Surgeon General finally warns about Skin Cancer

Look how the sun hits your body while swimming and playing...

Look how the sun hits your body while swimming and playing…

This past Tuesday, the United States surgeon general issued a call to action to prevent skin cancer, calling it a major public health problem that requires immediate action.

Nearly 5 million people are treated for skin cancer each year. According to the American Cancer Society,  more cases of skin cancer are diagnosed annually than breast, prostate, lung and colon cancer cases combined and skin cancer rates are increasing.

“We all need to take an active role to prevent skin cancer by protecting our skin outdoors and avoiding intentional sun exposure and indoor tanning,” said Acting Surgeon General Boris D. Lushniak, MD, MPH.

I say this all the time, but it bears repeating as often as possible:

“Most skin cancer is 100 percent preventable.” 

Most cases of melanoma – as many as 90 percent – are believed to be caused by cumulative exposure to UV rays. UV rays are also a major risk factor for the most common curable forms of skin cancer,  basal and squamous cell skin cancers. Exposure to UV rays comes from the sun and other sources like tanning beds and sunlamps and the U.S. Food and Drug Administration (FDA) now requires that tanning beds and sunlamps carry a warning stating people under 18 should not use them. Lushniak said there is a flawed perception in the US that tanned skin looks healthy, and that needs to change. I always say,

“Tanned skin is damaged skin.”

According to the Melanoma Education Foundation, One blistering sunburn before age 20 doubles your lifetime risk of melanoma. Three or more blistering sunburns before age 20 multiplies your lifetime risk by five.

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How many times have you gotten a bad sunburn?

Reduce your risk of skin cancer for yourself and your children:

-Jodi, proud owner of a lily white complexion.

Black Salve no skin cancer salvation!

Question:  I’ve read many accounts online about an alternative therapy of using an herbal “Black Salve” to treat skin cancer, but then I also saw many scary photographs and read many scary stories of disfiguring skin damage from the treatment. What’s your opinion?

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Just say “NO” to Black Salve and alternative cures you see online as skin cancer cures!

Answer: My opinion is firm:  When it comes to any type of skin cancer, medical treatment has more than a 90 percent cure rate when lesions are caught early and removed and conventional medicine has an excellent track record in successfully treating skin cancer and restoring health. In fact, while there may be a genetic predisposition (family history or skin type) to skin cancer, statistics show that 90 percent of all skin cancers are caused by long-term, unprotected exposure to the sun’s UV rays. Those at highest risk are people with fair skin, blond or red hair, and those with blue, green or grey eyes and workers in outdoor occupations.  So skin cancer prevention falls on you for keeping unprotected sun exposure to a minimum and in checking your own skin for suspicious growths and actively having them checked at least once per year by a dermatologic practitioner.

The skin cancer fear factor…

Once cancer is diagnosed, patients can get scared and can fall prey to online cure scams and alternative therapies that can do more harm than good, according to a 2009 FDA release entitled, “Beware of Online Cancer Fraud.”   “Anyone who suffers from cancer, or knows someone who does, understands the fear and desperation that can set in,” said Gary Coody, R.Ph., the National Health Fraud Coordinator and a Consumer Safety Officer with the Food and Drug Administration’s (FDA) Office of Regulatory Affairs. “There can be a great temptation to jump at anything that appears to offer a chance for a cure.”

Black Salve on the FDA list of Fake Cancer Cures

From what I’ve read, Black Salve is the most the most widely known alternative therapy you will find online. It is an herbal topical treatment classified as an escharotic which is a substance applied to the skin that causes tissue to die and fall off.  The types of Black Salve available on the internet today can be made from ingredients such as zinc chloride, chapparal (larrea tridentata) or bloodroot which are all caustic (or escharotic) to the skin.

The FDA release outlines how the salves are sold online despite being illegal and how they are sold with false promises that they will cure cancer by “drawing out” the disease from beneath the skin. “However, there is no scientific evidence that black salves are effective,” says Janet Woodcock, Director of FDA’s Center for Drug Evaluation and Research (CDER). “Even worse, black salves can cause direct harm to the patient.” The corrosive, oily salves “essentially burn off layers of the skin and surrounding normal tissue,” says Woodcock. “This is not a simple, painless process. There are documented cases of these salves destroying large parts of people’s skin and underlying tissue, leaving terrible scars.”

Black Salve does not distinguish diseased from healthy skin.

If you are questioning an alternative cancer cure you see online, check the FDA list, “187 Fake Cancer Cures Consumers Should Avoid.”

