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.

Want to be 25% less likely to get age spots?

Well, I’ve been saying this to my patients for years:  Daily sunscreen use prevents the ugly results of photo-aging (spots, roughness and wrinkles caused by years of cumulative sun exposure which speeds up your skin’s natural aging process)  and finally a study published in a June issue of the Annals of Internal Medicine entitled, “Sunscreen and Prevention of Skin Aging,” has proven this to be true.

shutterstock_124869277Studies have already proven that sunscreen prevents skin cancer, but previous studies on photo-aging had always been done on mice so this new study performed on over 900 white people in Australia under the age of 55 and measured over 4 years just confirms what we dermatologists have been saying to our patients:

“If you want to keep spots and wrinkles at bay,  use sunscreen every day.”

Initially, the researchers weren’t sure exactly what effect regular comprehensive use of sunscreen would have on skin aging caused by the sun over the years and they were also curious about the effect of taking dietary antioxidants such as β-carotene supplements to delay skin aging so they tested both.

The study was broken randomly into 4 sunscreen use groups:

  1. Specific daily use of broad-spectrum (protects against both UVA & UVB rays) sunscreen of SPF 15 applied to head, neck, arms, and hands each morning and after bathing, after spending more than a few hours in the sun, or after sweating heavily and 30 mg of β-carotene.
  2. Specific daily use (as described above) of the broad-spectrum SPF 15 sunscreen and placebo.
  3. Use of broad-spectrum SPF 15 sunscreen at the discretion of the participant and 30 mg of β-carotene.
  4. Use broad-spectrum SPF 15 sunscreen at the discretion of the participant and placebo.

Photos were taken of the backs of participants’ hands at the beginning of the study and 4.5 years later and were examined for microscopic changes of skin aging by researchers without the knowledge of  which study groups the participants had been assigned.

The sunscreen use findings:

Interestingly, not all of those in the daily use group applied their sunscreen daily as directed. But more participants assigned to the daily sunscreen use group reported applying sunscreen at least 3 to 4 days each week compared to the participants in the discretionary-use group. Those in the daily-use group were 24% less likely to have increased skin aging after 4.5 years than were those in the discretionary-use group.

No overall effect of taking β-carotene supplements on skin aging was found.

My advice:  If you want to prevent discolorations, spots and wrinkles from forming due to cumulative exposure to the sun’s rays as you age, use a broad-spectrum sunscreen (and make sure it specifies so on the label) daily of at least SPF 15 whenever you are outside and exposed to the sun.  Also,  seek the shade whenever possible and wear a broad-brimmed floppy hat and sun glasses to protect facial skin and your eyes!

-Jodi

Allergic to sunscreen? Read labels!

Question:  My daughter is apparently allergic to many of the sunscreens I have tried on her and gets an itchy, burning rash. What is it in the sunscreens that is causing this reaction?

Answer: There could be many different chemicals causing a skin reaction.

Read those sunscreen labels!

Read those sunscreen labels!

Most commonly, allergic reactions to sunscreens are caused by one of the original UVB sunscreen protection ingredients called para-aminobenzoid acid  or PABA.

Read sunscreen labels and look for refined and newer ingredients called PABA esters (such as glycerol PABA, padimate A and padimate O) instead of the original staining, reaction-forming PABA.

 

New “broad spectrum” sunscreen ingredients

This year,  the FDA requires sunscreens to protect against both UVB and UVA rays (labeled “broad-spectrum”), so new sunscreen ingredients have been developed and included such as include Mexoryl SX (ecamsule) and  Parsol 1789 (avobenzone) which protect against UVA rays.

Physical sunscreens including  titanium dioxide and zinc oxide have been around for decades. Remember Zinc Oxide on the noses of lifeguards back in the day? These ingredients physically block and scatter UV rays. These singular sunscreen formulas have no other chemical ingredients and so may be a better choice for sensitive skins. They also go on thicker and appear “whiter,”  but they also stay on longer and are gentler to sensitive skins.

Despite advances in technology, formulating products with these ingredients without the skin-whitening effect has proven difficult.   Zinc oxide has recently been approved by the FDA, like titanium dioxide, in microsized or ultrafine grades as  an allowable active ingredient in sunscreen products with the ability to provide more full-spectrum protection. Zinc oxide is less whitening in this form than titanium dioxide and provides better UV protection. You  can now find sunscreen products that contain these ingredients in combination with other sunscreen ingredients to increase their stability in water and sun and decrease unwanted “whiteness.”

