Cheryl Martin (Host): This podcast is for informational purposes only and is not intended to be used as personalized medical advice. Skin cancer is the most common cancer here in the United States. One in five Americans will develop it by age 70. So, let's learn more and get the facts about skin cancer with Dr. Michael Marchetti, a dermatologist at Skagit Regional Health. 

This is Be Well with Skagit Regional Health. I'm Cheryl Martin. Dr. Marchetti, so glad to have you on.

Dr. Michael Marchetti: Thank you so much for having me. 

Cheryl Martin (Host): So first, what is skin cancer and talk about the extent of the problem here in the United States.

Dr. Michael Marchetti: Skin cancer is a malignancy or cancer that arises from the cells in our skin. And it's a big problem in the United States. We're really living through an epidemic right now. It's actually the most common cancer in fair-skinned individuals overall, and it's just become much more common in the United States over time. And left alone, it can cause a lot of health problems. It can be disfiguring. It can lead to problems like bleeding, and it can even spread throughout our body and, unfortunately, lead to death.

Cheryl Martin (Host): Any idea why it's become just much more prevalent here in the United States?

Dr. Michael Marchetti: Probably two reasons. One of the most important is increasing exposure to the most important risk factor, which is ultraviolet radiation, so sunlight, indoor tanning. That's probably the biggest reason. The second is that we're looking harder for it. You know, we have more dermatologists available, people are living longer, they're getting checks and so we're finding more and more of it.

Cheryl Martin (Host): What are the main types of skin cancer?

Dr. Michael Marchetti: The most common one is basal cell carcinoma. But fortunately, it's the most indolent and it grows slowly. The second most common is squamous cell carcinoma, usually indolent, meaning slow-growing. But in certain patients, like those who have an impaired immune system, it can lead to serious health problems. Collectively, we refer to those two as non-melanoma skin cancer. And then, the third most common is melanoma. And although it's much less common, it actually accounts for the majority of deaths due to skin cancer in the United States.

Cheryl Martin (Host): Talk more about the risk factors for developing skin cancer.

Dr. Michael Marchetti: I like to say that anybody can get skin cancer, but there are three main risk factors. The first is age. It becomes much more common as we get older. The second is genetics, so what you inherit from mom and dad, and I can go into that in greater detail. And the third is ultraviolet light exposure: outdoor sun exposure, sunburns and indoor tanning. And from genetics, it's what we refer to as our phenotype, so fair skin, red, blonde hair, light eyes, people whose skin burns easily when exposed to the sun. And probably, the most important one for melanoma is if you're a moley person. So, do you have a lot of moles on the skin? That significantly increases your risk.

Cheryl Martin (Host): And when you say older, you're talking about what age.

Dr. Michael Marchetti: It's a continuum, so I wouldn't say there's a strict cutoff. But over time as we get older, the risk goes higher, and that continues to get higher the older and older we get.

Cheryl Martin (Host): So, describe what skin cancer looks like.

Dr. Michael Marchetti: Sure. Usually, it presents as a new or changing spot on the skin. For the non-melanoma skin cancers, it's typically pinker skin colored. It may start to bleed or get irritated. And in some individuals, they'll notice that it's a spot that heals, but then comes back, heals, and then comes back over time. And eventually, it turns into a larger growth. For melanoma, though, it's usually a little different. It starts more as a brown or black spot on the skin that changes, develops certain characteristics, becomes more asymmetric, it might have irregular borders and multiple colors. Rarely, melanoma can just be pink though. And so, any changing spot should really warrant some investigation.

Cheryl Martin (Host): So, are there some ABCDs of melanoma?

Dr. Michael Marchetti: Yeah. We like to educate the public about that because it's a useful mnemonic to remember certain features of skin melanoma. And I alluded to some of those. So, the A stands for asymmetry. The B stands for irregular borders, the C for multiple colors. D is for a larger diameter, typically greater than a pencil eraser. But I always like to add the E of the ABCDEs of melanoma because it emphasizes an evolving spot, something that's changing over time.

Cheryl Martin (Host): So, this really calls for us checking our skin on a regular basis and not taking these things for granted.

Dr. Michael Marchetti: That's a great point. It's very important that people are aware of the spots on their body, and that's been shown in studies that people who have greater self-awareness of their skin do better, because their skin cancers are found at earlier stages. And people can really take their health into their own hands by performing a skin self-exam, periodically thoroughly examining the skin surface from head to toe.

Cheryl Martin (Host): So, is that the best way to check your skin for skin cancer then, is to be self-aware?

