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Taylor Leddin-McMaster (Host): Hello listeners. Thanks for tuning into the Well Within Reach podcast, brought to you by Riverside Healthcare. I'm your host, Taylor Leddin-McMaster. Joining me today is Dr. Issra Rashed, Radiation Oncologist with the Riverside Cancer Institute to talk about skin cancer. Thank you for joining us.

Issra Rashed, MD: Thank you for having me.

Host: Before we get into the episode, we're going to take a quick break for a message about MyChart.

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Host: All right. And we're back. Today's topic is skin cancer, and first I'm going to ask, can you describe your role as a Radiation Oncologist and how it relates to skin cancer treatment?

Issra Rashed, MD: Yeah, so in radiation what we do is we use high energy x-rays to treat cancers. Skin cancer is a type of cancer that can be treated with radiation. And so that's kind of how we come into ah, into play.

Host: Yeah, and I know skin cancer can develop in several different forms. Can you tell us about the main types of skin cancer and how they differ in terms of severity and treatment options?

Issra Rashed, MD: Correct. So, like you said, there's a lot of different kinds. The most common are going to be skin cancers, squamous cell type and basal cell type. Both of these are related to sun exposure. Okay. There's other types of skin cancers that are not necessarily related to sun exposure. You might hear about melanomas, or other cancers of the skin, like lymphomas and that kind of thing.

The incidence of skin cancers is quite high. So it's actually the most common solid tumor that we see in America, with, I think they say one out of five Americans probably getting a skin cancer in their lifetime. Okay, there's some people that are more at risk than other people, but that's just the general number.

A lot of them are treatable, almost all of them actually, especially in their earlier stages when detected earlier. So, and where they are and how big they are. And the type. Okay, that kind of dictates what kind of treatment you are a candidate for, whether it's surgical or non-surgical, drug, radiation. Sometimes they do even like phototherapy and these kinds of things.

Host: You kind of answered this with that one in five number. How often do you see and treat skin cancer in your practice?

Issra Rashed, MD: Yeah, so you know, what we do when we treat any patient is we kind of want to balance curing the cancer, getting rid of it with toxicity and morbidity as well as logistics.You know, minimizing the number of times they got to go into the doctor's office for the treatment. So all of that has to be kind of, uh proactively weighed and figuring out what's the best thing that makes sense for that patient. Oftentimes for these tumors, you're seeing a dermatologist, who can really quickly cut it out for the really early ones, caught super early, especially in locations that are forgiving to having a small procedure done, something on the arm or the shoulder or the back, even the forehead, the scalp, these are all areas where you can have a tiny little incision. It'll cut and you'll almost never see a scar. So those are where patients are mostly taken care of for their skin cancers. I get involved when patients can't have surgery for one reason or another. The tumor's in a location where surgery's unacceptable because it might need more complicated things to get it to close properly, or it might be disfiguring and cosmetically, the outcome is just not acceptable.

Or patients just don't want surgery. They just say, I, I've had enough procedures done and I'd like to look at non-surgical options, and that's when radiation typically comes into play. So either they can't have it or it's not a good idea to have it, or they just don't want it.

Host: And you mentioned sun exposure, which comes to mind with skin cancer of course, but what are some other common risk factors that might be related?

Issra Rashed, MD: Yeah, so some things are definitely hereditary. Okay, s o familial risk factors. There's also like toxins that can be related as well, and occupational exposures. Sun is, really the most common. There's other people who have other like autoimmune diseases of some sort things that are immunosuppressive. Sometimes drugs can play a role, so you take something for a different medical condition and that happens to increase or decrease your immunity and increase your risk of getting skin cancers.

Those are usually the most common things. Trauma. So repeated trauma sometimes is associated with repetitive injury to your skin, your tissue, and, and that causes a area that is more predisposed to skin cancers.

Host: Interesting. And we talked about early detection being kind of key to catching something early and taking care of it. How does that impact treatment outcomes?

Issra Rashed, MD: Usually the smaller it is, the more options you have, right? So, usually anything can radiation, surgery, even topical drugs or other non-invasive treatments are usually depending on the type, they're kind of a your pick, dealer's choice, right? As you get into more advanced cases, you're cutting down what you can do.

Okay, and so obviously early detection for anything is better, sometimes and oftentimes actually the people who have risk factors, you know, for skin cancers, family history, personal history, sun exposure, autoimmune stuff, or, immune modulating drugs, these patients are usually seeing a dermatologist regularly and they're actually catching it before it becomes a cancer.

 So most of your patients you're going to talk to are actually being seen for precancers. So, in general, the way tumors are staged, staged refers to kind of the prognosis. So a stage one is going to be more curable than a stage two, than a three and then a four, which is often not curable. So the smaller the better in general.

Host: Well, great. Before we continue our conversation, we're going to take a moment to talk about the importance of primary care at Riverside Healthcare, your primary care provider is dedicated to being in your corner, helping you and your family stay healthy and thrive. Find the right primary care provider for you at myrhc.net/acceptingnew. From annual screenings to well checks and everything in between, having a primary care provider that you can trust makes all the difference.

Okay, we are back continuing our conversation about skin cancer and, there are several treatment options, some of which you had mentioned already, depending on the type and the stage. Can you tell us a little bit about the newest offering from Riverside, which is brachytherapy?

