Scott Webb (Host): Welcome to AHN MedTalks, an informative resource for physicians across various specialties as we delve into the latest medical insights and best practices, ensuring you stay at the forefront of your field. I'm Scott Webb. And today, I'm speaking with Dr. Charles Mount. He's the Co-Director of the AHN Cancer Institute Skin Cancer Center.

Doctor, it's so nice to have you here today. We're essentially going to talk about skin cancer and the evolving landscape. So, let's just start there, most obvious one. Give us an overview of skin cancer trends.

Dr. Charles Mount: Skin cancer as a whole is the most common cancer in humans by far. It exceeds essentially all other internal cancers combined, really. If you break that down, there's upwards of four million cases a year or more in the U.S. By the time one in five Americans turn 70, one of them will suffer skin cancer of some sort in that amount of lifetime or amount of years. It's really common. So, you could almost bet that somebody in your family might experience some sort of skin cancer.

Now, there's a broad range of different types of skin cancers, and some are much more common and thankfully not life-threatening, but more locally destructive types of cancer but need treated as cancer nonetheless. And there are some that are thankfully less common, but are very aggressive and much more likely to recur and be a lot of times life-threatening. The incidence is rising over the last 40 years or so, even 50 years. We've watched, since the 1960s and '70s, skin cancer rates start to climb in the U.S. And there's probably multiple reasons behind that. One, with a lot of different diseases is being increased detection, increased access to medical care. Humans are living longer than they used to 100, 200 years ago. So, skin cancer becomes more common as humans get into their 60s, 70s and 80s.

But things that we can control for and introduce measures to prevent our ultraviolet radiation exposure, outdoor and indoor tanning practice exposure. The culture has really shifted in the 20th Century where before that it was very in vogue to be fair. And then, sometime in early half of the 20th century, it became the opposite. Having some color on your skin tan was much more culturally, socially desirable. And, unfortunately, for fairer skin races, that over time will lead to skin cancer increases.

Host: Yeah. Just wondering, just broadly speaking, have the guidelines changed?

Dr. Charles Mount: They have in certain ways. In the 1970s and '80s, margins for skin cancer were very large. So, if you look at a melanoma scar from somebody that was treated and they're still alive today, something in the '70s or '80s, or certainly before that, their scars were much larger. It's still not a small scar by any means for melanoma, but thankfully not nearly the margins that we took 40, 50 years ago. In terms of atypical nevi, precancerous moles, that's a term that gets used a little bit loosely and has for some time. So, we try to really be careful nowadays how we use that terminology because it can be misleading and can create undue anxiety in patients and can create unnecessary costs perhaps, excessive biopsies and overtreatment perhaps. Some other cancers, like cervical cancer, had similar change over the years that every atypical or what used to really be called dysplastic mole or nevus was pre-cancerous, even a mildly one or a moderately one. We thought, if this thing is atypical now, this thing is eventually going to become melanoma if we don't cut it out. We figured out over several decades of watching this and looking back retrospectively that a lot of these atypical or dysplastic moles don't become melanoma. So, calling it a pre-cancer or a pre-melanoma isn't scientifically accurate. There are some that will become melanoma, and what we're working on now is getting better at, by a variety of methods and testing, figuring out which ones are truly the more concerning ones versus the ones that are just atypical, they're just funny and they don't have to be further excised or even biopsied in the first place. And we're getting better at that. Seventy percent of the time or more melanoma skin cancer actually comes from skin that didn't have a mole to begin with. So, most of the time, if you get a melanoma, it's in a spot of skin that there was nothing there. It showed up, it was brand new, and it was melanoma. It wasn't this mole you had a long time that was sitting as a pre-cancer on you for years that--

Host: Sort of turned.

Dr. Charles Mount: Yeah. Only about 30% of the time is that the case.

Host: Yeah. As somebody who had an atypical mole at one time, one of those just funny ones, this sort of checks out with me, even though you're the expert, of course. I know that, doctor, June is Men's Health Month. And we were discussing melanomas there, and I know it's more prevalent in men than women, but men often don't seek medical care or seek it later in the disease course. Why is that?

Dr. Charles Mount: It is correct that we broadly term or coin melanoma as a male disease after the age of 50, 55. It's more males that will suffer it. Younger people, 20s, 30s, even up into the 40-year category, it is typically females that will get melanoma. Males, again, it's another one of these social and cultural things where, you know, men just for whatever reason don't seek out medical care until whatever condition it might be is advanced, until they're really having problems.

And the thing about melanoma in males is it's typically in places where they may not be able to see as readily. It's on the shoulders, it's on their back. Females, it might be more likely to be on their legs where it might be a little bit more visible. Women, which benefits them, a lot of times are more in tune to their health and being proactive about their health. And that might stem from early age of getting plugged in with a PCP or an OB gynecologist early on, where guys don't start going to the doctor regularly until they're in their 40s and 50s when problems are starting to happen.

Host: Yeah. Until they really have to, right?

Dr. Charles Mount: You're right.

Host: Yeah. I've had a PCP for a long time, doctor, but it does seem that I tend to drag my feet. I'm sure a lot of men do and hopefully things like this, podcasts like this, things that educate, hopefully we can encourage them to get into their doctors sooner, have these things checked out. Wondering if you could discuss the role of some of the prescription drugs that are available now.

Dr. Charles Mount: Yeah. A number of different types of medications can increase the odds of an individual developing skin cancer by different mechanisms. The biggest category broadly speaking here is something that is immune suppressive. So, to fight off and prevent cancers of all sorts to include skin cancer, we need an intact functioning immune system, right? We're always getting these atypical cells in our tissues, especially in our skin. And when you lower the immune system, whether it's because the patient has a new organ like a kidney or lung or heart transplant, those patients are at the highest risk for skin cancer. But even other less immune suppressive types of therapies for autoimmune diseases, like Crohn's disease, ulcerative colitis, maybe some types of lupus, that little bit of lowering of their immune system that's absolutely necessary to treat whatever condition they might have, statistically speaking, increases their odds of getting skin cancer in their lifetime. So, it's important for those patients to establish with a dermatologist and start probably getting annual checks.

