Maggie McKay (Host): This is Community Connect: presented by Tampa General Hospital. I'm Maggie McKay. Joining me is Dr. Nishit Patel, USF Department Chair of Dermatology and Cutaneous Surgery, and Medical Director of Dermatology Service Line at Tampa General Hospital, to discuss melanoma and skin cancer awareness.

Welcome, Dr. Patel. Thank you so much for joining us.

Dr. Nishit Patel: Thank you for having me.

Host: Let's dive right in. What are the different forms of skin cancer, and how does someone know that they have one?

Dr. Nishit Patel: So, skin cancer is something that really encompasses lots of different types of individual cancers. The three most common being basal cell skin cancer, squamous cell skin cancer, and melanoma. Basal cell skin cancers are the most common skin cancer in the US. And the vast majority of these can be managed very easily with minor procedures often done in a dermatologist's office.

Squamous cell cancers are less common, but a little bit more aggressive than basal cell skin cancers. But again, the vast majority can be managed and remain within the skin with a small percentage spreading beyond. And of course, melanoma being the most serious form of skin cancer is the one that we spend the most focus on in many cases because of a higher likelihood of that skin cancer developing and spreading outside the skin.

The good news though is that all of the skin cancers that we are talking about can all be very safely managed if caught early. And so, that early detection piece, like in most forms of cancer, is so critical. But one of the nice things with skin cancer, it's something that both I as a dermatologist can see, but also as a patient, you have the ability to be part of the team of detecting those changes on yourself.

Host: So, what does a "suspicious mole" actually look like to a regular person? Is it about the color, the shape, or just that it looks different from all the others?

Dr. Nishit Patel: You know, in a lot of ways, it's all of the above. when we talk about melanoma, we focus a lot on this concept of ABCDEs. It's something that many may be familiar with. And that kind of describes what qualities of a spot or a mole you have that might make it more suspicious.

The A being asymmetry. So, does it look different on each half of that mole that you have? Are their borders nice and smooth or jagged and irregular? Is it one nice light brown color, or is it super dark black or multiple colors? And is the size or the diameter bigger than the size of a number two pencil eraser?

Those are kind of the big things we ask people to look at with their moles. But I often find that's a bit complicated to ask people to do. So, what I always focus on is two things. One is, as you mentioned, is there kind of a funny looking spot, kind of an ugly duckling, something that is on your skin that doesn't look like all the other spots on it? That's often one that we want to, zoom in on and really be thoughtful about whether it's concerning or not.

And then, I think, the second and perhaps more useful tactic is to really look at change over time. So, we can't expect patients to know all the details of every single thing that we spend years learning, but we can work together to say, if we know your spots are stable and unchanging, that's generally a good sign. Whereas if something is rapidly growing, not healing, or brand new, those are things that we definitely want to get a little bit more help with professional set of eyes on it.

Host: And what are the best sun protection strategies to protect against skin cancer? and for sunblock, does the SPF number really matter?

Dr. Nishit Patel: So, sun protection is such an amazing thing that we sometimes oversimplify as saying just use sunscreen. And I think that the reality is not everybody loves sunscreens. And so, sunscreens are an important tool, but one of many that can be used to protect your skin. In Florida, we're very lucky. We get over 200 days of beautiful full sunshine. But at the same time, that same sunlight can cause mutations in our skin cells that eventually, if unchecked, can develop into those skin cancers we were discussing.

So, we talk a lot about sun protection in kind of different categories. First and foremost, of course, is sunscreens. Sunscreens can be very effective at sort of blunting the harmful effects of UV light coming from sun exposure. But you can also layer that together with protective clothing, with hats, and avoidance of kind of the peak hours of sun, which are typically between 10:00 and 4:00. And so, if we can combine those things in different ways and, you know, maybe one patient prefers the clothing strategy, another may prefer sunscreen, some will do all of the above, we have to find what will work practically for every person. And the goal of course being that the more that we protect from the damaging effects of that UV light, the fewer skin cancers that people will hopefully experience over their lifetime.

Specifically around sunscreens, that SPF number is really important. You'll see numbers everything from an SPF of 5 all the way to, you know, 85 or, historically, even 100. And the sweet spot for sunscreen really is an SPF 30. If you get an SPF 30 sunscreen, you're gonna get about 97% protection. So, there's often reasons to go higher, but that's really the floor of what is meaningful. And unfortunately, it's not proportional. So just because you go from an SPF of 30 to 15, your protection doesn't just cut in half. It actually significantly reduces the level of protection. So, try to stay above an SPF 30. And in many cases an SPF 50 being applied in the real world, because most of us don't put on the amount of sunscreen we're supposed to, gets you a real world value of an SPF 30

Host: For someone who's never done a skin check at home, where do we even start? Do they need a mirror, a partner, or just a really bright light?

