Transcription:
Skin Cancer

Intro: This is Hello Healthy, a Dignity Health Podcast.

Caitlin Whyte: Welcome back to Hello Healthy. I'm your host, Caitlin Whyte. And today, we're talking skin cancer. With us today is Dr. Vip Dev, a plastic and reconstructive surgeon at Dignity Health. Now, first things first, Dr. Dev, what is skin cancer?

Vip Dev, MD: Skin cancer is an abnormal growth of a cell within the makeup of the skin. And abnormal meaning any cell that is out of the ordinary of the normal skin makeup, no matter what color the person is.

Caitlin Whyte: Can you tell us about the different types of skin cancer?

Vip Dev, MD: So generally speaking, there are three major types of skin cancers. I'll start with the simplest and then go with the most complex, but I'll also go with the simplest in terms of treatment compared to the most complex, okay?

The first is basal cell carcinoma. Now, basal cell carcinoma is a basic skin cancer that often happens either with the exposure of sunlight or, believe it or not, there is a congenital, meaning someone who's born with this problem and they can have basal cell carcinoma or basal cell cancer. We use the word carcinoma in all of these, except for melanoma, but we use carcinoma and that is a general term that we give to cancer in general.

So basal cell carcinoma is the simplest of all of them. It's also the one carcinoma or the type of skin cancer that does not spread as often as the second type and that is squamous cell carcinoma. Squamous cell carcinoma often has a 25% chance to spread or what we call metastasize, that is go to other parts of the body.

And then the third one, that's the biggest one that we're all really concerned about, and that's melanoma. Oftentimes as referred to as malignant melanoma, you'll find the plastic surgeon and dermatologists will almost never use those words because that's redundant. Melanoma by definition is malignant. So we will never say malignant melanoma. Melanoma. And that's how we describe it.

Now, when we talk about basal cell carcinoma, the simplest type, there are often 12 different types of basal cell carcinomas. I don't think that's really as important for patients to understand, but it's very important for the diagnosis of the right type of basal cell carcinoma because the treatments for it are different.

Squamous cell carcinoma, there's several different types of squamous cell carcinoma. And again, the treatment for that is different depending on the pathology. And then melanoma, of course, has multiple types of melanomas and the treatment for those are different because they may require chemotherapy and different types of cancer type treatments that we don't normally need for basal cell and squamous cell carcinomas.

Caitlin Whyte: Now catching skin cancer early is key. What does the screening process look like?

Vip Dev, MD: So the screening of these types of cancers, I always tell people it's a really simple test that all of us as human beings can do. And the one is always examine yourself, whether you're in a mirror, whether you have a loved one or a partner or a friend, always have them look at anything that looks out of the ordinary. If it's out of the ordinary, get to a primary care doctor or a specialist of your choice. So at least someone can evaluate it and then get you to the next level of care. So one is any kind of suspicion should be looked at.

The second, if there's any kind of growth, because a lot of times people look at the skin and say, "Oh well, you know, it's just amole." If you think it's a mole, you should make sure you get it looked at no matter what age. And I think it's very important, Caitlin, that we mentioned that the age is important. There are children that can have any of these types of skin cancers. It's very rare, but it happens up to the adults, the elderly. Believe it or not, it happens in people that have not been exposed to the sun as well.

The other is color of the skin. We oftentimes say, "Oh, well, they're really light-skinned and they're more prone to have it." No, no, no. I tell people, "It doesn't matter the color of your skin. If you have a suspicious colored area of the skin that you didn't notice before, get it looked at."

The final part I want everyone to know is look at the areas that are covered. So normally, our faces are not covered every day in most cultures, I should say, right? In most cultures, our faces are not covered, but neither are our hands, right? So these are the two areas on our bodies that are almost never covered on a daily basis, our hands and our face. But in other cultures where they wear. you know, either shorts or kind of wrap-around clothes where the feet are exposed and the hands are exposed all the time, that's important. The other is there are also cultures that wear hats all the time. And then there are other cultures where no hats are worn.

And therefore, what am I getting at? I'm saying is let's make sure that we have-- it's a very intimate time, but behind closed doors, in privacy, have someone do a once-over. If you're not comfortable going to the doctor right away, have them do a once-over without clothes on, especially on the back, on the front in areas that you don't normally look at.

And another part that's important is have your hairdresser or your barber, if they notice something on your head, have them bring it to your attention because that's often missed as well.

Caitlin Whyte: So if skin cancer is found, what happens after that? How is treatment performed?

Vip Dev, MD: So let's go through the steps of this. So let's just say it's a basal cell carcinoma, basal cell cancer or a squamous cell cancer. We won't know that, right? Most people don't know the difference between any of these. So the first thing I would say is if you're young, bring it to the attention of someone who you trust, number one.

If there's no one immediately available, then bring it to your family physician. The attention to the family physician is key. Now, nowadays we have nurse practitioners and PAs and people feel comfortable with their nurse practitioners, so I would urge you to bring it to their attention. A lot of women really consider their OB-GYN as their primary care, bring it to their attention, okay?

So what'll happen, the process will be you bring it to the attention of what we call a parahealth professional or your primary care doctor or your OB-GYN. And then what'll happen is they'll either do one of two things. They will do a biopsy themselves. And a biopsy is really quick. They inject a little lidocaine into the skin and they do a quick biopsy. And then you get the results somewhere between three to seven days.

