Bill Klaproth (Host): Being in a coastal area where people love to be outdoors, at the beach, on their boat, playing golf; that means a lot of sun exposure which can damage skin, cause wrinkles, skin spots and skin cancer. So, with us is Dr. Jackie Epperson, a physician at Tidelands Health, here to talk about skin protection, the types of skin cancer we should know about and advice on what to do if you notice problems. Dr. Epperson, thank you for your time. So, what are the best ways to protect your skin when you are outside and why is that so important?

William Jackson Epperson, MD (Guest): It is very important to realize that it’s okay to wear clothes outside. It’s an interesting part of our society. So many people don’t wear clothes, men working outside especially on roofs, that sort of stuff. You need to wear a shirt, preferably long-sleeves to block the sun directly. And also, as much as possible, when you have a situation being in the sun, when you are not having to be out there with work; avoiding the middle of the day hours when the sun is much more intense is often very important. The sun exposure, every bit of that that comes in contains the radiation called ultraviolet light and it goes into the skin and it breaks the DNA. We know that happens. We have so many studies showing that and that broken DNA can lead to skin cancers and also severe problems with collagen that leads to early aging.

Host: Well those are things we certainly want to avoid and good tips so far Dr. Epperson. Cover up and stay out of that midday sun if you can. And you were just talking about ultraviolet light. Can you decode SPF for us? What do those numbers really mean and what level should we use?

Dr. Epperson: Surely. The SPF is sun protection factor was decided a term to use for that. There’s an old mathematical method called logarithms that were used to examine large numbers; but basically, it’s photons of light that are being measured and the measurement comes out with numbers in the ranges of 15, 30, 100 that we see on sunscreens. Because it is logarithmic, it’s not linear so, my easy statement about this is that when you have a sun protection factor SPF of 30; you have blocked about 97% of the ultraviolet rays that can damage the skin. And so, anything 30 and higher is going to be fine, realizing also that if you go to an SPF of 60, you only go from 97% to 98.5%. So, you are not having that much more improvement with SPF 100. In the past, there was a lot of marketing to make it very expensive, our sunscreen has SPF of 100, but if you look at the science of that, the 100 and the 30 are almost exactly the same and practically they are the same as far as protection.

Host: Okay so, SPF 30 is really the minimum we should be looking at.

Dr. Epperson: Right. SPF 30, it is almost impossible to find a sunscreen now that is less than SPF 30 because that’s the number that’s known that’s blocking 97% of the rays and going up to 98%. What does 1% difference make really? Nothing that would make any sense. So, most all sunscreen now is between 30 to 100.

Host: Alright, very good to know. And which sunscreen is better, spray or lotion?

Dr. Epperson: Well I tell patients that the best sunscreen is the one that you will use because if you don’t like sprays, you won’t use them. The problems with sunscreen that we see is that individuals do not take the time to put enough sunscreen on. They put the coating too thin. They miss areas. We have probably all seen people that have streaks to where they are badly burned where the sunscreen missed along where say a strap of a bathing suit or something might have been blocking them from putting it on. So, it’s very important to put on a good coating. My personal opinion is that’s more easily accomplished with the sprays than it is with the lotions. But some people can’t stand the coolness of the spray and they don’t like the sticky feeling of that, and they have some of their lotions. Many times, women use sunscreen everyday on their face which is incredibly important, and they use that in their base makeup. And so, it’s up to the individual as to which one to use, spray or lotion. It’s just making sure you get a good coating of it and it’s something that you like to use that is not interfering with your lifestyle to where you will put it on and reapply it after a while.

Host: And speaking of reapplying, you just mentioned that. If we are out in the sun all day; how often should we reapply sunscreen?

