Intro: Duly Noted, a health and care podcast, is the official podcast series of Duly Health and Care. Each podcast features physicians or team members discussing groundbreaking topics and innovations that help listeners reimagine and better understand an extraordinary health and care experience.

Caitlin Whyte (Host): I was in Denver, Colorado a few weeks ago. And coming from the North, I was not expecting a weekend full of warm weather and blue skies just yet. And you know what? I ended up with my first sunburn of the year. Now that the sunny season will be with us soon, it's a good time to brush up on that sun and skin knowledge. Here to tell us a few surprising things you didn't know about melanoma is dermatologist, Dr. James Herrmann.

Doctor, according to the Melanoma Research Foundation, we have seen melanoma rates in the United States double since 1982. Can you start by telling us a bit about melanoma?

James Herrmann, MD, FAAD: So, melanoma is one of the more common skin cancers that we see. It is a cancer of our pigment cell, which is the melanocyte. And the melanocytes are the cells in our skin that produce our pigment, our melanin. When these melanocytes become cancerous, they form melanoma. Melanoma is becoming one of the most common cancers that we see in young adults. So, it's a public health issue that we all need to really be aware of.

Host: Absolutely. Well, a lot of people only associate melanoma with skin cancer in areas of skin that are exposed to the sun. But are there other areas of the body where melanoma can develop?

James Herrmann, MD, FAAD: Yes, there are. Wherever these pigment cells, our melanocytes, reside, we can get melanoma. They are found in the eye, and that's called ocular melanoma. You can find melanoma in the mouth, called mucosal melanoma. You can also find it in all body areas, whether they're sun-exposed areas or not. We see melanoma under the nails, the nails of the fingers and the toes, palms and soles of the hands and feet. You can also see melanoma in the brain. So even though 90% of all melanoma is on sun-exposed UV-related areas, the other 10% can occur in these other areas.

Host: That is fascinating. Thank you for sharing. So, some people say that tanning beds are safer than natural sunlight when it comes to that melanoma risk. Is that true?

James Herrmann, MD, FAAD: You know, really, it's not true, and what we have found in our research is that even after one exposure in the tanning bed, the risk of melanoma goes up. Tanning beds give off UVA, ultraviolet light. And although UVA is what's known as the tanning rays, we know that UVA causes specific mutations to the DNA in our skin cells and these mutations then lead to the formation of melanoma. So, although sunlight is broad-spectrum light, which includes UVA and UVB, you're getting a lot of UVA exposure in a short period of time in the tanning bed. That's why we see a lot of melanoma in young adults, especially women who do tanning as teenagers.

The other thing about tanning beds is that you're getting UV damage year round because people often go into the tanning bed in the winter. So instead of getting a reprieve from the sun in the winter, they're getting damage in the booth, and then in the summer, they're getting their regular UV damage, so it's a constant year-long assault when you're doing both UVA tanning and then normal sun exposure in the summers.

Host: Interesting point, and that brings me to my next question here. While melanoma is more commonly associated with older individuals, like you said, recent studies have shown a concerning rise in melanoma cases among young adults, age 20 to 39 years old. So, what are some other risk factors with developing melanoma earlier in life?

James Herrmann, MD, FAAD: The biggest risk factor is ultraviolet exposure. So, we know that we probably get 70-80% of our lifetime sun damage by the age of 21. And that's usually because we're you know, off school in the summers and running around and doing activities outside. So, we're getting a lot of damage early on in life. And then, the actual cancers don't start developing until after puberty, in general, is when we start seeing melanoma. But the biggest factor is early damage to the skin from being outside or going into booths, tanning booths.

The other risk factors for developing melanoma earlier in life can include genetic risk factors. So, if there's a family history of skin cancer, especially in parents and siblings, that could mean that there's a genetic mutation that's passed amongst family members from the parents to the children, and you can be tested for these mutations, but that can increase your risk too to get melanoma earlier in life.