The second option is they might say, "You know what? I'm comfortable that I've seen you before. You're my regular patient. And I think we can follow this. Come back in one month or three months." And then the final option could be, "Why don't we get you to a dermatologist or a plastic surgeon for further evaluation?" At that time, the dermatologist or plastic surgeon say, "You know what? I'm comfortable. I've seen this before. This is truly a mole. We're going to watch this. And you're going to come back and see me in three months."

The alternative maybe they might do what we call a punch biopsy. And that punch biopsy is done with a little lidocaine, a numbing medicine. And then they remove that little specimen and send it off to the pathologist and that result comes back. And if it comes back as a negative, which means benign, then they'll tell you, "Okay, we'll follow you up in a year. Go see your primary care doctor."

If it comes back as basal cell cancer, then here are going to be the treatments and we'll take each one separately after the pathology comes back. But the basal cell cancer treatment, squamous cell cancer, the treatment and melanoma treatments are all three different types of treatment. And we can go to that in the next step here.

Basal cell cancer, if it's proven positive, then the surgeon or the dermatologist will do what we call a wide excision. Wide excision means you have to have a margin and that is the peripheral areas of the spot that was the cancer should have about a half a centimeter margin, that means clear edges. It should have clear edges. And then the plastic surgeon or dermatologist will close up the defect.

If it is a type of basal cancer that we call morpheaform, which is the most aggressive type of basal cancer that we know. That basal cancer needs a really, really wide excision, maybe one centimeter or more wide excisions. Sometimes those kinds of basal cell cancers need aggressive therapy like chemotherapy or radiation therapy, but those are rare.

For squamous cell cancers, depending on where they are, if they're around the head and neck region, then what the dermatologist may do is they may send you to a plastic surgeon that will then do a little aggressive workup to find out if this cancer has spread anywhere, especially in the head and neck region, because, you know, sometimes people get squamous cell cancers because of other parts of the body and then it's showing on the skin. So we have to make sure that we work that up properly. Squamous cell cancer, the common treatment for that is wide excision again with one centimeter margins at a minimum, sometimes more to make sure that everything is out.

Now, when I talk about margins, the margins have to be on the sides and also below, on the bottom. And that's key that people understand that because a lot of the times the margins can be really all the way down to the muscle if it's left alone for a long period of time. If you have a squamous cell cancer on the scalp, sometimes it could go down to the bone on the scalp. So again, you have to be really careful in spotting these and treating them very aggressively.

Then the final is melanoma. Melanoma needs what we call very wide margins up to four centimeters. Four centimeters is almost two inches around the area. So think about it. You could have something the size of the tip of your pinky finger, your small finger, and the margin around that has to be almost two inches wide all the way around. So think about it. That's a big defect, right? You see? So can you imagine if you had a melanoma to the face, how wide of a defect that would be, right? So that's why it takes a lot of, a lot of diligence. And then once you remove that, what you also have to do in melanoma is sometimes you have to remove lymph nodes and you have to test those to see if it's spread. Melanoma is very notorious for spreading to the brain, to the liver, lungs, so we really have to be careful. The treatment is dictated by where it has spread.

Now, I've left out one other important part of this with the squamous cell and the basal cell, even with the melanomas. There are some topical treatments now available that we can use and these are topical skin creams that your surgeon or your dermatologist may get you started on if you are prone to having these. And they are precancerous types of growth on your skin. If a doctor finds those, they may ask you to use these creams. And if you use them regularly, you can get rid of this cancer before it gets to something really bad.

Caitlin Whyte: Well, the best defense against skin cancer is avoiding it completely. So what are some of your favorite tips for prevention?

Vip Dev, MD: Yeah, this is a great topic because it's simple. One is prevention. Prevention and common sense. And people are like, "Dr. Dev, what do you mean by prevention and common sense?" When you go out and it's really, really hot. What do you want? You want shade. That's what your body wants. So I always tell people, "Your skin needs shade." Whether it comes in the form of a hat, a long-sleeved shirt, a nice dry pair of gloves, meaning these white gloves, that you see a lot of people driving cars and they're wearing gloves. You know, I tell people it's not because they're driving Miss Daisy, it's because they're being careful of knowing that when their hands are on the steering wheel, they're getting hit by sunlight. And those brown spots that you see on a lot of the light-skinned folks is caused by that. And so cover up. Number one, cover up is simple.

Number two, sunblock. And now, remember I'm saying sunblock, not sunscreen. Sunblock. You want to block the sun with the highest SPF, and that is a 100, 110 or more. The next is keep yourself in certain activities that limit your exposure. See, people want to be outside and run outside and do all these things but, you know, there's a lot of things that they can do indoors during times of heat they can not do. The other is do things early morning or later in the evening when the sun is at its weakest. So common sense and prevention.

Caitlin Whyte: Well, doctor, anything else you'd like to add?

Vip Dev, MD: I think the final thing is resources. Nowadays, there's so many online resources that people can use, but nothing beats what we grew up knowing from what mom would tell us, right? When you go outside, cover up. Not all moms said that, but most moms would usually say that. And I'd say, "Look, refer to the internet." You can go to the American Cancer Society, Dignity Health, Adventist Health, all the healthcare systems now have these types of things in play, and I think they should be utilized as reference tools more often. And then, visit your doctor regularly, especially if you have any concerns.

Caitlin Whyte: Thank you so much for being with us, Dr. Dev, and sharing this information, especially as we head into the summer months.

Find more information and resources online at DignityHealth.org/bakersfield/cancercare. You can also find more informative and interesting podcasts in our podcast library and be sure to share them with your loved ones.

They has been Hello Healthy, a Dignity Health podcast. I'm Caitlin Whyte. Stay well.