Amanda Wilde (Host): External conditions, genetics, and certain medical disorders can damage your skin and raise cancer risks. So, we're talking about protecting your skin with Carol Chandler, a dermatology nurse practitioner at Tri-State Health. This is Tri-State Health Talk from Tri-State Health. I'm Amanda Wilde. Carol, thank you so much for being here.

Carol Chandler, APRN-BC: Thank you. Thank you for having me.

Host: This is a subject that affects absolutely everyone. Can you start by explaining the different types of skin cancer, and what makes melanoma more serious?

Carol Chandler, APRN-BC: We have three basic types of skin cancer. The first is our basal cell carcinoma. It is our most common skin cancer. It is not life-threatening, but it can be destructive. And by destructive what I mean is that the tissue will become softer and break down. And these cancers can cause tissue destruction and deformity.

So, basal cell skin cancer likes to pop up on the face, particularly the nose. And so, the nose is our most front and center part of who we are. It's, you know, you look at that face and that's what you see. So, we want to make sure that we catch that early. It is not the type of cancer that will spread internally. But again, that tissue destruction and deformity is something we want to prevent.

Our second most common is the squamous cell carcinoma. It is a skin cancer that generally comes from a large amount of sun exposure and can often evolve or change from the pre-cancerous condition, what we call an actinic keratosis. Now, these are a little more serious, particularly if you have a deeper form, meaning deeper in the skin, not through the body. But the deeper ones, particularly if they are on the head and neck, they do have a potential to spread internally. So, those can invade lymph nodes. Now, fortunately with this cancer, it does not happen very often, about 12%. But if it does, it is not a good outcome for patients. So, we want to prevent that from happening.

The melanoma is different in that it is our only genetic skin cancer. So if mom or dad or grandma, grandpa, sister, brother, if they have had this type of skin cancer, you can potentially inherit it as well. And our melanoma comes from moles. So, moles are something that can come up anywhere on the body from your scalp to feet, bottom of the feet between the toes, even the private area. Those are not things that are necessarily associated with sun exposure. So, that genetic factor is very important. And this is the type of cancer that is most likely to spread into lymph nodes.

Host: You mentioned the genetic factor. What are the most common risk factors people should be aware of?

Carol Chandler, APRN-BC: So when we talk about risk factors for skin cancer, fairness of skin, blonde hair, red hair, blue eyes, green eyes, history of sunburns, significant outdoor exposure, tanning bed use, family history, particularly for melanoma. And then, with melanoma being mole type cancer, the number of moles. If you have a large number of moles, then just statistically, from having so many, it does increase the risk of some of those being likely to change or transform.

Host: What are the key warning signs people should look for then when they're checking their skin?

Carol Chandler, APRN-BC: So, you want to look for things that are new or different, something that you're like I don't think that's been there before. You also want to look for things that have been there for a long time, but are suddenly changing. You see a change in size or shape or color. You may have symptoms with something, maybe it's itching or burning or bleeding. And that's not like, "Oh, I scraped this and it bled." But this is something that, for no reason at all, this little spot bleeds. And that's been doing that for a couple of weeks. So, my monitor for that is if something's persistently different for a month or more, if you've got like four to six weeks and you're like, "Wow, this is different," then we need to take a look at that. We want to find out why is that new, different or changing.

Host: Well, you've described the kind of things we should be looking for. How often should we be doing skin checks at home on ourselves?

Carol Chandler, APRN-BC: It's easy enough to just maybe once a month just take a little peek around and just kind of say, you know, I'm gonna take a couple minutes just to kind of look and see what's going on. I think that's reasonable and gets it often enough that it can make a habit, keep you on track so that something doesn't get too far ahead.

Host: And when is it time to have a spot that you're not sure of evaluated by a provider instead of just keeping an eye on it for changes.

Carol Chandler, APRN-BC: If something has been present or symptomatic for a month or more, so like four to six weeks, and especially if something is rapidly changing. So, "Boy, this spot popped up. And man, it's doubled in size and it's only been there a couple of weeks." Those are things that we need to look at and investigate further.

Host: And what does a typical skin exam look like? What can patients expect during that visit?