Dr. Epperson: Right. The big point about it is, is what is your behavior while you are in the sun? Every time you go swimming, you need to get out, dry off and reapply your sunscreen. If you are in a physical activity where there’s a lot of perspiration; you are of course going to be watering off the sunscreen and you need to apply more frequently, say every couple or three hours. If some people are just laying out in the sun and not doing a lot of activity; reapplication every four hours is probably quite adequate, making sure you focus the reapplication on the areas that are receiving the most sun. We have more of a tan on the upper part of the forearm, than we do under the bottom part which is more pale. So, you know you want to put more sunscreen on the areas that are receiving the most sun; anterior chest, anterior thighs, abdomen, that sort of thing.

Host: And Dr. Epperson, if you have been out in the sun a lot in your life, what are some of the signs of skin cancer we should watch out for?

Dr. Epperson: It’s very important to look for any pigmented lesions. The more deadly type is the melanoma which is a pigmented lesion so, if anyone sees a pigmented lesion that is dark, brown is okay; but if it’s irregular, if it’s black in color, if it has irregular coloration, irregular borders, all of those things matter and that’s concerning for melanoma. And in the United States, we have about a little less than 8000 people a year dying from melanoma.

What most people don’t realize, the next type of skin cancer that concerns us is squamous cell cancer. This is a red area that scales, that easily bleeds, it can be painful, itching and those are the type stories that patients tell me, and we have more than 15000 Americans die from squamous cell cancer of the skin each year. And so, it actually is more deadly than the melanoma is. The third that’s more common is the basal cell cancer. The basal cell cancer is a cancer that is locally erosive to the skin. Basal cell cancers almost never go to other parts of the body and spread, and there’s less than 3000 Americans a year dying from basal cell cancer. So, all of these cancers are deadly. All of them need to be found early and the features that an individual needs to be looking for are changes in a lesion, and any type of darkening or bleeding or ulceration or increasing in size and just a new lesion that’s come up that you can’t explain.

Host: So, if you see any of that, don’t delay. I imagine the message is go so your doctor right away, is that correct?

Dr. Epperson: I believe it’s important to get in within three to six weeks is certainly fine. This is not like chest pain where you need to be in there right then. It is something that grows somewhat slowly and so you certainly have time. If you spot the lesion the night when you are washing your face, you don’t need to see the doctor the next day, but it’s nice to get in within the next month or two.

Host: And you were just mentioning some of these common skin cancers. How are they generally treated?

Dr. Epperson: Most of the skin cancers are treated with excision. The area of the skin that’s abnormal is identified by the skin surgeon and I do about 17 to 20 of these a week. Clinically, I will observe the margins of this to where I see good tissue versus bad tissue and I will draw around that and then I will inject it to numb it, the way a dentist would numb a tooth. And then of course, it’s cleaned as you would do in a surgical operation. And the area is taken off by actually cutting it out through the skin. It is a skin cancer, so you don’t need to cut deeply into the fat. You just go down and get good margin around it and then you bring the skin back together. And the surgical treatment is the most common treatment and the best treatment for most all lesions. But we do have radiation treatment which is also very effective, and it helps preserve the horrendous scarring that can occur when people have cancers on their nose or ears, and they don’t have to have their nose removed. Radiation can certainly treat those equally effectively.

Host: So, it sounds like we really need to look over our bodies on a regular basis for as you were talking about these irregular shaped moles or black moles. We really need to be actively looking at our skin. Is that right?

Dr. Epperson: That is a great idea for northern Europeans. People of color, someone from India, someone from the Philippines; they rarely get skin cancers and so it’s less of a concern with those. Those who have blue eyes, those who have pale skin and a history of sun damage or a family history of skin cancers; they definitely need to be watching their skin maybe monthly, every two months, looking things over, having someone else observe their back and areas that they can’t see. So, but anyone can get a skin cancer, so it’s important if you see a changing lesion, to have that checked, but the surveillance is far more important to people with northern European descent.

Host: Absolutely. Great points. Dr. Epperson, thank you so much for your time today. For more information, about Tidelands Health physicians, services and facilities, visit www.tidelandshealth.org, that’s www.tidelandshealth.org. This is Better Health Radio. I’m Bill Klaproth. Thanks for listening.