But remember sunscreen protection is all in the proper application.  And, a lot has changed in how we recommend sunscreen to be purchased and used, so it pays to stay up on the news about sunscreen so you don’t get burned (literally!)

Other buzz words for sensitive skin

You will notice  lots of colorful kids’ sunscreen products on store shelves you might want to stay away from. Try to  avoid any sunscreen products containing dyes or perfumes, which are known allergens. And, for acne-prone or oily sensitive skins, definitely check for specific products labeled, “non-comedogenic” or “won’t clog pores.”

I cannot stress enough how important it is to be aware of sunscreen ingredients, especially when allergic reactions are concerned, and take the time to stand in the store aisles and read those labels!

-Jodi

Little known topical ways to prevent and treat skin cancer

Question:  My dermatologist gave me a topical cream with special ingredients to prevent skin cancer where he thought it might be forming. How is that even possible?

Answer:  It is now possible and FDA-approved.  There are some new topical medications that target different mechanisms to halt cancer cells from growing.

5-fluorouracil (5-FU):  This long-standing chemotherapy drug has been used internally and is also now FDA-approved for use on top of the skin to prevent and treat superficial Basal Cell Carcinoma (BCC). It is the active ingredient in proprietary topical skin cancer prevention formularies and several prescription creams with 5-FU or related medications available by prescription.

When applied on the skin topically, 5-FU selectively targets and destroys only cancerous or precancerous skin cells damaged by sun and aging while leaving normal skin cells alone. It’s something you can use at home, under a doctor’s supervision, on many parts of the body  such as chest, neck, hands, legs and back.

A course of treatment usually lasts approximately 14 days.  After several days of initial application,  the appearance of redness, scaling, and eventually crusting occurs on treated areas and indicates that precancerous cells are dying; how soon they appear and their severity depends on the strength of the 5-FU product and how often it is applied. The end result is a healthier looking, more attractive skin with a reduced tendency to develop skin cancer.

Imiquimod:  This cream is FDA-approved to treat superficial BCC’s that works by stimulating the immune system and causing the body to produce interferon, a chemical that attacks cancerous cells. The cream is rubbed in the  the lesion 5 times a week for 6-8 weeks (sometimes longer).  This treatment can also produce some discomfort, redness, irritation and inflammation.

Cure rates for both are 80-90 percent because they kill active cancerous or precancerous cells over time instead of all-at-once.

Never self-diagnose or try to use these medications without a doctor’s supervision, as in the rare case a BCC is locally advanced or  metastasizes (spreads), the cancer can become dangerous, even life-threatening.

Have you tried 5-FU or any of the topical skin cancer prevention treatments?

 

 

 

 

 

 

 

 

 

 

See how simple a Basal Cell Carcinoma removal can be

Question: My dermatologist said my scab was a Basal Cell Carcinoma…Now what? Do I have cancer?

Answer:  Relax. A Basal Cell Carcinoma (BCC) is rarely the spreading cancer that requires the systemic chemotherapy you’re thinking of. Cure rates for BCCs are close to 100 percent, and are easily treated when caught early.

After having your skin examined, the diagnosis of BCC is confirmed by biopsy, which is when the skin is numbed with a local anesthetic and a sample of your lesion is removed and sent to be a lab for examination under a microscope. If tumor cells are present, treatment is required.  BBCs rarely spread beyond the original tumor site so we simply remove them by  any number of methods depending on the type, size, location and depth of the tumor as well as your age and general health. Since BCCs are visible on the surface of the skin, we also take the likely outcome to your appearance into consideration.

Usually, treatment is performed on an outpatient basis in a dermatology office.

A local anesthetic is almost always used so pain during the procedure is minimal, although you may have some mild discomfort afterwards.  After removing a small BCC, wounds heal and the scars are usually cosmetically acceptable (and there are many other methods or repairing  or improving any resulting damage that is undesirable to you).

