Joey Wahler (Host): It can help avoid cancer and other conditions, so we're discussing skin care and skin cancer prevention. Our guests, Christina Johnson and Nathan Misel. Both are Dermatology Physician Assistants for Memorial Health System. This is Memorial Health Radio with Memorial Health System Ohio. Thanks so much for joining us. I'm Joey Wahler.

Christina and Nathan, hi there. Welcome.

So first, Christina, for you, how important are regular skin checks for early detection of skin cancer or other conditions which we'll discuss in a moment. How often should those be done?

Christina Johnson, PA: If you do not have a previous history of skin cancer, once a year you should be having annual skin checks to check for any abnormal lesions or moles. If you do have an existing history of skin cancer, a family history of skin cancer, you should have a skin check at least once a year or sometimes more frequently depending on the type of skin cancer that you had.

Host: So we know that people that are fair skinned, like yours truly, as I'm sure you can tell, are at higher risk. Anyone else that's more at risk to skin issues like cancer and other conditions?

Nathan Misel, PA: Yeah, I mean, there's a number of things that predispose you to skin cancer. Like you said, the lighter Fitzpatrick scale, so the, how much melanin you have in your skin. Certainly folks that are immunosuppressed, you know, whether they are on rejection medicines or something like that poses a higher risk.

 We do know there's some genetic components that make you a bit more susceptible or some of a predisposition for melanoma skin cancers.

Host: So Nathan, what are some preventative measures for melanoma and other skin cancers as well?

Nathan Misel, PA: Sure. So, sunscreen, sun protection are huge and starting those as early as possible because we know a lot of these skin cancers, the non melanoma skin cancers specifically are cummulative sun exposure change. So, from the time you are a kid up until adulthood. So, big things are like sunscreen 15 minutes before you go out, reapplying every 80 to 90 minutes if you're out for extended periods of time.

That's pretty huge. And if I can get somewhere in a sunscreen of SPF 50, I'm pretty happy with those.

Host: Absolutely. How about, Christina, any tips for using sunscreen and also protective clothing in the sun? What are a couple of things maybe people might not be as aware of?

Christina Johnson, PA: So like Nate said at least an SPF of 50 is ideal and then reapplying every 80 to 90 minutes. People also often don't use enough sunscreen, so a good rule of thumb is about a shot glass size of sunscreen to treat your entire body. And then, obviously, if you're sweating, if you're swimming, any kind of water sports, you should be reapplying more often.

Sun protective clothing, a wide brim hat, especially one that covers the rims of your ears is important as well, especially for people that don't love wearing the topical sunscreen; sun protective clothing can be helpful as well to protect their skin.

Host: When we say sun protective clothing, what is that exactly?

Nathan Misel, PA: Well, it has to do with the weave and the type of fabric. Most all clothing is going to provide some sun protective value. But there's some that are marketed specifically for and have done testing to show that they have an SPF of say 35 or 50. So those are the ones we're typically referring to.

Host: Gotcha. Christina, how about winter skincare advice? You know, we hear so much about this when the warm weather approaches, but skincare is just as important, even if for different reasons, in the cold weather, right?

Christina Johnson, PA: Sure, ideally you should be wearing sunscreen year round. We know that skin cancers are more common on the left side of your face compared to the right because you get that extra sun through the car window as you're driving. So, even on a cloudy day, even in the wintertime, it should be part of your daily skin care routine to apply sunscreen at least to your face, your hands, the parts of you that's going to be exposed.

Host: So, Nathan, how can we adapt other than that to the changing of the seasons and, say, maintaining hydration while combating dryness in our skin when it gets cold?

Nathan Misel, PA: Sure, so, hydration is huge. I think that's become a much more prevalent recommendation is just, adequate fluid intake. But from the outside in, moisturizing consistently is really, really important. I tell my patients that you want to shower, and then when you get out, pat dry and start applying moisturizer within two to three minutes.

