Understanding Skin Cancer: Prevention, Diagnosis, and Treatment Options at Image Dermatology® P.C.

Hi, everyone. My name is Dr. Jeanine Downie and I’m a board-certified dermatologist. I am the director and president of image Dermatology ® P.C. in Montclair, New Jersey. Today, I’m going to talk to you guys about skin cancer, something that I’m passionate about decreasing the incidences of in this country and, quite frankly, around the world.

Unfortunately, there are over 4.2 million new cases of skin cancer that were diagnosed last year alone. That number is expected to increase and then increase again and continue to increase. This is because of our increased leisure time and the fact that people do not put on sunblock and if they do they do not reapply it like they should.

Unfortunately, anybody with skin is at risk of skin cancer. That’s why it’s called skin cancer. The bottom line is you see more Caucasian males over the age of 50 than anyone else with skin cancer but the bottom line here is that pretty much after the age of 65 one in five Americans will get skin cancer. Many of these people are brown, they are not all Caucasian, so the thought that sunblock should only be worn by lighter races is a flawed construct and is not reality.

So who is most at risk for skin cancers? Like I started to say before, you see it a lot with Caucasian males over the age of 50 but you can see skin cancer in anyone and everyone. We see a lot of them in people that use tanning beds. That means there is a great increase in skin cancer in white females between the ages of 25 and 29. Many of them have melanomas. When you use a tanning bed, tanning beds are 12 to 15 times the Ultraviolet radiation of the sun so you’re increasing your chances of getting skin cancer by over 70 percent by using tanning beds. So I tell people not to use tanning beds, there is no such thing as a safe tan, and there is no such thing as getting a base tan so that you tan better.

Other people that are at risk for skin cancers are people that have a family history of skin cancers or that have a personal history of skin cancers. If you have either one of those two things, you need to be checked more frequently. If you have a ton of moles all over your body, you need to be checked more frequently and are at a higher risk for skin cancer. If you’ve got red hair – I’ve got my brown hair – you need to be checked more for skin cancer. So if you’re light skinned, that is, if you’re Caucasian if you’re Asian-American, if you’re a light-skinned Latino- American or light-skinned African-American, those people are also at risk for skin cancer and, in addition, people that have a history of severe blistering sunburns are absolutely at risk for skin cancer. That’s significant as well. So all of these things coupled together with the fact that people aren’t wearing sunscreen like they should and are not reapplying it, that’s what makes this a crisis situation with over 4.2 million new cases each year and getting worse and worse.

One of the most unfortunate stories that is well-known at this point is Bob Marley, the reggae legend, died of a malignant melanoma. So how this occurred, he had a streak underneath his toenail that was a junctional nevi, in other words, a benign mole, and it changed over time and it became a malignant melanoma. African-Americans and some other ethnic minorities can have these streaks in their fingernails, which are called pigment streaks. If and when they get darker and they change, they can become a skin cancer. Unfortunately, Bob Marley was misdiagnosed. He played a lot of kickball or soccer or football they call it down in Jamaica, and they thought it was a soccer injury, they thought it was a bruise. So by the time that he was properly diagnosed, the melanoma had already metastasized. It spread to his brain, and then it went on and it killed him.

So this is just to tell you that even if you wear sunblock all the time, things like that, the doctors need to know that those are the two ethnic minorities, Asian-Americans and African-Americans, where you can see ALM’s – that is, Acral Lentiginous Melanoma – underneath the toenail and underneath the fingernail. So doctors need to be made more aware of this, and Bob Marley died at 38. And he deprived us of a lot of good music as far as I’m concerned. He’s still one of my favorites today.

If you lived once in an area that was close by the Equator — Florida, the Caribbean, Mexico, South America, all over Africa, parts of Indonesia, Australia — the bottom line is you are more predisposed to getting skin cancer because of the amount of Ultraviolet light during the day every day that you took in. The time hours that one needs to avoid are mainly the hours between 10:00 in the morning and 2:00 in the afternoon. Those are the hours where you can get the maximum amount of burn. Of course, you can burn at 8 a.m. and, of course, you can burn at 5 p.m. but sun avoidance during those hours is critical. And if you are out and about, it’s important to put sunblock on, reapply it, wear sun-protective clothing, wear a sun-protective hat and wear sun-protective sunglasses. So that’s all very, very critical and those are things that I want people to think about when they’re thinking about when they should avoid exposure to the sun. That’s important.