Other medicines that people may not be aware of, however, one of them is a common blood pressure medication, hydrochlorothiazide. We've known for a number of years now, but I still find it interesting that a lot of non-dermatology providers aren't aware of this risk that it does increase the odds of at least non-melanoma skin cancer, especially squamous cell carcinoma. That's not to say that people shouldn't use this medication. It's a great, very effective, very cheap antihypertensive medicine that's used first line and often still should be, but certain patients might want to consider other options if they're high risk for skin cancer.

Host: Yeah. Yeah, you mentioned risk there. Let's talk about that. Let's talk about ways that we can manage risk. I'm assuming, sunscreen early, often reapplying, that kind of thing. But just generally speaking, how can we manage the risk and what should a prescribing provider consider?

Dr. Charles Mount: Sun protection is vital. Control what you can. I mean, we have to be outdoors to have a good, functional, healthy life, right? If you stay indoors your entire life, you're probably going to have an unhealthy, maybe shorter life for other reasons, other health problems. But protect your skin, don't use indoor tanning devices that's one thing that's not necessary, so that can be easily excluded, but when you are outdoors, wear protective clothing, wear sleeves when you can, wear a hat, wear something with a collar that protects the neck or the upper parts of your shoulder. Where you can't wear clothing, a good sunscreen SPF 30 or higher is ideal, so exposed areas of your arms, neck, face, ears. And nobody's perfect, right? Like, we're not all going to put this on every single moment that we can. But if you get into a routine over a number of years that become decades, that repetitive behavior is going to drastically reduce the cumulative exposure a person gets and have a positive effect in reducing their likelihood of getting skin cancer at some point.

Host: Yeah, for sure. I grew up in the '70s. I think I'm a bit older than you are, doctor, but I grew up in the '70s. And people back then used suntan oil, right? Those types of things. I don't even know if sunscreen existed in the '70s. And if it did, it wasn't a routine, it wasn't a habit for most. But it is now or needs to be now, especially for kids while they're young. I want to have you talk about shifting or maybe the latest treatment trends, like what's new, what's happening, what are you excited about.

Dr. Charles Mount: I'm excited that a lot of clothing brands are now offering options that are sun-protective design. A lot of these popular clothing brands that you can find at your local popular retailers have SPF or what's called UPF when it's in clothing built in. It's meant for surfing or fishing or going to the beach or outdoor running apparel, golf wear, the golf clothing companies are getting into this, making it easier for patients and more stylish, because we want to be health conscientious and protect ourselves, but everybody still wants to wear something comfortable and somewhat good-looking, at least a lot of folks do. You know, making these things look like regular clothing, I think that's exciting. And so, people will be more encouraged to use something that's a healthy option for them. A number of new sunscreens are out there that go on easier or easier to apply have less concerns. People might have concerns out there about a variety of ingredients in our sunscreens.

And I guess, lastly, just the way that skin cancer treatment has been revolutionized in the last 10 to 15 years with advanced immunotherapy treatments for melanoma and other types of advanced cancer have really shifted the expected survival of patients that suffer advanced disease.

Host: Yeah. So, I want to have you talk about the role of the dermatologist in all of this. I know why I take my 16-year-old to the dermatologist, but in general, talk about the role of Dermatology and the dermatologist when we think about skin cancer and the evolving landscape.

Dr. Charles Mount: I still have my friends that are not in the medical field tease me about, you know, what kind of serious medicine does a dermatologist practice? You know, we often get thought of as acne and warts and Botox nowadays. We really manage, you know, thousands of different conditions, and skin cancer is a big part of that and an essential part of that. We are at the front line of detecting the most common cancer of humans. You don't need a blood test or an x-ray or a CT MRI imaging. You just need a trained individual with a good set of eyes to look at this organ. And you can oftentimes detect something that is, you know, concerning for a cancer.

So, we are really at the front lines of detecting this in its earliest of stages and counseling patients on preventing it in the first place. We can treat these earliest stage cancers well before a patient may need to ever see a surgeon in the hospital setting that is, or a medical oncologist or a radiation oncologist. A number of well-trained dermatologists is essential to keeping our population healthy and just limiting the effect of this condition.

As time goes on, dermatologists are getting more and more integrated in the treatment of advanced skin cancer. Some dermatologists actually actively prescribe systemic therapy for some skin cancers involved in very advanced types of surgical management for skin cancers. And lastly, involved in the treatment and prevention of skin what we call cutaneous adverse events or side effects from chemotherapy and immune therapies, which are unfortunately not common in these otherwise very effective treatments. We can mitigate the side effects of their cancer treatment, so patients stay on therapy for something that is effectively treating their cancer. That's a field called Oncodermatology, and that's something that's evolved and grown in the last 10 years.

Host: For sure. Well, I really appreciate this today. We're heading towards summer here, and I got to remind myself to use my sunscreen and try to remind everybody what they can do to mitigate or minimize their risk. I appreciate your time, your expertise. Thank you so much.

Dr. Charles Mount: Thank you. Have a great day.

Host: I want to thank Dr. Mount for joining me today. And to learn more or refer a patient, please call 844-MD-REFER, or you can visit ahn.org. And thanks so much for listening to this edition of AHN MedTalks with the Allegheny Health Network. Please remember to subscribe, rate, and review AHN MedTalks on Apple, Spotify, iHeart, and Pandora. I'm Scott Webb. Thanks for joining me.