The types of treatment include:

  • Curettage and electrodesiccation: The growth is scraped off with a sharp, ring-shaped instrument (called a curette), and the tumor is dried out (dessicated) and destroyed with an electrocautery needle. The procedure is often repeated during the same procedure to ensure that all the cancer cells are eradicated. It has a 95 percent success rate for smaller lesions (and often for the first biopsy), although often not useful for aggressive BCCs or in those sites that where any scarring would be highly undesirable as sometimes a white scar is left at the surgical site.
  • Mohs Micrographic Surgery:  A physician specially-trained in Mohs Micrographic Surgery removes a thin layer of tissue containing the cancer and while the patient waits, the frozen previously removed sections are examined under a microscope by the Mohs surgeon. If skin cancer is still present in any of the tissue, the procedure is repeated only on the area where those cancer cells were identified, until the last layer is cancer-free. This technique saves a great amount of healthy tissue and has a high cure rate of 99 percent or better. It is often used in cosmetically important or large, critical areas and in those areas that have recurred, are hard to pinpoint or in critical areas  with little tissue to spare such as around the eyes, nose, lips and ears.
  • Excision surgery: We use a scalpel to remove the entire growth along with a surrounding border of apparently normal skin (called a safety margin) and then the site is closed with stitches.  A specimen is sent to the laboratory for microscopic examination to verify that all cancerous cells have been removed. Although cure rates are above 95 percent, if the tissue analysis shows cancer cells at the margin of tumor, a repeat excision may be necessary.
  • Radiation: X-ray radiation may be used in tumors that are hard to manage surgically, elderly patients or other patients in poor health. The radiation is directed at the tumor, with no need for cutting or anesthesia and total destruction usually requires several treatments a week for a few weeks. Cure rates are around 90% because the technique is not precise in identifying and removing cancer remaining at the margins of the tumor
  • Cryosurgery:  While not often used, sometimes we can destroy very superficial BCCs  by applying liquid nitrogen  to the growth with a Q-tip or a spray to freeze it, which also does not require cutting or anesthesia. After the treatment, it may be blistered,  crusty and fall off within weeks and the procedure can be repeated.
  • Erivedge™ (vismodegib): The first oral medication approved by the FDA for the treatment of  advanced BCC which is used for the limited circumstance where the nature of the cancer prevents the use of other treatment options. (Should not be used in woman who are pregnant or child-bearing.)
  • Topical medications: Certain prescription topical creams, gels and solutions are FDA-approved  to treat limited specific BCCs and some are used to prevent possible BCCs from growing.

The best treatment for BCCs is prevention:  Always wear sunscreen of SPF 30 or higher on exposed skin exposed and wear a hat whenever possible!

What’s your story about BCCs?

 

 

 

Are you at risk for this common spot for skin cancer?

Question: My hair has been thinning considerably for several years now, and my hairdresser recently found some  strange spots on my scalp. What are they?

Answer: Watch out for basal cell carcinoma (BCC), the most common, treatable form of skin cancer, on your scalp, especially if you are balding or your hair is noticeably thinning.

Think about it:  The top of your head, forehead (and also your nose) is exposed to the sun’s harmful rays more than any other part of the body. Once you lose the cover of your thicker hair, your scalp is highly vulnerable.

The tricky thing about BCCs is that those who have had one BCC are at an increased risk for developing more tumors later  in the same area or elsewhere on the body and you may also be at risk for other types of skin cancer. And the recurrence of scalp BCCs is even higher within the first two years after surgery because of the constant sun exposure.

No matter where you (or someone else) notices any type of strange lesion (there are 5 warning signs of a BCC), check in with a dermatologic practitioner regularly so your entire skin surface can be examined, especially in places like the top of your head that you cannot easily see yourself...and wear a hat!

Has anyone else ever found strange spots on you? What did they turn out to be?

 

 

 

Can you mistake skin cancer for something else?

Question:  I’ve noticed a small sore like a scab on my left upper arm that will not go away. What could that be? What should I do about it?

Answer:   Your sore could be a Basal Cell Carcinoma (BCC), so don’t take it lightly.

Sometimes a BCC can resemble something else like a mole, psoriasis or eczema,  a scar or any irritation. My rule of thumb is to watch it for one month:  If it does not go away or it enlarges or changes get it check out by a dermatologist, for an accurate diagnosis. The reason is because BCC is the most common type of skin cancer we see and anyone with a history of sun exposure is at risk of developing BCCs. A BCC is medically defined as any abnormal, uncontrolled growth or lesion that occurs in the skin’s basal cells (which line the deepest layer of the epidermis, the outermost layer of skin). They can start out as a barely noticeable lesion or rough patch, and while they rarely metastasize (spread) to larger organs beyond the original tumor site, they can be highly disfiguring and destructive to surrounding skin, if allowed to grow.

