Melanie Cole (Host): What are the best ways to protect yourself against skin cancer and what symptoms should lead you to see a doctor. My guest is Dr. Mark Russell, he is board certified dermatologist who specializes in treating skin cancer. Welcome to the show Dr. Russell, tell us what are some of the best ways to protect ourselves from skin cancer.

Dr. Mark Russell (Guest): Well, I think there are three areas that you should focus on prevention, early detection, and effective treatment. Along lines of prevention, sun exposure is the most preventable risk factor for all skin cancers including melanoma and you can prevent your risk by seeking shade whenever appropriate and usually the sun’s rays are strongest around 10:00 am to about 4:00 p.m., so if you are out in the sun at this point in the day then you should try to seek shade whenever possible, wear protective clothing such as a long sleeved shirt, pants, broad brimmed hat and sunglasses whenever possible. The use of sunscreen is also very important and we generally recommend the sun protection factor of 30 or greater as well as a broad spectrum sunscreen and this should be applied evenly and about 20 minutes before going out into the sun and re-apply it about every two hours even on cloudy days and may be more frequently when you are swimming or in the water. You should also use extra caution when you are around water, snow, or sand because you not only get this sun coming from the sky but you can also get reflected ultraviolet radiation coming from below and finally you want to avoid tanning beds because there are ultraviolet radiation rays that come from tanning beds as well which have been shown to increase your risk for not only sunburn, but also skin cancer.

Melanie: Dr. Russell if people were to give themselves a check and to see a dermatologist regularly to get themselves checked out for skin cancer, what would we be looking for? What are some of the signs, you know, that would send us to a doctor? What do they look like?

Dr. Russell: Well, you want to be aware of new growths on the skin. We do have the potential to get spots on our skin. They come especially with aging and the vast majority of these are not cancerous, but new growths that come up that may bleed or the crust or that are painful or tender that don’t heal or they heal and then recur in the same area would warrant further examination by a physician. Spots that may come up that look different than other spots on your skin, those should be checked out. A spot that has a change in sensation or develops sensation such as itchiness, tingling, burning, crawling sensation that could be suspicious, moles that change, that become larger, darker or irregular at the border would be a reason to get checked by a physician.

Melanie: So, what treatment options are available. If you spot something, we go to see you and you say yes this is something that we really need to take a second look at, what is the first thing that you do with patients?

Dr. Russell: Well, the first thing we do is we look over the entire patient to make sure we know what we are dealing with and how many potential spots are suspicious. We would move into doing biopsy if necessary to help confirm our suspicion and to develop the most specific diagnosis of skin cancer that we can get and then we move into a variety of potential treatment options and those will vary depending on things such as the type of skin cancer, the location of skin cancer, what if any previous treatments have been used and the patient’s age. We have fortunately a large number of treatment options including topical medications, various types of surgery, photodynamic therapy, laser treatment, radiation treatment, chemotherapies, and immunotherapies if necessary and really the best treatment plan is developed by a physician or even a team of physicians experienced in dealing with skin cancer.

Melanie: When you do a biopsy and you are checking to see if this is something more serious like melanoma, is there a chance that it’s going to come back right in the same place, do you do a mohs where you are really getting those markers very well, how does a patient kind of assess that this is what you are doing?

Dr. Russell: Well, we start with a biopsy to figure out exactly what the diagnosis is and then we may go further to do a surgical excision or procedure that will definitively remove the remainder of the cancer and it really depends on what type of cancer as to what type of treatment is best and the patient has to confer with the physician to understand exactly what it is the physician is treating and what the endpoint is in terms of removing the cancer. Generally, we try to remove all the cancer, get the margins clear and make sure that there is no cancer remaining and then put the patient into a surveillance routine where they are coming back checking with the physician periodically just to monitor for not only recurrence of the spot that was treated, but also potentially new spots that come up because when a patient has skin cancer, they are at risk for future skin cancers.

Melanie: So, Dr. Russel, you mentioned, you know, skin protection and there are so many sunscreens on the market, its so confusing, what do you want us to know when we are looking for these to protect ourselves from skin cancer, should we be reading the labels?

Dr. Russell: Absolutely, there are some components of a sunscreen that have been designated as being more effective. I would like to think of designation of BW30 when I am deciding on sunscreen, the B stands for broad-spectrum that means it protects not only against the ultraviolet B rays, but also with ultraviolet A rays. You would like to get a sun protection factor, an SPF of 30 or above and you also want it to be a water resistant sunscreen which is a designation that implies that it stays on longer in water when you are either swimming or participating in water sports or even out in the hot weather and sweating. An SPF of less than 15 would not be considered effective at preventing skin cancer or photoaging merely reducing your chance of sunburn, so you would like to look for those three factors, broad-spectrum, water resistant, and an SPF of 30 or above.

Melanie: Do you care if it’s a spray or a cream?

Dr. Russell: As long as is applied uniformly and evenly, both sprays and creams have been found to be effective.

Melanie: Because, you know, I mean for parents especially when they are trying to keep their kids from getting sunburn, those sprays are really one of the better inventions and they get much easier to get the kids as long as you say we get really good coverage and we make sure to put it on pretty thick.

Dr. Russell: Exactly, you just want to make sure that with those sprays, you are not doing it in a windy area because that can make it less effective, but once the spray or the cream or the lotion or whatever the type of sunscreen is put on, as long as it is put on evenly, it should distribute and be protective and it should be put on about 15 minutes before you actually go out into the sun to allow it to stabilize and settle.

Melanie: Dr. Russel, why should patients come to the UVA Cancer Center and please give us your best advice for preventing skin cancer.

Dr. Russell: Well, I think the physicians at the University of Virginia Health System are well-prepared to deal with everything from the relatively simple and uncomplicated cases of skin cancer to the most complex and when the need arises, the team at the University of Virginia can come together to gather their collective wisdom. There are many experts as are needed to develop a comprehensive plan for the patients and there is an outstanding team of physicians in UVA Health System with excellent training and substantial experience dealing with skin cancer. I think its this training and experience that leads the best outcomes for our patients, so in terms of best advice protect yourself, be prudent when out in the sun, try to minimize your ultraviolet exposure both from the sun and from tanning beds, monitor your skin monthly, any changing or suspicious spots on the skin, get those checked out early with the physician because the best chance of effective outcomes or good outcomes are to detect skin cancer early and treat it effectively.

Melanie: Thank you so much Dr. Mark Russell, board certified dermatologist, specializing in treating skin cancer. You are listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks so much for listening.