Carol Chandler, APRN-BC: So basically, we have people come into the office. I do recommend what we refer to as a full-body examination. So, we just have you get into a privacy gown or a cape. You can keep your under clothes on. So, bra and underwear can stay on or boxer shorts, briefs. And then, I just kind of start from the top of the scalp and work my way down to the feet and just kind of look and touch and describe what I see, what things look okay, what things are concerning and why.

Certainly, if people do have concerns in those private areas that's something that, yes, we can explore them. If it's on your skin, we want to check it. But, you know, it's something that they don't have to feel like they're completely exposed and vulnerable if they're not comfortable with that.

Host: Carol, eventually if skin cancer is detected, what are the treatment options?

Carol Chandler, APRN-BC: Surgical procedure is always an option, and that's always going to have your highest cure rate, because there will be some type of pathology involved in that where, You know, they're going back and saying, "These margins are clear. This looks good." But sometimes there are a couple of more superficial skin cancers that we will sometimes freeze with nitrogen or utilize some chemical topical agents to apply, or there's another procedure that we call electrodesiccation and curettage where we kind of scrape over that and use some cautery to destroy a smaller, non-life threatening skin cancer.

Host: I assume it depends on the individual skin cancer you're looking at in terms of how you decide which treatments will work best. What have you seen in terms of outcomes?

Carol Chandler, APRN-BC: Basically, patients do very well. They have a skin cancer, they have some type of a scar there that may be visible. But generally, they are not going to your local cancer center for chemotherapy or other invasive treatments. Fortunately, that is not common with our skin cancers. They do very, very well.

Host: Carol, there's a lot of misinformation out there. What are some of the biggest myths about sun exposure or tanning?

Carol Chandler, APRN-BC: There's a few out there. I think my first one, I hear this and see this all the time, that people tend to think if it's flat, it's a freckle. And if it's raised, it's a mole. Freckles are a totally different animal. They're usually lots of little, tan, irregular spots grouped together where moles are individual spots. And most of our moles are flat. Most of the melanoma skin cancers that I see physically on the surface of the skin, they are flat. So, that's one that I see and hear all the time. They'll say, "Oh, I didn't know that was a mole."

As far as other myths, like with tanning, tanning beds are never a good thing ever. A tan is never, ever a good thing. In my book, there's no such thing as "base tan", which I hear about all the time. So, that ultraviolet light damages your skin and actually damages your DNA and how those cells reproduced. A damaged skin cell always reproduces an identical twin. It reproduces another abnormal skin cell. So, there's no "safe way" to tan. You can develop some color to your skin if you wear a sunscreen, because they do filter the light, they're not blocking it completely. A sun block such as your mineral SPFs like zinc and titanium dioxide, they will block the light, but a screen filters that light. So, that's a "safer" way to develop some color to your skin. But you know, it's not necessarily a means to get a tan in my book.

Host: So, let's turn to protection. What are the best ways to protect your skin on a daily basis?

Carol Chandler, APRN-BC: I definitely recommend that daily SPF on any skin that is exposed because one of the things people don't realize is that ultraviolet A does penetrate window glass. So when we are driving in the car, we are still getting damaging ultraviolet A radiation. Wear your hat. Wear your sunglasses. Seek some shade. Wear some protective clothing. And now, they have a number of options for clothing that have UPF built directly into the fabrics, which are very nice.

Host: Right. I use those a lot. And it's really wonderful to just throw that on and not have to worry. Thank you for this very clear and comprehensive information. Carol, if listeners take away one or two things from this conversation, what do you think they should remember most?

Carol Chandler, APRN-BC: I would like them to remember that the skin is the largest organ of the body, and it is the most exposed. So, we want to do everything that we can to take care of it so that we can love the skin that we're in.

Host: Well, Carol, thank you for this enlightening conversation and for sharing your expertise today.

Carol Chandler, APRN-BC: Thank you so much for having me.

Host: That was Carol Chandler, dermatology nurse practitioner at Tri-State Health. For more information, go to tsh.org/dermatology. If you enjoyed this podcast, please share it on your social channels and explore our entire podcast library for more topics of interest to you. Thanks for listening to Tri-State Health Talk.