Who is at risk for BCCs? Aside from extensive exposure to UV sun rays such as in workers or athletes or even those who spend a lot of leisure time outdoors, we consider those with fair skin, blond or red hair, and those with blue, green or grey eyes to be at highest risk.

BCCs have generally been seen in older people but lately it seems the patients we are treating are younger and younger. And men have historically outnumbered women, although the number of women under age 40 diagnosed with BCC has more than doubled in the last 35 years.

There are five warning signs of a basal cell carcinoma; two or more are usually present in one tumor:

  1. Any non-healing open sore that bleeds, oozes or crusts and remains open for more than 3 weeks can be a very early sign of BCC.
  2. Any reddish or irritated area on the face, chest, shoulders, arms or leg which can be patchy or crusty may itch or hurt or may not have any sensation at all.
  3. Any pink growth that is slightly elevated with a rolled border and a crusted indentation in the center. If left to grow, tiny blood vessels may develop on the surface as it enlarges.
  4. Any shiny bump or nodule, often confused with a normal mole, that is pearly or clear, pink, red, white or even tan, black, or brown, especially in dark-skinned, dark-haired people.
  5. A scar-like area that is white, yellow or waxy and often has poorly defined borders or skin that looks shiny and taut, which indicate an aggressive, invasive BCC that is larger than appears on the surface.

BCCs are easily treated when caught early and cure rates are close to 100 percent, so any lesion that has been around for one month should be checked as soon as possible and treated and monitored by a dermatologist.

Do you have a growth that worries you? What does it look like?

 

 

How to apply sunscreen properly

Question:  When applying sunscreen, should you rub it in so it’s invisible, or leave it as a white coating (not quite as stylish)?

Answer: Well, it depends on the type of sunscreen you are using. Most spray-ons will rub in invisibly. But if you are using a white lotion, especially one containing physical UV blockers such as titanium dioxide or zinc-oxide, or any of those labelled “water-resistant,” they may go on much thicker (or whiter) no matter how much you rub because they are meant to stay on top and provide a layer of protection.

A new online survey of adults nationwide by the American Academy of Dermatology found that most people only apply 25 to 50 percent of the recommended amount of sunscreen. The recommended amount is to apply one full ounce of sunscreen for the entire body, or enough to fill a shot glass. And this amount should be re-applied every two hours.

My personal opinion is the whiter it looks the more it’s got you covered, plus you can easily see areas you missed like neck, ears, legs and feet. You’re right, not quite as stylish now, but you’ll be avoiding a painful sunburn, premature aging and that pesky skin cancer!

Who’s for the “white” look on the beach?

Kids starting camp? Choose sunscreen wisely…

Question: My son goes to camp all day and I need a good sunscreen because he has sensitive skin and is very fair. I’ve also heard that there is a certain chemical that kids should not be exposed to because it causes cancer. And, are the sprays as effective as the lotion? Help!

Answer: I know just how you feel and I send my  three-year old Annabelle outside wearing a hat at all times, so send your sun to camp wearing at least a baseball cap to shield his face, or even a broader-rimmed fishing hat to protect his face and back of his neck and ears, if possible. Also, you mentioned he is very fair-skinned, so you might consider having him wear a t-shirt when swimming to help deflect the sun’s rays and provide extra protection.

Sunscreen chemicals to avoid:  Recently available data from an FDA study indicate that a form of vitamin A commonly found in sunscreens, retinyl palmitate, may speed skin tumor development when applied to skin in the sun and requires further testing. In addition, according to the Environmental Working Group (EWG), a consumer environmental and health watchdog group, some 65 sunscreens advertised for babies and kids contain oxybenzone, a synthetic chemical that absorbs the sun’s rays but also readily penetrates the skin, more so in children, and can disrupt the body’s natural hormones and also cause allergic reactions. Also, look for glycerol PABA, padimate A and padimate O instead of the original staining, reaction-forming PABA, or para-aminobenzoic acid.

