Maggie McKay (Host): We hear the warnings about skin cancer constantly and may not realize how preventable it is. So today, Associate Professor of Dermatology, Dr. Anisha Patel, will discuss skin cancer, survivors, and sun safety. Welcome to the Cancerwise Podcast, presented by the University of Texas MD Anderson Cancer Center. I'm your host, Maggie McKay. Thank you so much for joining us, Dr. Patel.

Anisha Patel, MD: Thank you for having me.

Host: So, we're all at risk for skin cancer, that's no doubt. But if you've had it once, you are at an increased risk of developing a second skin cancer. So, tell us why.

Anisha Patel, MD: So, most skin cancers are actually related to UV or ultraviolet light exposure. So, if you've had one skin cancer, we know that you've had enough UV damage where you were able to develop that skin cancer. So, that puts you at risk for having more UV damage-induced skin cancers.

Host: And who else might have an increased risk of developing skin cancer? Does it go up for someone who has survived another kind of cancer, not just skin cancer?

Anisha Patel, MD: So, patients who have a family history of skin cancer also have an increased risk, and that might be due to some genetic components. Particularly for skin cancers like melanoma, we know that there is a familial or genetic component. If you've had other types of skin cancers, there's very few genetic syndromes that predispose you to skin cancer as well. One of those would be related to pancreatic cancer, but those are typically more rare.

Host: So, if someone in your family has had pancreatic cancer, you might get skin cancer because of that?

Anisha Patel, MD: So, if there are members of your family who've had pancreatic cancer or you have had pancreatic cancer, then that would be a reason for us to get a more thorough family history and to perhaps have you see one of our genetic counselors.

Host: Okay. The culprit, of course, is sun exposure. What's your recommendation for a skin cancer survivor for time spent outdoors?

Anisha Patel, MD: It's an interesting question, because you don't want to limit just the time spent outdoors, but the time spent during peak hours of sun exposure outdoors. So, really maximizing sun protection from all the different sources. So, using sunscreens or sunblockers, using sun-protective clothing, shade structures, and then avoiding the sunniest parts of the day are what we recommend for everyone, but in particular for patients who have had skin cancers.

Host: And aside from limiting exposure, what else can skin cancer survivors do to stay safe in the sun this summer?

Anisha Patel, MD: So, having regular skin exams with their board-certified dermatologist as well as doing self-skin exams, and we recommend doing those about monthly and taking a survey of any lesions on the skin that might be new or changing.

Host: So, you said do them once a month and how should someone conduct a skin check? How do you do it?

Anisha Patel, MD: You can start by just looking at the normal areas of the body, focusing really on areas that are sun-exposed, like the face, the neck, having someone help you with the back of your neck and perhaps your ears, looking at your hands and your arms. And we do want people to also look at their palms, their nails, their feet, areas that might be not the typical areas that you think of for skin cancer, but that are also exposed to the sun.

Host: I heard once that, surprisingly, legs, like from the knees down, like your calves, are kind of a very normal place to get skin cancer, because you know, you wear shorts or skirts or athletic wear. And I never would have thought to put sunscreen there.

Anisha Patel, MD: For Houston in particular, where we're wearing shorts a lot of the time, our legs do get a lot of sun exposure and even our feet when we're wearing sandals. But melanoma for women is most commonly on the legs. And so, that is an important point for people to remember to sun-protect even from the waist down.

Host: Wow. So, you know, I'm sure people ask you this all the time, but I need to hear it again, how often we should reapply sunscreen and what number SPF we should use.

Anisha Patel, MD: We recommend SPF 30 or above and reapplying every two hours. And if you're in the water, sweating a lot, those are reasons to reapply even more frequently than that.

Host: And if you don't reapply, is it like you have no sunscreen on at all?

Anisha Patel, MD: That's correct. Because especially in Houston, or if you're in the pool, you're sweating off that sunscreen even before it stops working.

Host: What else should we know? Anything we didn't cover? Anything you'd like to add in closing?

Anisha Patel, MD: UV protection is the cornerstone to skin cancer prevention. There's very few things we can control about our genetics, but we can control our environment. And to elaborate on the sunscreen point, you also want to look for broad-spectrum sunscreens. So, those block both UVA and UVB rays, both of which are associated with skin cancers. So, using SPF 30 or above and broad-spectrum sunscreen, reapplying every two hours, those are the key things that we can do for sun protection.

Host: Okay. Hats, I always worry about. I mean, I have hair, but still, even if you do, can you get skin cancer on your scalp if you don't wear a hat a lot?

Anisha Patel, MD: So, you can get skin cancer on your scalp, and we see the women in their parts is where you can get the most sun exposure. But also for men, because hair's cut shorter, we see skin cancers on the ears. Hats, especially broad-brimmed ones provide great shade for the rest of your face, the back of your neck, your ears as well. So, you can tell people who wear baseball caps, because their scalps will be well-protected, but the sides of their face and their necks will be the areas where they get skin cancer versus patients who wear the broad-brimmed hats, they get a much broader range of coverage.

Host: Well, thank you so much for joining us today and sharing your expertise. This has been such useful information.

Anisha Patel, MD: Thank you for having me. I hope that everyone learned something.

Host: Absolutely. I know I did. Again, that's Dr. Anisha Patel. And for more healthy living advice and expert insights from MD Anderson, visit mdanderson.org/cancerwise. I'm Maggie McKay. Thanks for listening to the Cancerwise Podcast from the University of Texas MD Anderson Cancer Center.