Dr. Nishit Patel: I think, self-exams are really important. One of the most important things when you're trying to do this is make sure that you have a chance for someone to get a good baseline on your spots. So whether that's a dermatologist or a trusted primary care provider who is comfortable with skin cancer monitoring, getting that initial evaluation is important because that gives you a good sense that what's on your skin is normal and safe. And that allows you to kind of come from a place where, again, you're looking at changes from what is familiar. it can be difficult, of course, to look at areas like your back or behind your legs. And there's some wonderful resources that you can access from the American Academy of Dermatology and from our sites to kind of teach you how to do a self-skin exam effectively.

If you do have a partner who can help, it's a powerful way of being able to take care of each other, where you can look at each other's backs and areas that are historically harder to see. Again, looking for things that are either significantly different than the others, violates those ABCDEs, perhaps a spot that isn't healing that keeps scabbing over or bleeding, that can often be a sign of a undetected skin cancer. And then again, once you have that initial baseline examination from a physician or a professional, you can look for interval changes as something to be concerned about.

Host: What if someone finds a spot that looks weird today? Who's the very first person they should call? Primary care doctor or go straight to a specialist?

Dr. Nishit Patel: So, I think some of this will depend on kind of where you live and what access to dermatology looks like. In many cases, primary care physicians are very effective at being able to look at a spot and make a determination of whether it's concerning or not. And also, if they are unsure, they will often refer to a specialist like a dermatologist.

In Florida, we're very lucky because of the number and rate of skin cancer we see, we do have the ability, through a role called Direct Access for patients to be able to see a dermatologist directly up to six times a year. So, I think the key is to make sure you go to somebody who's a trusted professional who can do a thoughtful evaluation and help connect you to the next steps.

Host: Six times a year? Does insurance cover that?

Dr. Nishit Patel: In Florida, there's a bill called Direct Access. And if you're a commercial insurance patient in Florida, that Direct Access rule exists and should not require a primary care referral necessarily. Now, of course, every payer and product is different, so you'd want to make sure that you're going the right route. But it's a very unique legislation to Florida because the incidence rates of skin cancer in Florida is so high, as you can imagine

One in five, Americans will have an experience with skin cancer, and a person dies every hour of melanoma in this country. So, these are highly preventable deaths. These are things that can be detected early and treated with very minor, low-cost procedures in a doctor's office. It's only when these skin cancers are more advanced, spread beyond the skin, spread to lymph nodes or other organs, where we have a whole different conversation around what does that mean for a patient and also how challenging it can be to manage.

Host: Yeah, let's talk about that a little bit. If a doctor tells someone that they have skin cancer, does that always mean a big surgery? Or what are the other ways it gets treated these days?

Dr. Nishit Patel: What I often find with my patients is the C word is scary. And even if it's prefixed by saying skin cancer, people tend to anchor on the word cancer as, of course, understandably a very scary term. The good news with skin cancer is the vast majority of skin cancers that we detect are not ones that require advanced complex surgical and radiation treatment.

The vast majority can be treated conservatively with a minor procedure done under local anesthetic in a dermatologist office, anywhere in the country. It's really the small percentage of those that are more advanced that weren't detected as early or perhaps have grown more rapidly than would be typical that will then require more of an multidisciplinary approach where we might work together as a dermatologist, a surgical oncologist, a radiation oncologist, a medical oncologist, and really bring together that interdisciplinary care for those smaller subset of skin cancers that need it.

But again, if you can detect a skin cancer early, it is absolutely manageable. You will live a wonderful life without a major consequence from it. And so that's why we focus so much on screening and early detection and self-monitoring.

Host: Right. So important. Dr. Patel, if someone listening only remembers one simple thing to do for their skin health today, what should it be?

Dr. Nishit Patel: Really the most important thing that anyone can do is to be familiar with their skin and the spots on their skin. And the reason I say that is one of the biggest and easiest opportunities for detection of early skin cancer is when something looks different, acts differently, wasn't there but is now there, something that's changing.

Those are things that anybody, regardless of, what level of experience they have in skin cancer detection can do on their own. And if you can do that on a regular basis for yourself, you'll have the chance to ask for help whenever you see those types of concerning, changes in your spots. And that's right next to protecting your skin, of course, which is the prevention side as well.

Host: Also important. Well, thank you so much for sharing this invaluable information that pretty much affects everybody at some point, right? Very informative. We appreciate your time.

Dr. Nishit Patel: Thank you so much.

Host: That has been Dr. Nishit Patel. For more information, please visit health.usf.edu/care/dermatology. If you enjoyed this episode, please be sure to like, subscribe, and follow Community Connect: presented by TGH on your favorite podcast platform. I'm Maggie McKay, and this is Community Connect: presented by TGH. Thanks for listening.