Joey Wahler (Host): It's the most common cancer in the United States, so we're discussing the ABCDEs of detecting and assessing skin cancer. Our guest, Dr. Ainah Tan, she's a Dermatologist for Duly Health and Care. This is Duly Noted, a health and care podcast. Thanks for listening. I'm Joey Wahler. Hi there, Dr. Tan. Thanks for joining us.

Ainah Tan, MD, FAAD: Hi, Joey. Thanks for having me.

Host: Great to have you aboard. So first, the A, B, C, D, E's of skin cancer. Let's start with that. It sounds like a great acronym for explaining this. So let's go one at a time. First, A stands for what?

Ainah Tan, MD, FAAD: Asymmetry. So, skin cancers typically don't follow a nice normal pattern. They don't look like a perfect circle. They'll start to have jagged shapes, and if you tried to fold it over each side, it wouldn't be symmetric. So that's what the A stands for.

Host: Gotcha. How about B?

Ainah Tan, MD, FAAD: B is for borders. So, kind of like asymmetry, in skin cancer, the borders are not nice and smooth or rounded. A lot of times there will be little jagged edges or roots that are reaching out or things like satellite lesions poking out. So that B stands for irregular borders.

Host: Okay. And C?

Ainah Tan, MD, FAAD: C is for color. So a lot of times skin cancers can have 2, 3, even 4 different colors. Usually nice normal moles will have one regular brown color, but if you start seeing blues, reds, purples, that usually means something else is going on, so C is for color.

Host: Okay. That brings us to D.

Ainah Tan, MD, FAAD: D is diameter, and actually this is one of my least favorites of the ABCDEs because some people just create larger moles than others, but when we're talking about D within skin cancer screening, we're really talking about a change in size or diameter. So that's what the D stands for. So if a lesion is rapidly growing or changing diameter, that's what we're worried about.

Host: Okay. And finally, E.

Ainah Tan, MD, FAAD: Okay. So E is actually my favorite. It's for evolution. So any kind of skin lesion that is constantly evolving, whether it's one of the previous ABCDs that we talked about, or it's just acting weird, like it's bleeding easily, causing pain, just a little bit different than all the other things on your body. That is definitely something to bring up to your dermatologist.

Host: Okay, so that's the ABCDE part of our conversation. Let's bounce off of that to this first. How can people perform self exams using those ABCDEs so they can monitor moles and spots for any potential signs of skin cancer?

Ainah Tan, MD, FAAD: So, while keeping the ABCDEs in mind, really just taking a look at your entire body, getting to know where your moles are and how they look is a really good start. And then from there, every month if you just take a look, compare to what you remember, but even with smartphones now, people can even take pictures of their body parts and compare how things look. If something looks different than before, you're seeing a lot of new lesions, or anything is evolving, one of the ABCDEs, that is definitely something to bring up to your doctor or your dermatologist.

Host: Okay, now how about the fact that sometimes to the layperson, one blemish could look similar to another, and yet one could be cancerous and the other not, correct?

Ainah Tan, MD, FAAD: Correct. So, for example, the most common type of skin cancer is called a basal cell carcinoma. These very frequently can look like a pimple. What's different about these spots, though, is that they are not going away like a pimple would after a few weeks. These can be consistently persistent. They might even bleed easily, cause pain, or constantly recur in the same exact spot. That's usually something to bring up.

Host: Okay. Also these blemishes that we get can be deceptive, can't they? Because we might think that it's going away as you just alluded to, but it might start to and then stop. And you might repeat that cycle several times, because I guess, am I correct, the body's trying to heal, but it can't in the normal way because there's cancer under there.

Ainah Tan, MD, FAAD: You're absolutely right. So that can happen back and forth. This can happen not only with cancerous lesions, but even pre cancerous lesions. So that is why it's important to just take a look at these spots, just kind of observe what's going on. And if things are not healing exactly right, or in the end of the day, f iyou just don't know what to do with these spots, it's always a good idea to have these lesions looked at by a dermatologist.

Host: And then when that takes place and an expert such as you and yours does take a look; you're typically not only looking at these marks on the skin on the surface with the naked eye, but you're looking through an instrument so that you can see underneath, right?

Ainah Tan, MD, FAAD: Correct. So we use a tool called a dermatoscope. So these are these little devices that kind of look like a fancy magnifying glass, but what they do is they have different light settings, like polarized light. We can even change the light settings that we have. And what we're really looking at is not only the spot itself and magnifying it, but also the pigment patterns, what kind of blood vessels are being formed, how the skin is healing. We can even see scar tissue. So there's a lot of things that we're really analyzing in our brains when we're taking a look at these individual lesions.

Host: Beyond those ABCDEs we discussed, any other warning signs or symptoms people should be aware of in trying to identify potential skin cancer?

