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Scott Webb: Skin cancer's the most common form of cancer in the US and the specialists at Franciscan Health identify, diagnose, and treat all forms of skin cancer with advanced methods and the highest quality of care. And joining me today to discuss skin cancer screening, self-detection, sunscreen tips, and more is Dr. Juliana Meyer. She's a breast and melanoma surgeon with Franciscan Health.

This is the Franciscan Health Doc Pod. I'm Scott Webb. Dr. Meyer, thanks so much for your time today. We're talking about skin cancer today. And as summer is approaching, it's definitely going to be on people's minds, whether it's skin cancer, how to prevent it, different types of sunscreens. So we're going to go through all of that today. But before we get rolling here, why is it important for all of us to be screened for skin cancer?

Dr. Juliana Meyer: That's an interesting question, because I don't think you would know this, but skin cancer is one of the most common cancers in the world. And so everyone has sun exposure and the risk for skin cancer. And so we all need to have a good look at our skin once a year to make sure that we don't have any lesions that are changing or any other areas of concern.

Scott Webb: Yeah, I think you're so right. And for so many of us, we associate, you know, the sun being out with being an issue. But the reality is that were just outside, a lot of us and, thankfully, after the pandemic, over the last year, it's nice to be outside. But whether it's sunny out or not, there's reasons to be concerned, right?

Dr. Juliana Meyer: That's exactly right. And so even on a cloudy day, you have that UV ray, you have that exposure risk. And so sunscreen every day is a thing that I preach quite a bit, probably more than most people would like to hear. I acknowledge that. But I do think it's really important. Even in the winter, you can get enough UV Ray to get not necessarily a sunburn, but still sun damage from those UV exposures.

Scott Webb: Yeah, I've got a couple of members of my family, my wife and my son who, you know, even on the cloudiest of days can come home sunburn. And so I'm always reminding my son, "Hey, don't forget the sunscreen." You know, he's a baseball player. "I know that it's time consuming. And I know you just want to head to the field, but you're doing yourself a favor, especially years from now as all of these exposure sort of adds up," right?

Dr. Juliana Meyer: That's exactly right. And you bring up a great point of our kids are in athletics earlier and longer now. And if you think of that 10, 12-year-old, I never would've put sunscreen on when I was 10 or 12 running around the yard. But these 10 and 12-year-olds are out at the baseball fields or out at the soccer fields, they're out at the swimming pool. Competitive sports are starting earlier and, gosh, put their sunscreen on.

And then the other thing is educating coaches and parents to reapply. They're still out at the fields two hours later, they got to put that sunscreen back on again. The other thing that I think people don't appreciate is that you can get burned through a simple cotton t-shirt. So making sure that the clothes you're wearing have an appropriate sunscreen rating. And if not, then you've got to put that sunscreen on. I know it's a hassle and I know my kids, when I come after them with sunscreen, I get the eye roll and I respect that. You know, I was a kid once too. But I do think it's so important, because the more that you can prevent that damage young, the easier it will be when you get into your 40s and 50s, and then you don't have to meet somebody like me.

Scott Webb: I do remember when I started seeing clothing that had UV protection built in, I didn't quite understand, but I think I do now that the sun is very powerful and it can make its way through our clothes. It's so interesting.

Dr. Juliana Meyer: Yeah. So you can have a UPF-rated shirt, which means that it's built almost like a sun protection or you can even get these special washes that you put in when you wash your clothes and dry your clothes that can increase the sun protection of a simple cotton t-shirt. Either one is fine, but again, never leave home without sunscreen.

Scott Webb: Yeah, that is one of the main takeaways today. And also we want to talk about the screening options. So let's go over that. What are the screening options? And also let's go over the ABCDEs of self-detection.

Dr. Juliana Meyer: Yeah. So we'll start with the ABCDEs. And so what that is is that's a mnemonic that those of us who work in this skin cancer world use to make it simple to look for changes in freckles and moles. And so freckles and moles are basically the same thing. Everyone has what we call pigmented lesions or spots on their skin, some more than others. And we look for patterns in these. Do the moles have changes? And so those changes are the ABCDEs. The A is asymmetry. The B is border. The C is color. The D is diameter. And the E is exposure, meaning is it on an area that gets changed.

