This is “Healthy Conversations,” a podcast presented by Adventist Health.

Maggie McKay (Host): The American Cancer Society says skin cancer is by far the most common type of cancer. So, how do you know if you have it, what type you have and how to treat it? Let's find out with Dr. Christine Kilcline, Dermatologist.

Welcome to Healthy Conversations, I'm Maggie McKay. Thank you so much for being here today, Dr. Kilcline. I can't wait to learn more about skin cancer because it's one of those things we all need to be aware of.

Christine Kilcline, MD: Thank you for having me, Maggie.

Host: So how does skin cancer develop to start with?

Christine Kilcline, MD: That's a great question. Skin cancer, like all cancers, is essentially caused by changes to the DNA that leads to uncontrolled growth of abnormal cells. And if you recall, DNA is our central kind of recipe of what runs our body. It runs all of our cellular functions. One unique feature about the skin, however, is that other than being the largest organ, it is also the most exposed organ to potential irritants and harmful injury from the environment. It's these injuries that lead to DNA damage.

Host: And how common is skin cancer?

Christine Kilcline, MD: Well, skin cancer is actually the most common cancer period in the country. There are four types of skin cancer, and overall the rate of skin cancer will occur in one of five Americans, or about 20% of the population by the age of 70 years. So this amounts to about 9,000 or so people being diagnosed each day.

There's also been a steady increase in the diagnosis and treatment of cancer, a 77 percent increase between 1994 and 2014.

Host: What are the different types of skin cancer? 

Christine Kilcline, MD: As I mentioned, there are four types of skin cancer. Basal cell carcinoma is the most common form of skin cancer with approximately 3.6 million cases diagnosed each year. It is also the most common form of cancer overall. Squamous cell carcinoma is the second most common form of skin cancer and it is sometimes referred to as cutaneous squamous cell carcinoma. This is to distinguish it from other forms of squamous cell that can affect the mouth, lung, or throat. Squamous cell carcinoma has an estimated 1.8 million cases diagnosed each year, and this has also seen a steady increase of 200 percent over the past three decades. The next forms of skin cancer include melanoma and Merkel cell carcinoma. Fortunately, these are less common, they are also the more dangerous forms of skin cancer.

Host: Is that what Jimmy Buffett just passed away from? Merkel cell? 

Christine Kilcline, MD: Yes, exactly. So, Jimmy Buffett was diagnosed with this form of skin cancer and battled it for four years before passing away recently. 

Host: Is it more common, skin cancer in general, if you live in a climate where there's sun every day like Southern California or Hawaii?

Christine Kilcline, MD: Exactly. So, all forms of skin cancer, their greatest risk factor is UV exposure or sunlight exposure. But especially so with a melanoma and Merkel cell carcinoma.

Host: Does skin cancer spread easily?

Christine Kilcline, MD: So how easily skin cancer spreads really depends on the type. Basal cell carcinoma is the slowest growing form, making it highly curable with minimal damage when caught early. There are certain locations such as the face, the ears, the hands and feet that can be associated with higher risk of recurrence and damage to local tissues. And rarely in unusual cases, basal cell can be aggressive and spread to other areas of the body.

Squamous cell carcinoma, like BCC, most often remains in local tissue. However, it does have a greater risk of spreading to other areas of the body. This is typically higher in locations such as the head and neck, an underlying risk factor such as a weakened immune system, or sometimes in rapidly growing lesions.

And then lastly, melanoma and Merkel cell carcinoma are the two most dangerous forms of skin cancer. These each involve a staging workup or evaluation at the time of diagnosis. And then depending on which stage the cancer is diagnosed in, will determine any risk factors for metastases or spreading to other areas of the body. 

Both of these forms of skin cancer can spread to the lymph nodes, the lung, the brain, the liver, or other areas of the skin, as well as other organs, if they're not caught at an early stage. 

Host: So, if that information doesn't get you to start using sunscreen, I don't know what would. What are the treatments or procedures for skin cancer, Dr. Kilcline?

Christine Kilcline, MD: The treatment of skin cancer is truly disease and individual specific. So with early forms of basal cell and squamous cell, we can actually sometimes use chemotherapeutic topical agents or locally destructive techniques that are really minimally invasive. Other locations or size of the lesion may also determine if surgical removal is the best option.

Mohs surgery is a specialized form of skin cancer surgery that spares as much normal tissue. This is especially useful in areas of high risk of recurrence, or that can have an impact on local structures, such as like the center of the face, the ears, the backs of the hands, areas that we don't really have a lot of normal tissue margin before potentially encroaching on a very important structure.

And then lastly, which is not used quite as commonly, but can still be very helpful, radiation therapy can be localized to the area involved in the skin cancer and it can provide local cure rates. And then when it comes to advanced forms of basal cell, squamous cell, melanoma, and Merkel cell, there are a number of chemotherapy regimens that are now available for locally advanced stages of disease. The landscape of treatment has really expanded rapidly in particular for the two most dangerous forms of skin cancer, melanoma and Merkel cell carcinoma, making long term survival much more possible than it had been in previous years. 

