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Prakash Chandran (Host): Millions of Americans are affected by skin cancer each year. And it happens to be the most common type of cancer in the United States. Today, we're here to learn everything you need to know about skin cancer and measures that you can take to prevent yourself from getting it. We're going to talk today with Chelsea Trask, a Dermatology Physician Assistant at Ridgecrest Regional Hospital.

This is the Ridgecrest Regional Hospital Podcast. My name is Prakash Chandran. And so first of all, Chelsea, it's really great to have you here today. Thank you so much for your time. Can you give us a high level summary around what skin cancer is?

Chelsea Trask, DSc, PA-C (Guest): Yes, absolutely. So skin cancer is the uncontrolled growth of abnormal cells in the epidermis, which is the outer most skin layer. So this is caused by unrepaired DNA damage that triggers mutations. And these are the mutations that lead the skin cells to multiply and form these malignant cancers.

Host: Okay. And you just mentioned cancers there, which I guess means that there are multiple types. Can you talk to us about what they are?

Chelsea: So there are multiple types of skin cancers. The three types are basal cell skin cancer, squamous cell skin cancer and then melanoma. A basal cell carcinoma is by far the most common type of skin cancer. And the American Academy of Dermatology has even called it the most common type of cancer in the world.

In the United States alone, it's estimated that about 2 million Americans are diagnosed each year. It often happens in individuals with fair complexion skin. But people of all colors can get this form of skin cancer. For most people, it is not life threatening and it is very treatable when caught early. They are found usually on the head, neck and arms, however, they can be created anywhere on the body, including the chest, abdomen and legs.

Host: And just to clarify, when you say it's found, are people looking for a lesion or a dark spot, can you talk at a high level around what they can expect the skin cancer to represent as on their skin?

Chelsea: Yeah. So a common sign to look out for is a slow growing non-healing spot. Sometimes bleeds. People will often come in and I'll see something on their arms and I'll ask about it. And they'll say, yeah, it's been there for several months, and I don't know what it is, but it just doesn't go away. And that's usually a cue that we should probably biopsy it. Especially if it's been there for longer than four weeks. It's something we get a little bit more concerned about.

Host: Okay. Understood. So we just covered basal cell, which is by far the most common. And I think you mentioned the next one is called, is it squamal cell?

Chelsea: Correct. Squamouscell carcinoma is the other form of skin cancer. Its precursor is something called an actinic keratosis. We call those AK's oftenly. They can look like dry scaly patches or spots on the skin and those are caused by too much sun exposure. And studies have shown that the rate of conversion of AKs to squamous cells can be up to 10% over the course of 10 years, which is why we try to treat these as soon as we can. And we want to prevent them from progressing.

Host: Yeah, that totally makes sense. And the third type of cancer that you mentioned was melanoma, right?

Chelsea: Yeah. So melanoma is the third type of skin cancer. And although sun exposure has an influence on this cancer, genetics is also a big component of this malignancy. So melanoma can develop within a mole that you already had on your skin, or it can appear suddenly as a dark spot that looks different from other skin lesions on your body. Early diagnosis and treatment is critical for melanoma, since it has a tendency to spread to different parts of the body.

Host: Okay. And one of the things that I wanted to ask you to expand on was the risk factors for all of these types of cancers. I think, you know, people are aware of sun exposure, right, being a cause for a lot of the skin cancers that we get, but maybe you can expand more broadly on the risk factors that people should be aware of.

Chelsea: Yeah, so the CDC lays out nicely the common risk factors for skin cancer and what we find to be the most consistent among our patients is the occurrence in individuals with lighter skin color, skin that burns, freckles or reddens easily, individuals with a large number of moles, personal history of skin cancer. And then of course, the family history of melanoma, and of course, reducing exposure to UV rays will help decrease the chance of skin cancer occurrence. However, if you're going to be in the sun, making sun protection an everyday habit is key in preventing skin cancer.

Host: So, when I think about how people operate in the world today, it feels like they are usually putting on sunscreen only when they go to the beach. And in terms of that sun protective clothing, I don't know that that's necessarily best practice or people don't necessarily have a framework to operate in. Can you just speak more broadly to how people should be thinking about the risk factor of the sun and how it actually affects people over time?