We know that you will start to evaporate and lose the hydration you've gained from a bath or a shower within just a couple minutes of getting out. So, jump out, pat dry, moisturize, then go about your routine. Don't get out, bone dry, brush your teeth or do your hair, whatever, and then put moisturizer on.

It's really important that first two to three minutes after getting out of the shower. And ideally now is a really good time to start. If you're not someone who's vigilant about moisturizing year round, I would try to really get after it now as we can hopefully prevent the really more intense dry skin come deep winter.

Host: Back to you, Christina, and how about talking about the differences in the various types of cancer? What are they, and in a nutshell, what are the different types of skin cancer?

Christina Johnson, PA: So, there are several types, but the three main types are basal cell carcinoma, squamous cell carcinoma, and melanoma. Basal cell carcinoma is the most common type of skin cancer. It's typically caused by the sun. It's often seen in sun exposed areas of the body. And it is sometimes described by patients as a pimple that doesn't want to heal and then it starts to bleed. They often bleed, they grow, they can sometimes be painful.

The second most common type of skin cancer is a squamous cell carcinoma, also often caused by sun exposure. So again, generally seen in sun exposed areas of the body. These also can grow, they can bleed, they can be painful. Patients sometimes describe these as a scab that doesn't want to heal or go away and then it starts bleeding.

One of the least common types of skin cancers, but possibly one of the most dangerous, is a melanoma. Melanomas can arise in existing moles or in new moles. They are related to sun exposure. There's also a genetic link to them. They can occur anywhere on the body. These are lesions that are often rapidly changing in size, shape, or color.

Host: And so, as you pointed out there, Christina, I think one of the keys you mentioned is if someone sees that they have a lesion, a blemish that isn't healing for quite some time, let's say a month or two, that could very well be a sign, right, especially if it looks like it's just about healed and then it kind of regresses back to where it was, right?

Christina Johnson, PA: Correct. If something is not healing, it's bleeding spontaneously, or you feel it's changing in size, shape, or color, or if you have a lesion that doesn't look like any of your other lesions, it's certainly worth getting it checked to be safe.

Host: Absolutely. Nathan, how is skin cancer typically treated because so often it occurs on or around the face and that's going to be treated typically differently than if it's elsewhere on the body, right?

Nathan Misel, PA: Sure. So, we could kind of get in the weeds with the number of each of those types of skin cancers. There's different variants, but really the long and the short is surgical excision is going to be your mainstay of therapy for skin cancers that involve the dermis. And then there are some creams that are available for very superficial skin cancers and head and neck skin cancers, we typically talk about something called MOHS, which is a skin cancer procedure where they take out only what they perceive to be the cancer, no extra, looked at under the microscope, and then they go back and forth until that cancer is completely resolved; in theory leaving you with the smallest hole and the best cosmetic closure.

Host: And like so many things in the medical world, am I right, if it's caught early, most skin cancers are very treatable and it's kind of nipped in the bud, right?

Nathan Misel, PA: Yeah, thankfully for most of the skin cancer that we deal with, that surgical excision is curative. Now, we do know that about 50 percent of folks that get a non melanoma skin cancer will get another one. So, doesn't mean you'll never get another skin cancer, but thankfully, back to your point, even melanoma, caught early, five year survival is 99%, percent or better.

So, getting things checked out paramount.

Host: So, switching gears a bit, let's discuss a few other skin conditions. Christina, what causes psoriasis and what are the different forms of that?

Christina Johnson, PA: Psoriasis is a genetically linked process. It's an autoimmune disorder. So most people have a genetic predisposition to it. Sometimes it can be turned on by certain illnesses, like a strep infection, stress, sometimes it is, can be random. There's several different types of psoriasis, but the most common type is plaque psoriasis that causes red scaly, to gray, scaly, thick patches and plaques on your elbows, knees, posterior scalp are the most common locations for it.

Host: And so, Nathan, how is psoriasis typically treated?