Host: And how preventable is skin cancer?

Christine Kilcline, MD: That's another great question, and it's an area of active research. Of course, the obvious preventive is sun protection. That's probably the most important factor for prevention of skin cancer. Even if you've already had a lot of sun damage as a child, there are numerous studies showing that people that regularly use sun protection, even if they've had prior precancers and skin cancers, have lower rates of new lesions as compared to groups that are not regular users.

Another area of research includes the use of oral antioxidants, the use of lasers and light therapy, as well as topical DNA repair enzymes.

Host: There's a lot of skin cancer in my family and so I am pretty diligent about going every year to the dermatologist and getting the yearly checkup, but I just changed dermatologist and she has me coming every six months. So how often should people get regular skin cancer checkups? 

Christine Kilcline, MD: In general, without any personal family risk factors, a baseline screening is recommended between the ages of 30 and 50. This allows your dermatologist or your primary care provider a chance to assess for other underlying risk factors, such as your total mole count, the number of sunburns you had as a child, a family history, or any other underlying medical history, such as a weakened immune system, that can increase your risk. Of course, at these exams, we can also see the amount of sun damage. And so, at some point we might say, Hey, you need to come more often than once a year. And sometimes we even have folks coming at intervals as often as every two to three months. It really just depends on the burden of underlying sun damage that's present, as well as the frequency of diagnosis of skin cancers and pre cancers in that individual.

Host: I once heard that your legs are a very common place to get skin cancer, which I never really considered, but it makes sense. Is that accurate?

Christine Kilcline, MD: Yes, and for women in particular, the lower extremities or the lower legs is probably one of the most common sites for melanoma to be detected, but also squamous cells. You know, if you think about all those afternoons you sat on the edge of the pool with your legs dangling in the water or legs dangling in the lake. That's where all that sun damage is coming from. 

Host: Oh, is there anything else you'd like to add that we didn't cover?

Christine Kilcline, MD: Well, I think the main take home message is that don't feel frustrated if you already have a lot of sun damage. The key component is to get connected with a dermatologist or even some really savvy primary care providers that really have an interest in skin are really great at, at least doing a screening exam.

The next thing is, of course, to really practice diligent sun protection. And another question that I often get is, well, what about vitamin D? And I say, yes, vitamin D is very important, but the best way to get it is really through supplementation. So a common cocktail that I'll recommend for my patients if they're looking to prevent skin cancers is to take a common vitamin, vitamin B3, that also happens to be an antioxidant, along with vitamin D.

And the dose that I recommend is 500 milligrams twice a day of the vitamin B3, sometimes also known as nicotinamide or non-flushing, niacin. And then I also recommend vitamin D3, 5,000 international units a day. So B3, B as in boy, and D, D as in dog, D3 are the two, most important vitamins that, that you can take. 

And then there's one last really cool supplement that we now have about two decades of research on. It's got a big, long, fancy name, polypodium leucotomus extract, or PLE for short. And it is a botanically sourced antioxidant from a Brazilian fern that's highly resistant to UV damage. And we have lots of data now showing that daily supplementation with this compound has been shown to decrease the development of skin cancer in high risk populations.

So I actually recommend this quite often for my very active outdoor lifestyle patients, folks that are hiking every day, surfing, runners, pickleball players.

Host: Ha. 

Christine Kilcline, MD: Which is probably the most expanding population out there in the United States today, but really, you know, even with good sunscreen and sun protection, you're still getting UV, so you need sometimes a little boost to help protect you. 

Host: So, if you go to a drugstore and say, where's the PLE, are they going to know what you're talking about? Or do you have to go to like a Whole Foods type? 

Christine Kilcline, MD: No, it's actually available as a, you know, no plug here, but it's called HelioCare is a common, over the counter brand of it. It's been available for many years, like in Europe and such, so you can find it as an extract on its own, but the HelioCare is the randomized controlled trial that has the most data to back it up.

Host: Okay. Oh, that's great. I have a big, long list of things to do now. Thank you. I wrote down everything you said. It's so helpful. This has been really informative about something that we all need to, like you said, be diligent about because our skin, as you said, is our biggest organ and we got to take care of it.

Christine Kilcline, MD: Exactly.

Host: Thank you so much. Again, that's Dr. Christine Kilcline. If you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. I'm Maggie McKay. This is Healthy Conversations. Thank you for listening. 

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Disclaimer: This program is a community service and is not intended to be a substitute for medical advice. Listeners having questions about their health should make an appointment to see their personal physician. Any opinions or statements made during the program are those of the individuals or physicians making the statements and are not the opinions or statements of the hospital.