You might catch more than a few rays

Self-checks, sun­screen and cov­er­ing up are es­sen­tial to skin cancer preven­tion

The Hamilton Spectator - - HEALTH - IRENE MA­HER Tampa Bay Times

Would you rec­og­nize skin cancer if you saw it?

The new aware­ness cam­paign by the Amer­i­can Academy of Der­ma­tol­ogy, “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 ( 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.

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.”

Just a lit­tle sun­screen won’t work

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.

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 Tu­mour Bi­ol­ogy at Mof­fitt Cancer Cen­ter in Tampa. At Mof­fitt, a spe­cialty cancer re­fer­ral cen­tre, he di­ag­noses five to 10 cases of melanoma 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 colour, 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.

“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 and be­tween fin­gers and toes.

Tsai also rec­om­mends a broad spec­trum sun­screen with an SPF of at least 30. And he favours us­ing sun blocks con­tain­ing ti­ta­nium diox­ide or zinc ox­ide. “Peo­ple don’t like them be­cause they give your skin a grey 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 young 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.”

Base tan: not a good thing

Dr. Sailesh Konda hears this one all the time: Get­ting a lit­tle colour 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.”


Ap­ply­ing sun­screen once a day is not enough, says der­ma­tol­o­gist Meryl Jo­erg. She sug­gests reap­ply­ing ev­ery hour and find­ing some shade.

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