Nathan Misel, PA: Now's a great time to be in practice. You know, I've been at this for about 17 years in dermatology. From where we were to where we are now is dramatically different. So, a lot of it's based on severity, both patient perceived as well as clinical severity. So I always try to get a feel for how much does it bother my patients as well as what we see clinically.

We can treat from everything with topicals, topical steroids, some non steroidal topicals and now we have a whole litany of biologics, which are the injections that work really, really quite well for psoriasis.

Host: Back to you Christina. When we talk about skin conditions, perhaps the granddaddy of them all, as the saying goes, is acne, which of course is largely a concern for younger people. What are the things that cause it most of the time?

Christina Johnson, PA: So acne is multifactorial. Genetics play a role in it. Hormones are a large driving factor. That's why we often see it in teenagers, young adults. Personal hygiene, there's lots of things that contribute to acne.

Host: And so Nathan, how is acne, how is the run of the mill zit, so to speak, treated most effectively these days?

Nathan Misel, PA: We are coming out with new topicals all the time, and again, I think a theme of my practice is trying to correlate how much does the condition bother the patient and what I'm seeing clinically, so same thing applies to acne. If it's something I think we can treat topical, there's a lot of different topical treatments now, it's not just the old tretinoin, which was the old standby for many, many years. There's lots of combination medicines now, there's some new molecules that go after different mechanisms within acne.

So there's lots of topical treatments, there's new oral treatments, everything up to and including Accutane.

Host: And when you talk about a topical, I can recall as a kid when I had acne, I tried some of the over the counter medications, ointments that were often advertised on TV. Those commercials were big at the time to plug those. And that stuff worked okay, but then my aunt had a prescription medication for acne and she gave me some of that and it worked so much better.

I remember thinking it was like gold in a tube because it would get rid of it it seemed like in hours. I still remember that. How about, how can acne Nathan, when we talk about scarring, acne scarring, how can that be prevented and treated?

Nathan Misel, PA: Well, I think one of the general themes here is going to be early. You can treat acne early, you can treat skin cancer early, early is better than waiting. So if we can be proactive and instead of reactionary, then we're going to decrease the likelihood for scarring and some of it is a genetic predisposition, unfortunately, but a big part of it is treating early.

Host: And then in summary here, let's talk about rosacea. Christina, what is it? What causes it?

Christina Johnson, PA: Again, rosacea is an inflammatory condition of the skin> there's multiple different types. There's redness, there's acne like bumps, there's ocular rosacea, which causes irritation of the eyes, scalp rosacea. Again, genetics, skin type, lifestyle, all of those things can contribute to rosacea. There are dietary factors.

Some people can have rosacea flares secondary to temperature, hot foods, spicy hot food, alcohol is a trigger for some people, stress, also weather changes. There are a lot of different things that can contribute to rosacea.

Host: And then finally, Nathan, since you've become our treatment expert during this interview. How is that one handled?

Nathan Misel, PA: Again, so avoiding triggers is going to be really, really important. So, if you can identify what causes your flares and avoid that, that's huge. But then there's still the old mainstays, metronidazole and Finacea. Those are medicines that have been around treating rosacea for a long time.

 We've seen the introduction of like ivermectin topically works pretty well if we need to, oral antibiotics for their anti inflammatory effects. So again, we have lots of different options, primarily based on the presentation, you know, which type of those rosacea presentations you have.

Host: Folks, we trust you're now more familiar with skin care and skin cancer prevention. Christina, Nathan, valuable information indeed. And as we've discovered year round as well. Thanks so much again.

Nathan Misel, PA: Thank you.

Joey Wahler (Host): And for more information and to connect with a provider, please visit mhsystem.org/dermatology.

Please remember you can subscribe, rate, and review this podcast and all the other Memorial Health System podcasts as well. If you found this one helpful, please do share it on your social media. I'm Joey Wahler. Thanks again for being part of Memorial Health Radio with Memorial Health System, Ohio.