So with A, we look at asymmetry. Is one side of a mole or freckle changing, and the other is staying the same? B with border, is the border getting irregular? Is it not clear? Is it not smooth at the edges? C is color. And again, that's that is their part of the mole that's got a different color than the other? And D diameter, we see melanomas and again, of the skin cancers, melanoma is the most serious, and that's what I spend most of my time on. We see melanomas of all shapes and sizes, but we do know that if there's a lesion that's changing rapidly in terms of color and size, diameter, that's where we want to pay attention. That's where the D comes in. It used to be that anything a centimeter or greater would trigger it. But now, we do think that probably closer to 0.5 centimeters, which is 5 millimeters or greater, we need to just kind of keep an eye on it.

And then taking those ABCDEs, which you can kind of do yourself in the mirror with your family. "Hey, look at my back. Look at my legs. Make sure everything looks the same as it did last month." The next step up is to talk to your primary care doctor, to talk to your dermatologist and say, "Hey, once a year, let's take a look at this. Let's make sure that everything looks the same to me." A lot of really great primary care docs do a really great job of skin checks. But if for some reason you don't have a primary care doc who's comfortable with skin checks, I always recommend a dermatologist once a year just to take a look from head to toe and make sure that those moles, those lesions all look the same.

Scott Webb: It's so good that we can do self-detection at home. We may need our family members, as you say, "Hey, take a look at this. Look at my legs and so on," but good that we can do some self-detection. But as you say, primaries are key, dermatologists. Is that referral process fairly simple?

Dr. Juliana Meyer: It is actually really easy. So obviously, your primary care doctor should be someone you're seeing once a year already. And then the dermatologist often at least depending on the region and regionally in the Midwest, a lot of them are private practice still. And so you can just go on in and insurance covers usually a pretty solid amount of it. And it's well worth a small copay.

Scott Webb: Yeah, definitely worth the copay. So Dr. Meyer, I was at the store the other day and I was trying to stock up on a sunscreen for the summer, right? Get my haul, get loaded up. And my head started spinning. There's just so many options in so many kinds and so many SPFs, that it's really hard for us to sort of figure out what to buy and how much to buy. So what are your recommendations?

Dr. Juliana Meyer: So as far as sunscreen goes, really, as long as you're putting something on as opposed to nothing, that's my first recommendation. But beyond that, if you want to get technical, my strongest recommendation is to do a mineral-based sunscreen. And what that means is when you look at the sunscreen, when you flip it over and you look at the top and it says active ingredients all the way at the top, you'll see zinc and/or zinc and titanium at the top of the list. And you want that because mineral sunscreen not only is a chemical barrier to the sun, but it's a physical barrier. It's a physical block from the sun. And what that means is remember the lifeguards with the old kind of white stripe along their nose.

Scott Webb: You always knew who the lifeguards were because they had the white noses.

Dr. Juliana Meyer: And then there's a reason for that, right? Because it works the best. And they're out in the sun all day long and they don't want skin cancer on their nose. Now, the good news is the new sunscreens, the new zinc sunscreens, even though you might see a little bit of a white sheen when you're rubbing it in, or when you get in and out of the water, it's a lot more blendable with the skin. So you don't have that white nose look, unfortunately, or fortunately, depending on what look you're going for is, but you don't get that look anymore. And so you'll see on the front of the sunscreen, it will say mineral, or it will say baby, because often baby sunscreens are a high mineral content because you don't want allergic reactions from some of the other chemical sunscreen. You want to use the mineral sunscreen on your sensitive baby skin.

And if you look at the front of other sunscreens, you may see something that says sensitive skin or, you know, all of those, if you flip them over, most likely are going to have zinc or titanium. I'm not a brand loyalist. I'm the first person to say, "Hey, what's on sale at Target this week?" But just pick the things that are on sale, pick the ones that are mineral-based or sensitive skin or baby, depending on what it's branded as, but just make sure it's got zinc or zinc and titanium in it.

Scott Webb: Yeah. And so doctor, when I was looking at the SPFs, I was wondering myself, 30, 50, 70, you know, does it make a difference? Should I split the difference? So maybe you can go through the SPFs and give us a sense of, you know, how much is enough and when it comes to cost, you know, how can we sort of balance that in our heads?

