 21:27but they're getting a lot of reflected
  • 21:30UV that's coming off the water.
  • 21:32Or swimmers, etc.
  • 21:33And also the other place is when
  • 21:35you're on the ski mountain,
  • 21:37the UV reflection off the snow and even
  • 21:40off concrete or different surfaces.
  • 21:42There is reflected UV,
  • 21:43so that's going to come up
  • 21:46and under your hat.
  • 21:47But I am a big advocate for wide
  • 21:49brim hats, we're trying to make
  • 21:51them cool and stylish again.
  • 21:55And then finally the other question has to
  • 21:58do with, you've talked a
  • 22:00little bit about people getting
  • 22:02sunburn and we know that sunburn,
  • 22:04particularly in childhood,
  • 22:05will increase your risk of skin cancer.
  • 22:08But there are some people,
  • 22:10particularly who are darker skinned
  • 22:12who rather than burning, tan.
  • 22:14So how important is it for them
  • 22:16also to engage in all of these
  • 22:19sun protective measures?
  • 22:20Is it just as important,
  • 22:22or do they have some
  • 22:24protection already?
  • 22:26Let's go back to your
  • 22:28point about sunburns.
  • 22:30I think that it's really important
  • 22:32to focus on this for a second.
  • 22:35If you have had more than
  • 22:37five sunburns in your life,
  • 22:39your risk of Melanoma doubles.
  • 22:41If you have had more than
  • 22:43one blistering sunburn,
  • 22:44your risk of Melanoma doubles.
  • 22:46So that's really, really significant,
  • 22:48and these sunburns are most
  • 22:50often in your youth.
  • 22:52We know that that damage
  • 22:55occurs early,
  • 22:56and that's why sun protection for our
  • 22:58kids is so critically critically important.
  • 23:01So let's talk about the
  • 23:02other forms of skin cancer.
  • 23:04Basal cell carcinoma is also associated
  • 23:06with intense intermittent sun exposure,
  • 23:08so the sun exposure
  • 23:10you get on your summer holiday,
  • 23:13and this includes going back into your youth.
  • 23:16But this doesn't even need
  • 23:17to necessarily be a sunburn,
  • 23:19just that intense intermittent
  • 23:21exposure squamous cell,
  • 23:22on the other hand,
  • 23:23is more associated with chronic lifetime
  • 23:25exposure and so that's an exposure
  • 23:29that accumulates with time and leads to
  • 23:32increased risk of squamous cell carcinoma.
  • 23:34So patients who have higher endogenous
  • 23:37pigmentation, have darker skin types,
  • 23:40do have inherent UV protection,
  • 23:42but that doesn't mean
  • 23:44that they're fully immune,
  • 23:46so for example,
  • 23:49we see many Hispanic patients that
  • 23:51develop non Melanoma skin cancer.
  • 23:53In fact,
  • 23:54the statistics for Hispanic populations
  • 23:57are about four to 5% of all cancers
  • 24:00in the Hispanic population,
  • 24:01or skin cancers, that's lower
  • 24:04for African American patients.
  • 24:05That's somewhere on the order of 1 to 2%.
  • 24:09So you know,
  • 24:11while they do have protection
  • 24:13from their darker skin type,
  • 24:15Ii's not perfect and we still see
  • 24:17skin cancers in these populations.
  • 24:19You had mentioned earlier
  • 24:22that African Americans going back to the
  • 24:25example of Bob Marley can get skin cancers
  • 24:27or melanomas in other places as well.
  • 24:30So under the nails and you had
  • 24:33mentioned that some people can get
  • 24:35even with a full head of hair,
  • 24:37skin cancers on their scalp.
  • 24:39So I want us to move a little bit from
  • 24:42how do we protect ourselves from the sun?
  • 24:46To how do we survey our skin and
  • 24:48nail beds and other areas to try
  • 24:51to find these skin cancers early?
  • 24:54Because certainly,
  • 24:57they may not cause problems in the sense of causing a
  • 25:00lump or bleeding or things like that
  • 25:03that we may notice with other cancers.
  • 25:05And yet, early detection is
  • 25:07probably still important.
  • 25:08So how do we find them early?