Ainah Tan, MD, FAAD: So my favorite that I actually tell all of my patients when they come in, especially if they're new, is the ugly duckling sign. If there is just a spot that is not following your other moles, freckles, age spots, acting out of the ordinary, causing you pain, bleeding, just acting differently, definitely that is the one that I'm going to be a little bit more concerned about than the other spots that tend to match each other.

Host: And if someone has any doubt about whether something looks right, they really should get it checked out, right? Because the longer you wait, the worse it's likely to get if it is precancerous or cancerous, correct?

Ainah Tan, MD, FAAD: So absolutely, we always recommend getting any suspicious spots looked at by a dermatologist. Now I can reassure listeners here that an overwhelming majority of skin cancers do tend to be relatively slow growing, but it is always a good idea to get these treated sooner than later because unfortunately these can continue to grow not only wider but deeper and cause further issues, such as spreading to other structures.

And of course the worst case scenario would be spreading to other sites like the lymph nodes and in cases like aggressive melanomas can even cause death. Now, I don't want to scare anybody, but that's why we want to do these screenings and definitely take a look at any spot that you may be concerned about.

Host: Okay, so you led me beautifully there into my next question, Doc, which is, in terms of screening; for both the average person and then for someone who in terms of whatever their risk factors may be is at higher risk, how should each of those groups proceed in terms of how often to get screened? The typical person and the person that needs to have it done more often.

Ainah Tan, MD, FAAD: So we always say each patient is very different, but in general, younger people tend to have a lower risk of skin cancer than older people. So we generally recommend starting in adulthood, maybe in your 20s and 30s, just getting a baseline. And then your dermatologist may be able to determine what your risk factors are, such as how much sun damage you've accumulated, your family history, and that can determine how frequently you are to get your skin checks.

Now, in kids, skin cancer is incredibly rare, though not unheard of, but we always recommend that any suspicious lesions be evaluated by a pediatrician, and they would refer over to a dermatologist if they are at all concerned. So, again, it really kind of depends on age, your individual risk factors, and that'll determine frequency of skin cancer screenings.

Host: Gotcha. Now, especially with outdoor season approaching, what are some proactive steps to protect our skin from harmful UV radiation and to reduce that risk of developing skin cancer?

Ainah Tan, MD, FAAD: So sun protection is absolutely number one. So when everybody talks about sun protection, we most of the time think of sunscreen. But sunscreen's not the only thing. We also think about sun protective clothing like hats. Also, UPF, or sun protected clothing, like long sleeve shirts, those rash guards that kids might be playing in the pool with, those all really help contribute to decreasing your risk of skin cancer.

And when we're talking about sunscreen specifically, we really do recommend at least an SPF rating of 30 and above for daily wear. But if you're really going to be at a pool, beach, baseball game, where you're really going to be under a lot of sun exposure, you want to bump that up to SPF of 50 and above, and also make sure to look for the words broad spectrum, because the SPF rating only detects, decreasing in terms of your susceptibility to sunburns, but broad spectrum denotes the protection against all the rays of the sun, including the rays that can cause skin cancer.

Host: Interesting. I did not know about the broad spectrum tip.

Ainah Tan, MD, FAAD: Luckily here in the United States, most of our sunscreen are broad spectrum, but I have seen some really low SPF rated sunscreens out there that do not offer the broad spectrum.

Host: And remind people again how long they should typically wait between applying sunscreen and going out in the sun because many make the mistake of going straight out and that's kind of somewhat defeating the purpose, right?

Ainah Tan, MD, FAAD: Well, actually it depends. So, what's important too, is to look at what type of sunscreen you're using. So the sunscreens that we typically recommend in the broad spectrum category are going to be mineral base, zozinc oxide, or titanium dioxide base, or even ferrous oxide base. And these are physical blockers.

That means that really, once you apply it, there is a physical blocking of the UV rays to the sun. Versus there are other types of broad spectrum sunscreens that are chemical based blockers. And for those, we do usually recommend applying a good 15, 20 minutes before being out in the sun so it can be absorbed in the skin and therefore work correctly.

Host: Absolutely. And so, Doctor, in summary here, what steps should people take if they suspect even that they have a spot or a mole that might be of concern?

Ainah Tan, MD, FAAD: So they should always bring it up to a dermatologist. Or, if you do not have access to a dermatologist right away, you can bring it up to your primary and they may be able to determine whether or not it is something that really needs to go to a specialist to be evaluated for.

Host: Okay, well folks, we trust you're now more familiar with the ABCDEs of combating skin cancer. Dr. Tan, valuable information indeed. Thanks so much again.

Ainah Tan, MD, FAAD: Thank you for having me!

Host: Thanks for being with us. And for more information, please visit dulyhealthandcare.com. Again, that's dulyhealthandcare.com. If you found this podcast helpful, please share it on your social media. I'm Joey Wahler, and thanks again for listening to Duly Noted, a health and care podcast.