Issra Rashed, MD: So brachytherapy is great for those tiny tumors, really confined to the outer layer of skin. So very early stage tumors for the most part. They don't have to be necessarily small per se. We can actually treat larger ones as long as they really are confined to the epidermis. So they're still very early stage cancers.

The nice thing with it is the type of radiation you can just kind of sit it on the tumor and it radiates the tumor while just sitting on it. And in this situation, the tumor can get the radiation it needs and that radiation doesn't have to go deeper than it needs to, to get to it. But in general it's, it's like a topical form of radiation, if you will.

And it's extremely effective. It's just as good really as any other radiation, often just as good as surgery and toxicity wise, you'll get a sunburn. Not much else. The nice thing with it is it's not disfiguring because there's no cutting, okay. Long term you might get a little bit of discoloration of the skin.

Sometimes some hypopigmentation you might notice that, you know, this spot's on your scalp and you're indirect sun for a long time. That the area that was radiated is more prone to a sunburn. But very minor things, life threatening complications, I don't think I've ever seen anything like that.

Host: You kind of answered this just now. Are there long-term effects patients should be aware of with any of the different treatment options?

Issra Rashed, MD: So like the radiation, you know, we hit on a little bit, but in general for most patients, whether it's surgical or radiation, really well tolerated. I mean, you might have a little bit of recovery period right after surgery or right after radiation, and most of that stuff is confined to a skin reaction, oftentimes. Sometimes a little bit. Other organs get involved, but that's not very common at all. So it, really is a minor recovery process, I think.

Host: So how would you say that you and other people on the Cancer Institute team work with other specialists such as dermatologists to coordinate care?

Issra Rashed, MD: Yeah. So sometimes patients come to me first, okay. And it's a spot that's like on their shoulder or something, and I know I can radiate it, but I know for them what makes more sense is one day of minor surgical outpatient procedure as opposed to 10 or 30 days of radiation, depending on what radiation we do.

So then I'll immediately get a dermatologist in play. So, a lot of the times though they're coming to me either from medical oncology is the most common provider, sometimes primary care doctors, and then most of the times dermatologists. And so dermatologists they know enough about my radiation and what I do to know, hey, this is a patient that might be better served with radiation. And that's usually how I get involved in those patients. And so we collaborate together. We also call each other when we're not sure, you know, Hey, we got a tough case. And I actually don't know.

Plastic surgery here also is involved in these cases. ENT sometimes gets involved in these cases. So we, we do work as a team and we try to figure it out for the patient and also just individualizing to what the patient wants. So sometimes the patient can have it all and they say, absolutely not.

I won't do it this way. You know, and so that's when you kind of have to think of what they will do and make sure that works out for them.

Host: Yeah. That's great that you collaborate and kind of figure out as a team what the best case will be and listen to the voice of the patient too is important.So that's great.

In addition to sunscreen, what are some of the best ways to protect against skin cancer?

Issra Rashed, MD: Yeah, that's a really good question. So I think, you know, there's like the bad stuff like tanning beds, which most people I think don't do. But even with sunscreen, I think you really need to just limit sun exposure.

I don't think that sunscreen is the end all be all. It definitely helps. It definitely decreases your risk, but sun is, as much as we all love it, okay. Especially being in Chicago and missing it for many, many months. Um, I think you have to just be cognizant of that. So you can sit there, but you can be covered. I think you just have to be mindful of that. Hats. You know, t-shirts as opposed to spaghetti straps and that kind of thing. And, obviously reapplying, sunscreen all throughout. And then there's other things you just can't look out for. So the things you can't protect against, then you have to be aggressive with dermatology to catch it, like I said earlier.

So there's people we know are inherently risky. The ways to prevent it, we really can't, or they need this, that might cause it. And so at that point it's just about early detection or pre-cancer detection.

Host: For sure. Yes. I know for myself, I'm quite fair skinned, and I've had melanoma and so it's become sunscreen and dermatology checks have become like that's my high horse, when I talk to people, I'm like, you gotta do these two things. What are some of the things on this subject that you would really like listeners to know?

Issra Rashed, MD: I'd like them to know that they've got options, you know, so I think that's the, the big takeaway and I'd like them to know that they don't need to be scared to go get checked out for these things.

So preventative care is not a diagnosis, it's preventative care, and it helps prevent a, sometimes really heart wrenching diagnosis and experience. So there's no reason for that. I think just being proactive, I think asking questions ahead of time. So like you've said, you've got the history, you've got the risk factor, you're a Caucasian woman.

And anybody who kind of talks to the primary care doctor about these things can also get other risk factors and figure out if they're a candidate for someone to just be on top of it before something happens. So I think that's the number one thing. And then, if something were to happen, just know that there's many other doctors here. And each of them has a role to play. So not just dermatology. It's not just cutting if that's not what you want to do. And there's radiation, many different types of radiation, and there's even drug therapy now. So things that our medical oncologists do so we'll find something that works for your lifestyle and, and still get you a good disease outcome.

Host: Yeah, that's really reassuring to hear. Well, thank you so much and thank you all for tuning into the Well Within Reach podcast with Dr. Issra Rashed, Radiation Oncologist at the Riverside Cancer Institute, and your host Taylor Leddin-McMaster. To learn more about services provided by the Riverside Cancer Institute, visit myrhc.net/cancer or call 815-933-9660.