Sunscreen, so this is one of my favorite topics. My patients call me the ‘sunscreen or sunblock police.’ First of all, understand that there is no true sunblock. Nothing is blocking totally from the sun unless it’s night-time. So people need to wear an SPF 30 every single day, rain or shine, January through December, regardless of your ethnicity. An SPF of 15 gives you about 93.5 protection from the sun’s rays. An SPF of 30 gives you about 96.7 percent protection from the sun’s rays. When you go above a 30, it levels out around a 45 so maybe it’s 97 percent. But even if you use an SPF of 100, it’s never 100 percent protection from the sun’s rays. So the bottom line is, if you live closer to the Equator, you need to reapply it properly every hour. If you live farther away from the Equator, you need to reapply it every two hours.

At a minimum, sunscreen should be reapplied every two hours while you are out in the sun and while you’re doing your daily activities, even if you are sitting by a sunny window. UVA rays penetrate through the glass or through your car when you’re driving and UVB rays are deflecting, so you still need sunblock on in the car and you need it on in dreary and rainy weather, because 77 percent of the sun’s rays penetrate through the clouds on a cloudy day. So you need to put it on. You need to reapply it, and I don’t want people to get fooled by an SPF of 70 or 100. Bottom line is those are helpful, but they still need to be diligently applied and reapplied. And people should use about a shot glass-full all over their face, their neck, their ears, an the backs of their hands, which are the most critical and the most over-exposed areas and this is where we as doctors find the majority of the skin cancers that we detect.

The importance of self-exams with skin cancers is obvious. The bottom line is that so many of my patients come in here on an almost daily basis. And they say to me, ‘Hey, Dr. Downie, that mole is changing.’ And I say to them, ‘OK.’ And we talk about it and many times I biopsy it. They help me save their lives. So if you see a mole that’s changing, that’s important to bring it to the attention of their board-certified dermatologist. So once a month I ask my patients just pick a day of the month. Typically, I say if you’re born on the 27th of the month like I was for October, I pick that day and I go through my skin head-to-toe and I make sure that I have no abnormal moles. I look at my back. I look everywhere. If there’s something I see that’s different, I’ll show it to my husband and ask him if he think it’s different. So it’s important that you look at yourself once a month and make sure no moles are changing. Now, another thing you need to worry about is if you have a lump or a bump or a patch that’s not healing. That could also be a skin cancer.

So in terms of warning signs – what do you look for in moles specifically? Asymmetry – there is the ABCDs of melanoma. ‘A’ is Asymmetry. So if you have a mole on yourself that can’t fold back on itself, so it’s jagged and it’s asymmetrical. That is a mole that could be a problem, that could be changing. Bring it to the attention of your board-certified dermatologist. If you have a mole that’s irregular, that looks like a jigsaw puzzle, that means the borders are irregular. Again, bring it to the attention of your board-certified dermatologist. There was a gentleman that came in here the summer before last that had pink, blue, light-brown, and red, and black all in his melanoma it turned out to be. The minute I saw his large patch of mole on his back, my heart fell and my stomach clenched, because I knew before I even did a biopsy. So if you have unusual colors in a mole, please, for the sake of yourself and your loved ones, bring it to our attention. So that’s color. So that’s Asymmetry, Borders, and Colors and then ‘D’ is ‘diameter.’ If it’s bigger than the size of a pencil eraser, again, it could be a problem. However, there are many basal cells, squamous cells, and melanomas that are tiny, that are pinpoint, that are still an issue.

So if you have a mole that’s changing, that’s causing you pain, that’s swelling, that’s bleeding. If you think something is a pimple and it’s not healing. All pimples heal. Just please bring it to our attention, so we can either reassure you or we can biopsy it. Those are the two choices. And then we can take it from there. But educated we stand when we’re together. As a board-certified dermatologist, myself and my colleagues are here to educate people on skin cancer and to help people in terms of what their decisions are with their overall skin health. Cancer on the skin can be seen, so it can be detected. So if you can help us help you decrease the incidence of skin cancer by listening to my tips, I would so appreciate it. And so will your loved ones and your family. Thank you so much.