That being said, I would not recommend desperate attempts at using Black Salve or other alternative therapies once skin cancer has already taken hold, especially since Melanoma is dangerous and can spread. Here’s why:

  • Alternative therapies have not been medically and scientifically tested for efficacy and safety .
  • The use and sale of alternative therapies online is completely unregulated so you cannot be sure the purity or concentration of ingredients you are putting on your skin.
  • Alternative therapies can contain unknown compounds with questionable benefit and the potential for great harm and they are promoted on the internet illegally without full consideration or information about potential toxicity.
  • With alternative therapies instead of surgical procedures and medically researched treatments, there is a large risk of incomplete tumor removal and tumor growth and metastases (spreading).
  • Alternative therapies untested on healthy skin leaves unwary patients open to damage of surrounding healthy tissues and marked scarring with poor cosmetic outcomes

If you think you have a lesion, spot or growth that could be skin cancer, go directly to the dermatologist who will test the tissue via a biopsy and advise you whether the tumor needs to be removed.  In cases such as skin cancer, when medical treatment has a high success rate, don’t look elsewhere at alternative therapies.

Have you been tempted by Black Salve? Did the online photos scare you away?

What moms must know about teens and indoor tanning

We now know that intense UVA exposure causes dangerous types of skin cancer and that the earlier the use, the higher the risk of melanoma

Question:  My teenage daughters love using tanning beds, especially now that its winter. Tell me once and for all, is this a dangerous practice leading to skin cancer or a safe way to get some color? I’ve read conflicting reports online…

Answer:  Did you know that 36 states currently restrict indoor tanning use by minors, and in October, 2011 California became the first state  to prohibit the use of indoor tanning devices for all children and adolescents under the age of 18? Also, in 2011, the American Academy of Pediatrics called for a ban on youth tanning and the American Academy of Dermatology  supports this ban. As a mom and a dermatology practitioner knowing what I know and seeing what I see every day in the office, I support this ban. But when teens want to do something its hard to persuade them of future danger as a reason not to do it…in this case, indoor tanning. You can only tell them the truth.

The use of tanning bed safety has been in debate since the first tanning bed came into use in the 1980’s. Since then there has been much research into the types of Ultraviolet (UV) rays emitted by tanning beds, in what concentrations as well as how they cause skin cell DNA mutations that lead to cancer. Currently, approximately 90 percent of all skin cancers are associated with exposure to UV radiation mostly from the sun.

But, in 2009, a group of 20 scientists from around the world convened for the International Agency for Research on Cancer (IARC), part of the World Health Organization, and added UV radiation from tanning beds to the IARC’s Group I list of the most carcinogenic (cancer-causing) forms of radiation.

The reason for the debate on tanning bed safety is that tanning devices use fluorescent lamps which emit mostly UVA rays (UVB rays represent less than 5 percent of the lamp’s output) to induce a quick tan. And, by the end of the 1980’s, scientists had documented the carcinogenic properties of UVB rays: That they caused pre-cancerous DNA cell mutations in skin, triggered growth of squamous cell carcinomas in rodents and that UVB rays were the primary cause of sunburn.  There was no proof yet of any link between UVA exposure and skin cancer. With only a low amount of UVB emitted from a tanning bed, tanning salons could argue that tanning bed use was safe (or even safer than outdoor sun exposure) when obtained in a salon.

Since then, data has mounted and strengthened the evidence for a causal relationship between high doses of UVA exposure, indoor tanning and skin cancer, especially melanoma of the skin and eyes.  Be wary of any safety or health claims made by indoor tanning salons, the American Suntanning Association or the Indoor Tanning Association:

  • No scientific evidence supports a claim of a protective effect from tanning bed use against future sun damage (getting a “base tan”), as you may have heard.
  • There is no such thing as a “safe” tan because a tan, and especially a sunburn, is skin’s reaction to damage caused by UV radiation (whether from the sun or a tanning bed) and it causes DNA changes in the skin cells.
  • The tanning industry jumped all over the news that Vitamin D from sun exposure is necessary for health, and that it was safer to get that Vitamin D from a tanning salon rather than outdoors. It is not.

Here are 5 strong findings from June 2009 IARC monograph that put tanning beds in the classification of most carcinogenic forms of radiation:

