Maggie McKay (Host): We've heard it for decades, wear sunscreen and reapply it, wear a hat. But there's so much more to know about skin cancer and prevention. Today, our guest is Dr. James Spellman, Jr. to talk about how crucial it is to catch skin cancer early and what your surgical options are, should you need a procedure.

 Welcome to the Beebe Healthcare Podcast. I'm your host, Maggie McKay. Thank you so much for being here, Dr. Spellman. Would you please introduce yourself?

James Spellman Jr., MD, FACS: Hi. Thank you, Maggie. I'm Jim Spellman. I'm a Surgical Oncologist. I've been here in lower Delaware for 20 plus years. And I'm also the Surgeon in Chief for the Healthcare System.

Host: So when it comes to skin cancer, why is early detection and being diligent about getting screened regularly so important?

James Spellman Jr., MD, FACS: Well, because it makes a difference, not only in longevity, but also in potential disability. There are two basic types of skin cancers that we are concerned with. Melanoma skin cancers, and the nonmelanoma skin cancers such as squamous and basal cell cancers.

Host: And what are the signs to look for?

James Spellman Jr., MD, FACS: Let's start with the melanoma, since it's the most dangerous and has the potential to be fatal. So you want to look for pigmented lesions. Sometimes non pigmented lesions that are in the process of changing, particularly if they're bleeding, if they're itching, if they're changing color, or the borders are becoming irregular, and you have Celtic features, and particularly if you've had a number of sunburns in the past. Those are things to bring to your physician's attention.

Host: And you mentioned the different types of cancers and the two to be concerned about. Are there any other types?

James Spellman Jr., MD, FACS: Well, there's a squamous carcinoma and there are basal cell carcinomas, and those are just histologic subtypes. They're more nuisance types of skin cancers. But they can become problematic if ignored. But certainly not to the degree that melanoma can cause problems.

Host: So how often should we get a screening?

James Spellman Jr., MD, FACS: Well, if you're an at risk person, as mentioned earlier, people of Celtic origin, so that would be all basic Europeans, fair hair, blue eyes, fair skin, and if you have a tendency to burn, you should be seen by your primary care physician or a dermatologist at least once a year, preferably twice a year.

Host: Starting at what age?

James Spellman Jr., MD, FACS: You can begin in your teens. It usually starts becoming important by the time you are 20 years old, because by that time most people had spent too much time in the sun, unprotected.

Host: That's so true. And what if your parents had skin cancer? Is it hereditary?

James Spellman Jr., MD, FACS: Very rarely is it hereditary. Usually what's hereditary is the features that you inherited from them, such as your eye color and your hair color, and your skin tone.

Host: And I don't remember skin screening being a part of a physical or a doctor's visit when I was younger. So today we are so lucky to have the opportunity. Can you talk about access to screenings?

James Spellman Jr., MD, FACS: We run a what we call a Skin Lesion Clinic, every other Thursday in our office from one to four o'clock. But the Tunnell Cancer Center also does outreach programs, and we're going to be rolling out the population health mobile unit, to go out to the communities to give free skin exams, and we'll be announcing that in the near future.

Host: That is such a great idea cause you've seen dental mobile units, et cetera, but I've never seen a skin cancer screening one. That's brilliant. Tell us a little bit about your experience and your expertise and what Beebe offers when it comes to skin screening and prevention.

James Spellman Jr., MD, FACS: I had done a surgical oncology fellowship at the University of Chicago, and from there I went to join the staff at Roswell Park Cancer Institute in Buffalo as one of the melanoma sarcoma surgeons. And I spent four years there specializing in melanoma and sarcoma prior to moving here, and I've been here for 25 plus years.

So, melanoma is the fifth most common cancer in Delaware. We certainly have a large beach population. So, with our increasing population, most of whom are very fair, melanoma becomes a particular health hazard.

Host: And the continuum of care available from your clinic. You mentioned a little bit, but it is extensive. Can you tell us a little bit more about that?

James Spellman Jr., MD, FACS: Yeah. So how we treat melanoma and other types of skin cancers really depends upon, the staging of the tumor when the patient presents. And in the case of melanoma, the most important feature we are looking for is the thickness of the melanoma as measured under a microscope. So as opposed to what other types, or other specialists will do in diagnosing skin cancers, shave biopsy or so forth; we actually like to excise these lesions completely in the office. So we get, the most information on tumor thickness that we possibly can because it dictates what we do. The earlier a person is seen and the thinner the lesion, the less we have to do surgically. As the lesions get thicker, we need to start investigating whether or not disease has spread to lymph nodes with specialized types of procedures. And, sometimes people are even eligible to take our newer immunotherapies and checkpoint inhibitor therapies to prevent relapse. So it does make a, a difference, the earlier we can see these people and catch this disease, the less we have to do for them.

Host: And how can we protect our skin from the sun?

James Spellman Jr., MD, FACS: For very fair-skinned people, it's best to go out either in the early morning or the very late afternoon. The best time to go out is when your shadow is taller than you are. That way, you know, the sun is setting. You should cover up. There are plenty of clothing lines that have an SPF of 50 in the weave, which is good. But you should lather up, what you don't cover up, at least an SPF 30. There are two types of sunscreens. One is a chemical protectant, that's what we normally wear where the rays are absorbed by the chemicals in the sunscreen itself.

