Prakash Chandran (Host): May is Skin Cancer Awareness Month, a time to shed light on America's most common cancer. With over 5 million cases diagnosed in the United States each year, it's crucial to educate ourselves on the facts and take the preventative measures to protect our skin and our overall health. Here to help spread awareness is Chelsea Trask. She's a Dermatology Physician Assistant at Ridgecrest Regional Hospital. Welcome to the Ridgecrest Regional Hospital Podcast. I'm your host, Prakash Chandran. So Chelsea, thank you so much for joining us today. I really appreciate your time. So let's get right into it. What exactly is melanoma skin cancer?

Chelsea Trask, DSc, PA-C: Yes, absolutely. And thank you for having me. Melanoma is an aggressive malignancy of pigment producing cells known as melanocytes. It can arise anywhere on the body. And really anywhere that melanocytes are present, which includes skin, mucus membranes and around our nails, it can also occur in the eyes, which is more rare. And the majority of melanomas do appear in new moles. So what we would say is arise de novo and they also can occur in about or about 30% occur in already existing moles.

Host: So you started to allude to this, but I know that there are different types. Can you talk about the different types of melanoma cancer?

Chelsea Trask, DSc, PA-C: Absolutely. So there are four main subtypes of melanoma. These include superficial spreading melanoma, which happens to be the most common type. There's also nodular melanoma, lentigo, maligna melanoma and acral lentiginous melanoma. Acral lentiginous melanoma is actually the least common type. That will usually occur on the palms, the soles of the feet or around the nails.

Host: And is there one type that is more common than the other?

Chelsea Trask, DSc, PA-C: Yes, so superficial spreading melanoma is the most common type.

Host: Okay.

Chelsea Trask, DSc, PA-C: And this usually can be identified by an asymmetric mole with varied pigment and irregular borders.

Host: Yeah. So I am curious, do we know what actually causes melanoma?

Chelsea Trask, DSc, PA-C: So the etiology of melanoma is not completely understood. However, there is a strong correlation with ultraviolet radiation exposure, and this does play a role in some melanomas, but there is also a genetic component to the skin cancer as well.

Host: So I imagine that with the genetic component, there's not a whole lot that we can do, but is there anything that we can do to prevent melanoma disease besides reducing our sun exposure?

Chelsea Trask, DSc, PA-C: Yes. Early detection is critical for preventing melanoma. Uh, it is important to identify the risk factors that are associated with it and scheduling for full body examinations yearly.

Host: Okay. And at what age should you start getting these full body scans?

Chelsea Trask, DSc, PA-C: So I would recommend getting full body checks, it really depends on risk factors. So if someone has several moles, I would say start in pediatric age. So as early as we start recognizing these atypical looking moles. If there's a family history of melanoma, that's also an indication to start earlier on around puberty timeframe.

But of course, if there's anything that's changing. We see kids that are as young as five years old or even sometimes younger for full body checks depending on family history.

Host: Okay. And what about like skin color? Like my wife for example, she's a redhead, she has fairer skin, whereas I'm on the browner side, or as my mom likes to say, coffee au lait. Um, does that play a role in, I guess the risk factor around getting melanoma? Or does that not matter?

Chelsea Trask, DSc, PA-C: Yes. So it does matter. So, risk factors from melanoma include, of course, the family history or prior, prior personal history of melanoma, history of severe or blistering sunburns, a changing mole, a giant congenital nevis, older age, and then the lighter skin phenotype. So there's different phenotypes that we kind of rate skin on, and lighter complexions are at higher risk.

Host: Okay, so you started talking about this, but can you talk about like the most common warning signs that people should be aware of?

Chelsea Trask, DSc, PA-C: Yes. So the most common warning signs, we follow something called the ABCDEs in dermatology. So is there a mole that's asymmetrical? Is there a mole that has irregular borders? Is the color varied throughout the mole? Also is the diameter greater than six millimeters and evolution E. So is it changing? That's probably the most important.

Host: Okay, so it is important to obviously take note of what's on your body, and especially if you notice something like, you know, the mole that you're talking about that isn't necessarily raised, is it changing, right? Is the color varying or is it growing in size? Is that correct?