Dr. Michael Marchetti: That's one way, right? So at home, being self-aware, it may be helpful to have, a family member help with that process. So, it could be a loved one or potentially a friend, because there are some areas of the body that are a little harder for us to check and having someone help us with that can be useful.

Cheryl Martin (Host): So, what should you do if you find suspicious skin spots? 

Dr. Michael Marchetti: I would recommend that someone see a board-certified dermatologist and if they're unable to schedule an appointment with one directly to ask their primary care doctor for a referral, and to proceed from there. It's important to have that spot correctly evaluated.

Cheryl Martin (Host): And so, how is skin cancer diagnosed? What can we expect if we go to a dermatologist?

Dr. Michael Marchetti: Someone comes into the office; we're going to start with a visual examination of any spot that was worrisome to the patient. So, we're going to use our eyes, we're going to take a look at that spot. We may feel the spot, the texture of it. These days, we're often using tools that improve our ability to examine the skin, something called a dermatoscope. And that allows us to visualize the skin with greater accuracy. And if that spot was sufficiently worrisome, we would recommend a skin biopsy. So, we would take a sample from the skin, send it to a pathologist, who would examine it under the microscope, and give us a more accurate diagnosis.

Cheryl Martin (Host): What are the ways skin cancer can be prevented?

Dr. Michael Marchetti: I'm a big believer in prevention because if we can avoid the problem in the first place, that's better than treatment. The most critical period of life where we can prevent skin cancer is childhood and adolescence. So, I really educate patients to do everything they can for their children and loved ones to avoid excessive sun exposure during those ages. I prefer using sun-protective clothing, hats as the primary means of protection from the sun. And sunscreen obviously can complement that to areas of the body that we can't cover up. But I do find that using clothes is just a more effective way block sun's rays to our skin.

There are some additional things that people can consider. People who might be particularly into supplements, there is a supplement that's over-the-counter called nicotinamide that some studies have suggested can help prevent the non-melanoma skin cancers, like basal cell carcinoma and squamous cell carcinoma. And so if someone was interested in something like that, I would encourage them to have a conversation with their physician to discuss if that might be a good option for them.

Cheryl Martin (Host): When you talked about the clothing, does that mean then, doctor, even in the summertime, we probably should not be wearing sleeveless? We should wear long sleeves. How does that work?

Dr. Michael Marchetti: I'm a big believer that people should still try to do activities that make them happy, things that they enjoy, but try to do it in a way that minimizes the exposure. So, if someone wants to wear a short-sleeved shirt, that's where sunscreen is going to help with covering the rest of the skin. But if it was a particularly high-risk exposure, like a sunny holiday, you're at the beach all day, you're at the pool all day, that's where I would encourage someone to maybe think about other ways to protect the skin, just because how frequently we see people getting sunburns.

Cheryl Martin (Host): So, do you recommend some should see a dermatologist for regular skin cancer screenings? And if so, who would fit that category? 

Dr. Michael Marchetti: I want to emphasize that anybody who has a concerning skin lesion should definitely see a dermatologist to have that evaluated. And at the same time, they can get an assessment of their risk, because sometimes patients aren't always aware of their risk factors. And having a dermatologist evaluate them can help with that discussion.

Otherwise, it's a bit of an unanswered question right now. Current guidelines that create recommendations in the United States around various health interventions like cancer screening actually don't recommend that the average person in the United States, the general population, receive regular skin cancer screenings. But there are certain groups of individuals that I would say definitely do benefit. So, if someone has ever had a history of skin cancer, someone who might have had a pre-skin cancer change on their skin, people who are very moley, people who have a family history of melanoma, people who have a strong family history of basal cell or squamous cell carcinoma, and then anyone who has a compromised immune system, whether it's from medications that they're taking or potentially they've had an organ transplant, like a kidney transplant, those people are at particularly high risk for some types of skin cancer. And I always try to encourage our older white males, so individuals 50 or 60 or older, to see a dermatologist, because often they don't like seeing doctors and actually about half of melanoma deaths in the United States occur in those individuals. So, I try to encourage them to see a dermatologist as well.

Cheryl Martin (Host): Well, Dr. Michael Marchetti, thanks so much for educating us on skin cancer. Thank you.

Dr. Michael Marchetti: Thank you.

Cheryl Martin (Host): For more information, visit SkagitRegionalHealth.org. And if you found this podcast helpful, please share it on your social channels, and check out the entire podcast library for other topics of interest to you. This is Be Well with Skagit Regional Health. Thanks for listening.