Dr. Juliana Meyer: So that's a great question. We get that question every week. And what I always recommend is if you think about it, a 35 SPF sunscreen has the ability to block 97% of the sun's rays. If you go up to a 55, it's only blocking 98%. So for 1% difference, your best bang for your buck is to just reapply your sunscreen at that 30 SPF, at 35 SPF every two hours. And you're really going to prevent most of the skin cancer, damaging UV rays that you can, right? So 97% versus 98%. If you go up to a 75 SPF, you're going to go to 99%. And so for some people that might be beneficial, but for most people, get the 35 mineral-based sunscreen and just go from there.

Scott Webb: Ah, that's such great advice. I wish I'd had your advice before I went to target the other day. So mineral based, I got it. I'm taking some notes here. Doctor, I'd love to have you tell us about the melanoma clinic at Franciscan Health.

Dr. Juliana Meyer: Yeah, I'd love to tell you about it. And what we do at Franciscan is we have what's called a multidisciplinary clinic. And in the world of cancer, which is where I spend most of my time, multidisciplinary clinics have multiple doctors who treat that specific cancer, come together and make a specific targeted plan for each patient who has that diagnosis. And that has been shown to be the standard of care across the country for treating cancer because not all cancers are the same. And I'm not saying from type to type, but even within the world of melanoma, patient A melanoma versus patient B melanoma may need very different treatment. And so we really work on targeting therapy to each patient. And so the multidisciplinary clinic for melanoma that we run involves myself, a medical oncologist who manages immunotherapy, radiation doctors, pathologists, dermatologists, and we all work together to make sure that the standard of care is the highest possible.

Scott Webb: That's so great. Meeting that standard of care, patient-centered, multidisciplinary, all the buzzwords that I love to hear. So let's talk about the treatment options and the therapies, whether as you say, targeted radiation therapy, surgery, immunotherapy, and so on. Let's go through the options for people.

Dr. Juliana Meyer: Yeah. So hopefully our goal is for you to have a very thin melanoma. And melanoma is broken into three parts. There's thin, intermediate and thick. And depending on the level of the melanoma changes, what type of surgery and what type of treatment you have.

So for a very thin melanoma, your treatment is typically what's called a wide excision. We take the melanoma out with a big rim of tissue around it, close it all up, and then you just commit to being best friends with your dermatologist for a lot of years to come, and lots of sunscreen.

Now, as the melanomas get deeper, there's a risk of it going into lymph nodes. And that's where I get involved a little bit more heavily. That's where the medical oncologist gets involved a little more heavily. If it goes into the lymph nodes, then we do often a little bit more surgery, sometimes taking out lymph nodes, sometimes taking out a lot of lymph nodes. But now the standard of care is to do immunotherapy. Traditional chemotherapy, that makes you sick to your stomach, that makes you lose your hair. It's not what we do anymore. Immunotherapy has really been shown to treat melanoma much, much better, much more safely, and the patients tolerate it so very well, which is exactly what you want to hear both as a patient and a physician, is "I can take a medicine. It's going to make a difference and I'm not going to feel miserable for the year that I'm on it."

Immunotherapy is either IV or pills and it depends on what kind of melanoma you have and you work with both myself and a medical oncologist to kind of work through that process. Radiation is not as common with melanoma. It depends on how many lymph nodes are involved or if there's a specific area that we can't get to by surgery, sometimes we'll use targeted radiation as well.

Scott Webb: Doctor, as we wrap up, what are your takeaways? We've talked about, you know, mineral-based sunscreens, how we screen ourselves, but put a period at the end of the sentence for us. What are your takeaways when it comes to skin cancer?

Dr. Juliana Meyer: The biggest takeaway is to pay attention to your skin, wear lots of sunscreen and don't ever use a tanning bed. Oh, I had to slide that in. I had to slide it in.

Scott Webb: I knew you were going to get it in there somewhere. I was just thinking, I don't even know that we had sunscreen when I was a kid. And I remember people just lathering themselves up with baby oil or whatever it was. And it's just amazing. You're talking about immunotherapy, you know, for people with melanomas. It's really amazing. And so great to speak with you today. So thank you so much and you stay well.

Dr. Juliana Meyer: Thanks for having me. You too. Take care.

Scott Webb: For more information, go to Franciscan health.org/cancer care.

And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.