Chelsea Trask, DSc, PA-C: Yes, so that is the, the most important thing. And as we are growing, of course, our moles are going to get a little bit larger as we grow. But generally at the age of 30, or within your thirties, you can have new moles, but after that, you shouldn't be noticing much change in moles that have already been present.

Host: So I think a lot of people may not necessarily understand the impact of melanoma. I was hoping that you might share some facts just to kind of educate our audience around this disease and its impact.

Chelsea Trask, DSc, PA-C: Yeah, absolutely. So some facts regarding melanoma. The average age of diagnosis is around 65 years old. The number of new cases of melanoma in the United States have been steadily increasing since 1975. The lifetime risk of being diagnosed with melanoma in the United States is estimated to be about 2.1%.

Melanoma can also metastasize to any organ in the body. I know when I first started dermatology, I thought it to be just a skin cancer and we're just going to see it on your skin, but it actually can metastasize to lymph nodes, your lungs, liver, and brain. And another important fact, which I'm not going to get too much into detail with, is that for pediatric patients, sometimes the ABCDEs don't quite fit for that population. So really with anything concerning in our pediatric populations, we have them come in sooner so that we can evaluate.

Host: Okay. And is this something like, for example, at a younger age, you know, during a well visit, is this something that they'll notice or do they usually need to go to a dermatologist or specialist?

Chelsea Trask, DSc, PA-C: Primary care providers and pediatricians are trained to recognize abnormal skin lesions. So they usually are the first people noticing these things and then referring them to dermatology for further evaluation.

Host: Okay. And just to confirm, you said the A, B,C,D,Es, which I know we covered, but just to be clear, A is for that asymmetry, B is for border, C is for color, D is for the diameter. I think you said more than six millimeters. And then E is for evolving or changing.

Chelsea Trask, DSc, PA-C: That is correct.

Host: Okay. And I am curious like is melanoma more common in men or women? I know we talked about skin color and the differences there, but what about men versus women?

Chelsea Trask, DSc, PA-C: So men are more prone to developing melanoma on the head, neck, and trunk. And the mortality rates are also higher among men when compared to women. Women tend to develop the melanoma in different locations, more on the extremities compared to men where they have it on the head, neck, and trunk. But it is men who are most commonly being diagnosed.

Host: Okay, we talked about how early detection is critical, but just more broadly, like how can we start thinking about taking care of our skin and our bodies?

Chelsea Trask, DSc, PA-C: From a very young age, we can start wearing our sunscreen. So early diagnosis and treatment of melanoma is very important in leading to a favorable prognosis. So making sure that you have a relationship with your dermatologist and you're going yearly. And then also being aware of just what's on our bodies, doing little skin checks at home and being aware of things that might be changing or that are new and with any concern, it should be brought up to a healthcare professional. And that would be the best way for early detection.

Host: Yeah, that makes a lot of sense. And, one thing that I heard, and maybe you can, um, verify this, is that when you wear sunscreen, you should really be putting it on like 30 minutes before sun exposure because it takes time to actually absorb and protect your skin. Is that correct?

Chelsea Trask, DSc, PA-C: Yes, that is correct. So you should be putting sunscreen on about 20 to 30 minutes before going outside to allow it to kind of take effect.

Host: Yeah I can guarantee you that most people, and unfortunately this includes myself, like they'll put sunscreen on right when we're like at the beach about to like, or when we're outside already. So this is a really important tip.

Chelsea Trask, DSc, PA-C: Yes, yes. I am guilty of it as well, but it is the, the guidelines and the recommendations.

Host: Okay. Awesome. Chelsea, this has been super informative. Thank you so much for your time.

Chelsea Trask, DSc, PA-C: Yeah. Thank you.

Host: That was Chelsea Trask. She's a Dermatology Physician Assistant at Ridgecrest Regional Hospital. You can call 760-446-6404 to schedule your appointment. 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 for checking out this episode of the Ridgecrest Regional Hospital Podcast. My name's Prakash Chandran. Stay well.