And the other is a mechanical screen such as the zinc oxide. So you see lifeguards walking around with white paste on their noses, and that's the physical type of blocking agent. And if you're going to be at the beach, you should sit under an umbrella or wear a large brim hat, cover your legs with your beach towel when you're, when you've come out of the water. And, because people sweat at a hot beach, you should reapply these agents every few hours because they're not waterproof, even though they advertise to be, they are not.

Host: And what about those rash guards that don't have sunscreen in them? Just, you know, that kids wear.

James Spellman Jr., MD, FACS: Well in anything that acts as a physical blocking device, long-sleeved shirt, surfers wear rash guards. They do help. So anything that prevents the ultraviolet radiation from actually hitting your skin is going to be a big help. Now, if you're out on a boat, you have to be extra careful because you get hit by these, the ultraviolet radiation coming down, and then it reflects back up off the water and hits you a second time. So you have to be doubly careful when you're out fishing on a boat.

Host: And what about tinted sunscreens? Is that just for cosmetic reasons or is that better?

James Spellman Jr., MD, FACS: No tinted sunscreens really are, are for cosmesis. It, the dyes that cause people to look brown is, not something that absorbs the ultraviolet radiation to any significant extent. It's really the sunscreen itself.

Host: Crazy question. Do we need to wear sunscreen indoors?

James Spellman Jr., MD, FACS: No, you do not.

Host: That's what I thought. But one nurse told me that and I thought, what? And she said that the fluorescent lights could harm your skin. I'm like, okay. But I knew that couldn't be right.

James Spellman Jr., MD, FACS: I don't think so.

Host: So when it comes to using sunscreen on our little ones, do we do it as early as, you know, when they're babies or do we wait till they're toddlers?

James Spellman Jr., MD, FACS: Oh no. As, as soon as someone is going outside, they need to be protected. Younger ones, in particular, have a more compact body frame and they can get significant exposure to ultraviolet radiation. You really need to protect these people. The longer someone is exposed to sun over the course of years, the higher their risk.

Host: Any misconceptions about sunscreen that you'd like to dispel?

James Spellman Jr., MD, FACS: I think there's controversy as to which is the best strength. I don't know that there's really controversy behind that. If people wear a four and they think they're fine, I think that would be the only thing I would caution them about. One of the best tests we can have to decide which strength sunscreen to wear is there are actually beads that turn color when exposed to sunlight, so they go from white to purple.

And so you can set up a little experiment in your own backyard and set out rows of those beads and spray each row with a different strength sunscreen. And the one that doesn't turn purple is, the one you wear.

Host: Wow. Where do you get those?

James Spellman Jr., MD, FACS: Well, you can buy them on Amazon.

Host: Okay. I've never heard of that. That's so cool. Dr. Spellman, what are some of the surgical interventions or also the treatments if you do get skin cancer? What's available currently?

James Spellman Jr., MD, FACS: There are two basic schools of philosophy about this. Dermatology will attack skin cancer, and even earlier stage melanoma with one type of procedure or surgical oncology goes straight for excision. For melanoma, the margins around that melanoma have been prescribed by a number of very large studies at a very large cancer institutions like the Sydney Melanoma Unit in Australia, and University of Alabama's database as well.

So the thicker the melanoma, the wider we go. The more likely we are to also perform a procedure called a sentinel lymph node biopsy, which is a radioactive and a colored dye study to identify which set of lymph nodes accept lymphatic drainage from that part of the skin where the melanoma lies, so that we can selectively harvest lymph nodes, to be examined under the microscope.

If we find disease in those lymph nodes, then these patients are a higher stage at a higher risk of spread and relapse, and these are the people that are going to get our immunotherapy treatments. For non-melanoma skin cancers, there are all sorts of treatments from chemotherapy cream, one we call Efudex, to liquid nitrogen, to cautery and curretage, and also something called a Moh's procedure where they can continually check margins, as the lesion's being excised. And then there's some little degree of reconstruction associated with that procedure as well. But the surgical oncologist will address melanoma surgically, pretty aggressively and will be removing big chunks of skin possibly, depending on the area.

Host: Yikes. So another good reason to be diligent about your screenings and your sunscreen. Is there any cutting edge research being done right now on skin cancer treatment?

James Spellman Jr., MD, FACS: It's hard to know if it's cutting edge. There are a number of tumor systems that we're involved with that have a panel of genetic mutational analysis done on them to see if they can decide which lesions are at a higher risk of spread. These are, as of yet, untested and unaccepted by our national society. So, I would caution patients that they submit themselves on recommendations from physicians to go through these type of analyses because we don't know what to do with this information yet, and there are no algorithms based on that information.

Host: Dr. Spellman, in closing, is there anything else you'd like to add that you would like people to know that we didn't cover?

James Spellman Jr., MD, FACS: Be careful when you go out. Wear your hat, wear your sunglasses, wear sunscreen, go out at the right time of day. That's basically it. And if you have any concerns about a pigmented lesion or a scaly lesion or a bleeding lesion and you want to have it checked, you can call our office. You can call Beebe dermatology. The worst thing that can happen is you ignore it and find yourself in potentially very serious situation.

Host: Right. Thank you so much for sharing your expertise with us. You gave us so much useful information to think about, especially during summer, so we appreciate you and the work that you do.

James Spellman Jr., MD, FACS: Well, thank you. You're quite welcome.

Host: Again, that's Dr. James Spellman Jr. If you'd like to find out more, please visit beebehealthcare.org.

And if you found this podcast helpful, please share it on your social channels and check out our full podcast library for topics of interest to you this has been the Beebe Healthcare Podcast presented by Beebe healthcare. I'm Maggie McKay. Thanks for listening.