Chelsea: You brought up a great point. Often times I ask patients if they're wearing sunscreen daily and a common response is, well, I wear it when I'm outside hiking or when I go to the beach, but I don't think we always understand or realize the amount of exposure we're getting even just driving in our cars, getting in our car and going into work daily, you're getting a little bit of exposure there. And that over time is what increases your risk for developing these skin cancers. So making it a habit and a routine of putting on skin protectant, such as mineral based sunscreen daily is crucial to preventing skin cancer.

Host: And to be clear, is it cumulative? Like, you know, if I expose myself to the sun or I sit by a window that has direct sunlight every single day, that's building up. Right?

Chelsea: Absolutely. Yeah. So skin cancer, going back to the first statement of what skin cancer is, it's the damage to the epidermis, that top skin layer and over time with more of that sun exposure, you're increasing that damage to the skin, which causes the skin cancers to occur. So often with driving, we see patients that have a lot of skin cancers on the left arm and that's just because they're having their arm out the window or that's just where the sun is hitting. So it's definitely cumulative over time.

Host: Yeah, that's really interesting to know. And just because we're talking about it, if someone were interested in wearing sunscreen on a daily basis, is there a certain SPF or protection grade that they should be considering?

Chelsea: Yeah, we do recommend SPF 30 or higher. But definitely 30 as the minimum and mineral based sunscreen. So anything with zinc oxide or titanium dioxide is what we recommend, that tends to be better for our patients that have more sensitive or acne prone skin.

Host: Okay. Understood. And, I imagine that people that live in sunier states like California and Florida are more susceptible to skin cancer. I'm assuming that's just because of more sun exposure, but can you speak to why that is?

Chelsea: It has been shown that locations close to the equator and at higher altitudes have higher squamous cell carcinoma and basal cell carcinoma rates. However, I also think in these states, we embrace a culture of outdoor activities and beaches are just a popular destination in these areas. I think that also attributes to the skin cancer occurrence.

Host: That totally makes sense to me. Now talking about the demographics of people that get skin cancer. Are there specific age groups that are more susceptible than others?

Chelsea: Most cases of skin cancer that we see are in people older than 65 years of age. I feel that this is most likely due to the lack of education regarding sun protection while they were growing up. And maybe that's just the common age now, and maybe it'll be different in the future now that we have more of this education regarding sun protection.

But I often hear from patients that they were sun worshipers, or they baked in the sun when they were younger and used that baby oil to tan. And that of course is not common practice nowadays, but, it was very common back in the day. And that's why I think we see more of our skin cancers in our elderly population.

Host: Okay. So someone might be listening to this that is a little bit younger and they want to be proactive about preventing getting skin cancer. What are some steps that they can immediately take?

Chelsea: It's important now, starting as young as you possibly can to wear that sunscreen and to reapply it throughout the day. That will help prevent the sun damage over time, but there's also other things that you can do to help improve the health factors within your skin, such as eating a healthy diet, including antioxidants in your diet from things like blueberries and vitamin A from things like carrots. Just overall taking care of your body will help your skin repair the damage that it's getting from the sun exposure.

Host: Okay. So even just eating a healthy diet, you're able to actually repair skin damage. I just thought that there was no repair, but you're saying you can repair it.

Chelsea: I just came back from a dermatology conference and there was a big discussion on nutraceuticals and just diet related habits that you can incorporate into your daily routine that actually improves the health of your skin and protects it against oxidative damage and sun damage, which I thought was really cool.

And it makes sense if you think about just living your best life and taking care of your body, and we need to take care of our body in order for it to protect itself.

Host: Absolutely. So what are some of the foods that people should be focused on eating?

Chelsea: So they say, one Brazil nut or a handful of almonds a day, as well as tomatoes, half an avocado, two third cup of carrots. And then a vitamin D supplement was also very important. But antioxidants is something that we said definitely be focusing on in regards to protecting our skin. And that includes things like blueberries.