  1. UVA causes similar but deeper skin damage: The cancer-causing mechanisms of UVB differ, but often overlap those of UVA rays. Sun exposure causes a specific cell mutation pattern that was thought to be caused by UVB rays, but researchers have now tested and found the same pattern in the skin of UVA-exposed mice (the Tp53 gene of UVA or UVB-induced skin tumors of hairless mice and the TP53 gene in human actinic keratoses -precancerous sun spots- and malignant skin tumors). UVA rays actually penetrate the skin more deeply than UVB and can damage cells (including melanocytes, those that produce the skin pigment in a “tan”) deep in the dermis whereas UVB rays cause damage to the epidermis, skin’s outermost layer.  UVB rays cause DNA mutations directly and UVA rays cause more indirect damage. For example, recent evidence found that the body’s repair and removal of damaged DNA is impaired when caused by UVA rays.
  2. Time span of  tanning bed use increases melanoma risk: Experiments in human volunteers show that tanning lamps produce the types of skin DNA damage associated with sun exposure but that the excess UV exposure in the stronger tanning beds used more often than routine sun exposure, over time, can weaken the immune system and increase vulnerability to cancer and other diseases.
  3. Intensity of  tanning beds increases melanoma risk:  We now know  that tanning bed units may be 10-15 times stronger than midday sunlight on the Mediterranean Sea, which subjects indoor tanners to UVA doses above those experienced during daily life or even when specifically tanning or active outdoors. Reviews of epidemiological (specific population) studies provide strong evidence that the intermittent, intense sun exposure (the type from outdoor weekend activities or sunny vacations) which leads to sunburn, is the main environmental risk factor for melanoma (the most dangerous form of spreading skin cancer) and that this pattern of over-exposure is simulated by indoor tanning bed use designed to induce a quick tan.
  4. Youth tanning bed use increases melanoma risk: Tanning beds have greater potential to cause melanoma at younger ages than even chronic sun exposure. Currently, 30 million people tan indoors every year in the U.S. and 2.3 million of them are teenagers, like yours. Also, melanoma is now the most common form of cancer for young adults aged  25-29. Although epidemiological studies have not consistently shown that tanning bed use is always a risk factor for melanoma that starts in the skin, a 2006 IARC meta-analysis (review of many studies) found a significant increase in melanoma risk (40-228% increase) when indoor tanning bed use started as a teen or young adult. An overall 75% increase in melanoma risk was found when indoor tanning bed use began before age 35.
  5. Not just skin cancer, but dangerous eye cancer, too:  Even scarier, 4 case-controlled studies consistently reported an increased risk for ocular (eye) melanoma with a clear causal relationship among indoor UV tanners and an even greater risk for subjects who started indoor tanning before age 20. Eye cancer is a risk even with goggle use because the rays can get in around the goggles.

All the recent research on UV rays substantiated a role for both UVA and UVB in human skin cancer development and especially melanoma, the most dangerous form of cancer that starts in the skin and can spread. So, the entire UV spectrum and UV-emitting tanning devices were classified as carcinogenic to humans.

It’s true that teenagers think they are impervious to danger. But at least you can provide them with the current scientific facts…and a reason to check their bodies for any suspicious, new or changing freckles, moles or scabs or spots that could be pre-cancerous or more.

If anyone has found a way to get their teens to stop indoor tanning, please share it here!

Skin cancer terms

Skin Cancer

A tumor arising in the skin caused by uncontrolled cell division. Classified as melanoma and non-melanoma skin cancer (basal and squamous cell carcinoma).

Basal Cell Carcinoma (BCC)

The most common type of skin cancer, it originates from the basal cells in skin and usually appears as a red lump or scaly area. It rarely spreads to other organs (metastasizes).

Squamous Cell Carcinoma (SCC)

A scaly or plate-like malignant tumor of the skin that sometimes spreads (metastasizes) to other organs. The second most common form of skin cancer

Malignant Melanoma (Melanoma)

Malignant Melanoma is a cancer of melanocytes and usually has an irregular outline and patchy coloring. It is the most dangerous type of skin cancer that can spread to other organs (metastasize).

Check your spots!

Meet Snooki ... she has lots of spots!

As healthcare professionals, we are expected to do a thorough review of systems, assess your medication, evaluate your past medical and family history, equip you with health maintenance and, of course, conduct a physical exam. Examining the skin is the focus in dermatology, but this kind of exam should be part of any internal medicine visit.

Often people ask me, how do you do an effective skin exam and identify a mole that is suspicious?

When I examine a patient’s skin, I am very methodical, often starting at the head and working my way down a person’s body. Additionally, I am always looking out for the “ugly duckling”–the mole that stands out and looks different from the rest.

Don’t forget the ABCDE’s:

Asymmetry–is there a lack of symmetry in the color or shape of the lesion?

Border–is the edge irregular or jagged?

Color–what color is the lesion? Is it brown, black, gray, blue, red or a mixture?

Diameter–is the lesion larger than the size of a pencil eraser (> 6mm) or changing in size?

Evolving–is the lesion new, growing, spreading or changing? Can you affirm for its changelessness?

Most moles on an individual have a pattern, a “look”. The patterns or arrangement of moles on an individual’s skin are good; they serve as an example or point of reference when examining a patient’s skin. When a mole doesn’t fit the pattern, it deserves further investigation (e.g., biopsy, etc.).

When a patient says that a lesion is changing, I believe them, even if I am not alarmed by the way it looks. After all, you see your body every day. If you notice something is different, if some aspect about the mole seems to be evolving, say something. Get it checked.

And always question an inflamed lesion, with or without pigment.

My rule of thumb is one month. If something you notice does not resolve within a month, if the mole looks different and those changes last one month, get yourself to a dermatologist for a full skin check-up and have the lesion examined.

If you live in an area where access to a dermatologist is restricted, get to your primary care giver or internist, who may be able to do a biopsy or refer you to a surgeon who can.   As part of health maintenance (this goes for everyone), you should have a full skin exam by a dermatologic practitioner yearly. If you have more than 50 moles, have had skin cancer or pre-cancerous/suspicious moles or growths, have a family history of atypical moles or melanoma, you should have a skin exam performed more frequently.