Safer active ingredients include Mexoryl SX (ecamsule),  Parsol 1789, also called avobenzone, and titanium dioxide and zinc oxide, which physically block ultraviolet radiation. Although these sunscreen formulas may go on thicker and appear “whiter,”  they also stay on longer and are gentler to sensitive skins which is a good thing at camp!

Simply make a list of ingredients to avoid and to look for and take it with you to the store. Read labels to make the best choice.

Sunscreen recommendations:  Consumer Reports recently rated sunscreens according to the new FDA labeling requirements and reported that two for kids completely failed  tests so do not choose Alba Botanica and Banana Boat Kids, whose labels claimed broad-spectrum protection and failed the wavelength test. Banana Boat Kids was also poor against UVA rays. Do choose All-Terrain AquaSport Sunscreen Lotion, SPF 30,  recommended by both the EWG and Consumer Reports ratings. I also like the chemical-free Neutrogena Pure & Free Baby, especially for sensitive skins.

You might also speak to camp counselors about how they reapply sunscreens for outdoor activities because sunscreens need to be re-applied after swimming or sweating, or every two hours.

What about spray-on sunscreen?  Stick to the lotions with an SPF between 30-50. Currently, the FDA has requested additional data to establish effectiveness of spray-on sunscreen and to determine whether there is safety hazard if  unintentionally inhaled by children.

Check out the infographic below from EWG which gives a great picture of what to avoid when looking for sunscreen for your child…

Sunscreen Infographic

What you must know about new FDA sunscreen label rules

Courtesy FDA

Sunscreen labels are changing for the better...learn what the differences mean to you. Photo courtesy FDA.

Question: “I read about some new sunscreen labeling rules in a magazine but I don’t really know how they apply to me when I’m standing in the store aisle trying to choose sunscreen! Can you help?”

Answer:  Of course! These new FDA sunscreen label requirements are meant to clear up confusion about exactly what type of protection a sunscreen provides. There are some new terms you will see on sunscreen bottles starting this summer (although brands have until December 2012 to comply) that will help you make a more informed choice.

  • “Broad Spectrum”  This designation means the sunscreen protects against both UVA and UVB sunlight rays, and will distinguish sunscreens from those that only protect against UVB. To earn the designation, brands now need to pass the FDA’s broad spectrum test to claim they are, in fact, broad spectrum. Furthermore, only those labeled “broad spectrum” with an SPF of 15 of higher can claim that they protect against sunburn caused by UVB rays but also decrease skin cancer risk and protect against skin aging caused by UVA rays.
  • “FDA Skin Cancer/Skin Aging Alert”  For sunscreens with SPF values below 15 or those that are not broad spectrum (because they only protect against UVB rays), you will see the following new FDA alert:

“Spending time in the sun increases your risk of skin cancer and early skin aging. This product has been shown only to help prevent sunburn, not skin cancer or early skin aging.

  • “Water-Resistant”  This tells users exactly how much time they can expect to get the declared SPF level of protection while swimming or sweating, based on new standard testing. Labels will specify 40  or 80 minutes. If this term with a time limit is not on the label, the product is not water-resistant.
  • “Drug Facts”  Information such as active ingredients, usage, warnings and directions will now appear in the drug facts chart , like the one above, so you can see it at-a-glance and choose accordingly.

The following terms have been banned from labeling because they are misleading and inaccurate, according to the FDA:

  • Waterpoof
  • Sweatproof
  • Sunblock
  • Instant Protection

The biggest mistake you can make, no matter what sunscreen you choose, is not applying enough of it and not re-applying it. The general guideline is to apply a shot glass worth (about 1 ounce) to your body, but studies have shown that most people are applying only one-quarter of that amount! And, no matter what the SPF, no sunscreen protection lasts beyond two hours, so to protect skin fully, that same one ounce should be re-applied every two hours when spending the day outdoors in the sun.

I think sunscreen and skin cancer protection is really a year-round concern and sunscreen should be worn on areas exposed to the sun such as arms, neck and face every day, even if cold or cloudy. Have you seen that recent photo of the truck driver whose left side of his face looks dramatically older than the right side of his face? That’s proof of the sun’s aging power and the case was studied  by Jennifer R.S. Gordon and Joaquin C. Brieva, dermatologists at Northwestern University, with findings published in the New England Journal of Medicine.

Tell the truth:  Do you wear enough sunscreen? Will you change how you choose and apply sunscreen this summer?