  • 25:12So early detection is critically important,
  • 25:14and to date, the US preventative task
  • 25:17Force that gives us guidelines on
  • 25:19cancer screening does not yet have a
  • 25:22recommendation for skin cancer screening,
  • 25:24and this is a little bit problematic
  • 25:27because it's hard for people to know
  • 25:29if and when they need to see a dermatologist,
  • 25:32and so there's two parts of surveillance.
  • 25:34So number one is self screening and
  • 25:37we can talk about that in a minute.
  • 25:40But #2 is screening by a dermatologist,
  • 25:43and so what I recommend is that everyone
  • 25:46have a baseline full body skin exam by
  • 25:50a board certified dermatologist after
  • 25:53that exam and with a review of the
  • 25:57patients background and other risk factors,
  • 25:59the dermatologists can then recommend whether
  • 26:02that patient needs annual exams,
  • 26:05more frequent exams or
  • 26:07needs less frequent exams.
  • 26:08So that's very important.
  • 26:11Then in addition,
  • 26:12self exam is also very important
  • 26:14and what is probably the most
  • 26:17important factor for detecting skin
  • 26:19cancer is evolution of a lesion,
  • 26:21and as a dermatologist
  • 26:23when we're doing skin exams,
  • 26:25we're only seeing any lesion on
  • 26:27the skin at one point in time,
  • 26:30so I put a lot of stock in when
  • 26:33a patient tells me look this mole
  • 26:35used to be pinpoint and now it's
  • 26:38the size of a pencil eraser.
  • 26:41I know it's worrying,
  • 26:42and even if my exam does
  • 26:44not elevate a lot of alarms,
  • 26:47that history of evolution of the
  • 26:49lesion is going to put me at a higher
  • 26:52alert that it might need a biopsy.
  • 26:55But in general,
  • 26:56there's different things
  • 26:58to look for when we're talking about
  • 27:00non Melanoma type of skin cancers
  • 27:03versus Melanoma type of skin cancers.
  • 27:05So for non Melanoma type of skin cancers,
  • 27:08again this is the basal cell and
  • 27:11squamous cell type of skin cancers,
  • 27:13these can present really with a
  • 27:15variety of clinical presentations,
  • 27:17but often what I tell patients is to
  • 27:19report anything that bleeds spontaneously,
  • 27:22so a lesion on the skin that keeps
  • 27:24developing a scab and you can't really
  • 27:27point to any trauma that that lesion
  • 27:30has had that should be evaluated.
  • 27:32Also a lesion on the skin that's
  • 27:35tender to touch.
  • 27:36Have that evaluated sooner rather than later.
  • 27:39In terms of the Melanoma type of skin
  • 27:42cancers, we have the mnemonic ABCDE,
  • 27:45and this refers to
  • 27:46when you're evaluating moles at home,
  • 27:49things to look for.
  • 27:50So a stands for asymmetry of the lesion.
  • 27:53You know if you were to cut the
  • 27:56lesion in half in any direction,
  • 27:58does it look the same on both sides?
  • 28:01B is for border.
  • 28:02Is it a smooth round lesion or
  • 28:04does it have some jagged edges?
  • 28:06C is for color. Is the color uniform?
  • 28:09Are there different colors within the lesion,
  • 28:11particularly are there areas of blue,
  • 28:13red or white in addition to
  • 28:16different shades of brown?
  • 28:17D is for diameter.
  • 28:19When the lesion is greater than
  • 28:215 millimeters or about the size
  • 28:23of a pencil eraser
  • 28:24and E is what I already mentioned,
  • 28:27evolution, has this lesion been changing?
  • 28:30Doctor Kathleen Suozzi is an assistant
  • 28:32professor of dermatology and dermatologic
  • 28:34surgery at the Yale School of Medicine.
  • 28:37If you have questions the addresses cancer
  • 28:39answers at yale.edu and past editions of
  • 28:42the program are available in audio and
  • 28:44written form at yalecancercenter.org.
  • 28:46We hope you'll join us next week to
  • 28:49learn more about the fight against cancer
  • 28:51here on Connecticut Public radio funding
  • 28:54for Yale Cancer Answers is provided by
  • 28:57Smilow Cancer Hospital and AstraZeneca.