Host: Well, melanoma does not discriminate. People of all skin types are susceptible to developing melanoma. So, what can we do to help prevent the development of melanoma?

James Herrmann, MD, FAAD: So, that's a great question. We see melanoma in all skin types, even in darker skin types. When we see them in darker skin types, about 50 percent of the time, they're on the hands and feet. When we see all patients in the office for skin checks, regardless of their skin type, we need to check all these areas, including under the nails, palms and soles. There was a famous reggae singer, Bob Marley, who died of metastatic melanoma that started under his toenail and was never detected and ultimately led to his death. So, we see these in all skin types, in all areas of the body.

We need to not only encourage our patients to use sunscreen early on, regardless of their skin type, but also doing self skin exams is very important. When you're cutting your nails, you know, look at your nails, look at your palms and soles the best you can. Wear protective clothing, long sleeves if it's reasonable. You can get UV clothing, which is really helpful, which helps protect from the UV exposure. Wearing hats is helpful. We also know that ocular melanoma, as well as cataracts, are due to UV from the sun. So, wearing sunglasses is very helpful when you're outside or in your car. And then, you know, checking each other, because the most common places for melanoma in men are on the back and in women are on the back and the back of the legs. And these are areas that are hard to see yourself, so looking at each other is very helpful. A lot of the melanoma we see in our office was found by a family member, so that's very helpful as well. And then just, you know, education, educating programs like this. The American Academy of Dermatology promotes skin cancer screenings for everybody so that if you do develop melanoma, you can certainly find it early.

Host: Well, what are some signs or symptoms that a patient could look out for when they are checking for skin cancer?

James Herrmann, MD, FAAD: Well, you always want to look for change, so what we call evolution of a mole or a spot on your skin. So first of all, look for change, and change could be that all of a sudden the spot is growing, or changing color. Instead of just being a nice, even, light brown, all of a sudden it develops reds in it, or darker brown areas. Also, if it's growing, if it gets over the size of a pencilhead eraser, that can be a sign that this mole is changing and becoming a melanoma.

Most melanomas arise as a melanoma from day one, but about 20 % of melanomas arise in pre-existing moles that are changing. So, you want to look for change, asymmetry of your mole. So if one half of the spot looks different than the other half, that's considered asymmetry and that can be a sign of melanoma, border irregularity. So instead of nice sharp borders, they're like jagged or irregular borders. So, these are what we call the A, B, C, D, E of melanoma. So, A is asymmetry; B is border irregularity; C is variation in color, so more than one color; D is diameter, like I said, greater than a pencilhead eraser, which is approximately six millimeters; and then, E is change or evolution. So, these are things that we could all do when we're checking ourselves or checking each other. And also, you know, it's helpful to periodically have an eye exam to just check the eyes to make sure there's nothing in the colored part of the eye that looks, you know, suspicious.

Host: Some great tips there, Doctor. Thank you so much. And as we wrap up here, what are the recommended screening methods for skin cancer? And if someone finds something worrisome, something changing, what should they then do?

James Herrmann, MD, FAAD: Yeah, that's a great question. So again, we're looking for change. So, self-skin exams are still the best way to find melanoma. So, do the best you can to use a mirror to look at your back, look in the groin area. Check your nails. Look at each other, your family members. And certainly, if you think something is changing, contact your physician. Your healthcare provider can, you know, refer you to a dermatologist if they're concerned.

The goal of preventing death from melanoma is early detection. And the earlier we find it, the much greater likelihood we have of a complete cure. And as I said earlier, you know, we know that melanoma is now the leading cause of death in women aged 25 to 30. So, it can occur in young adults and we just want to find it early and get it out of there and then people in general do very well.

Host: Of course. Well, just some wonderful information, Doctor, a lot that I did not know about melanoma, especially with your fingernails and toenails. Thank you so much for sharing it with us today. And thank you for listening. If you found this podcast helpful, please share it on your social channels and check out our full podcast library on your favorite podcast app or dulyhealthandcare.com. This is Duly Noted, a health and care podcast from Duly Health and Care.