Host: So we've been talking just now about prevention measures, but what about for people that want to set a baseline for themselves and get screened or just to check to see if something on their skin is not skin cancer? What can they do?

Chelsea: I recommend getting a full body check at least yearly. And depending what your dermatologist finds during the exam, you may need to come more frequently. So for baseline, it is important to just get that initial visit and make sure that you don't have anything concerning. Cause often as patients, we don't recognize the things that might be more concerning on our skin, but we may notice something that is completely benign and we're not concerned with at all. So it's nice to also have that education too and during our visit.

Host: Okay. So just to be clear, they would go to see a dermatologist and ask for a full body check. Can you tell people what they can expect out of this appointment? Like how long does it take? What happens if someone finds something? Talk broadly about that?

Chelsea: So during the full body check, we have patients come in, we give them a gown. We have a very systematic way of going throughout the exam. We usually start with the arms and we usually feel for those rough patches, which are those actinic keratoses that we talked about earlier that can progress to the squamous cell carcinomas.

So that is one thing we're checking for. We're also looking at the moles and it's usually the flat moles that we see that can progress to things like melanoma. So we're taking a real close look at that with something that we use is called the dermatoscope. And that's like a fancy, magnifying glass for our exams, super helpful.

So we go through our entire exam and if there's something we need to biopsy, we usually have the time then to just do a quick biopsy that honestly takes maybe five minutes to do. So we send that off for pathology and that kind of guides our decision-making for how frequently that we need to be seeing that patient.

Host: So, you know, just before we close here Chelsea, there's a question that I like to ask everyone that I have a conversation with, and that is a given all of your experience in this field and after all of the patients that you've seen, what is one thing that you know to be true, that you wish more patients knew?

Chelsea: I wish more patients knew the importance of wearing sunscreen and UV protectant clothing. Even just walking outside to the car. I cannot stress the importance of still wearing that sunscreen during the day. It's just critical in preventing actinic keratoses and skin cancer occurrence. And I hope to see more of our patients implementing that routine into their daily habits.

Host: Yeah. I just wrote a note to myself after this conversation, just saying, buy daily sunscreen when you get home, because, I think societaly, like I mentioned, the culture is just on a hike or you go to the beach and you think of those as massive sun exposure days. And that's when you put the sunscreen on. And I even hear that they'll put it on immediately and then go for the hiker to the beach and it takes 30 minutes to set in. Is that true?

Chelsea: Yes. You should be applying it at least 20 to 30 minutes before your activities outside.

Host: Right? Yeah. So first of all, people are applying it and not giving themself the time for it to actually set in. And secondly, they're only doing it on those days and not on a daily basis. But what I'm hearing from you is that probably one of the reasons why it is one of the biggest cancers in the United States is because there's a lack of education. You know, people don't realize there's a cumulative effect. And if they don't protect themselves, that over time, it's going to get them.

Chelsea: Exactly. And a lot of people I hear from the patients that they don't like the feeling of the sunscreen or they don't like how it looks on their skin. But another thing maybe we don't see it in the stores or we don't know to go looking for it, but there are tinted sunscreens that we recommend to our patients all the time, because they just don't like that, the thick white residue it leaves on their skin, but there are other options to make it more comfortable and easy for patients to use throughout the day.

Host: Well, I think this is a perfect place to end. I've learned so much today and I'm definitely going to change my habits and behaviors. Is there anything else you'd like to leave with the audience before we close here?

Chelsea: I think it's important to have fun, enjoy the outdoor activity, especially living here in Ridgecrest. I mean, that's what we all love do. Being up in the mountains and skiing and hiking. It's one of the nice things about being in this town. But to not be fearful of being in the sun, but taking that time to protect ourself.

Host: Well, that's perfect advice. Thanks so much Chelsea.

Chelsea: Thank you.

Host: That was Chelsea Trask, a Dermatology Physician Assistant at Ridgecrest Regional Hospital. Thanks for checking out this episode of the Ridgecrest Regional Hospital podcast. To learn more, you can visit rrh.org. If you found this podcast to be helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you.

Thanks again for listening. My name's Prakash Chandran and we'll talk next time.