City of hope is a leader in the diagnosis and treatment of skin cancers and precancerous conditions.. Our multidisciplinary team of health care professionals take an integrated approach to treating this disease by combining the latest research findings with outstanding patient care.
Do you know the warning signs of skin cancer?
If we are using more sunscreen as a nation, why are skin cancers on the rise?
What are some of the risk factors? Who is most at risk? Is there anything more we can do to protect ourselves from skin cancer?
As one of a handful of institutes to attain the elite designation of Comprehensive Cancer Center by the National Cancer Institute, City of Hope is acknowledged as a leader in research and treatment of skin cancer.
Joining the show is Hans Schoellhammer, M.D. Surgical Oncologist at City of Hope, to help you avoid skin cancer and learn the facts.
Selected Podcast
What You Need To Know About Melanoma & Other Skin Cancers
Featured Speaker:
During his residency, Dr. Schoellhammer became a post-doctoral research fellow in the Department of Melanoma Research at the John Wayne Cancer Institute in Santa Monica, CA, and then returned to Harbor-UCLA as a senior resident in general surgery. He was then appointed chief resident in general surgery in 2011. In 2012, he began a surgical oncology fellowship at the City of Hope, and has recently been appointed on the faculty as an assistant clinical professor of surgery at City of Hope's Antelope Valley community practice.
Hans Schoellhammer, MD
Hans Francis Schoellhammer, M.D. earned his bachelor’s degree in Molecular and Cell Biology with an emphasis in Immunology from the University of California at Berkeley and subsequently attended medical school at Drexel University College of Medicine, Philadelphia, PA. He did his internship in general surgery at Harbor-UCLA Medical Center in Torrance, CA where he received the Intern of the Year Award from the Department of Surgery. In 2005, he began his residency at the same institution.During his residency, Dr. Schoellhammer became a post-doctoral research fellow in the Department of Melanoma Research at the John Wayne Cancer Institute in Santa Monica, CA, and then returned to Harbor-UCLA as a senior resident in general surgery. He was then appointed chief resident in general surgery in 2011. In 2012, he began a surgical oncology fellowship at the City of Hope, and has recently been appointed on the faculty as an assistant clinical professor of surgery at City of Hope's Antelope Valley community practice.
Transcription:
What You Need To Know About Melanoma & Other Skin Cancers
Melanie Cole (Host): City of Hope is a leader in the diagnosis and treatment of skin cancers and precancerous conditions. The multidisciplinary team of healthcare professionals take an integrated approach to treating this disease by combining the latest research findings with outstanding patient care. My guest today is Dr. Hans Schoellhammer. He’s a surgical oncologist at City of Hope. Welcome to the show, Dr. Schoellhammer. What are some of the warning signs of skin cancer? Would we know? Do we look all over our bodies every year? How would we know?
Dr. Hans Schoellhammer (Guest): Well, there are some warning signs, yes, definitely. But not every small mole or pigmented dark lesion is worrisome. Specifically for melanoma, I talk to my patients about the ABCDEs of melanoma, which is a useful mnemonic for people to know about the warning signs of what to look for. A meaning asymmetry, so any mole that’s looking asymmetric on the skin. B for borders that look ragged or rough, borders of the mole that don’t look smooth. C for color, colors that are different or strange, even a mole that looks like it has red or blue pigment in it. D for the diameter. Usually I say that something that is larger than the eraser of a pencil is worrisome. E for things that are evolving. Any mole that is changing or has any of the other characteristics, those would be things to watch out for. Those would be things that then I think need attention and should be biopsied.
Melanie: Dr. Schoellhammer, is skin cancer becoming more common, or are we becoming more aware of UVA, UVB, and its effect on our skin?
Dr. Schoellhammer: I think the answer to both questions, unfortunately, is yes. Specifically for melanoma, the rate of melanoma continues to go up actually pretty dramatically. Even for a period from 2002 to 2006, the rate of melanoma for men went up 33 percent. I think in general, people are becoming more cognizant of the effects of UVA, UVB. But that being said, there still is quite a bit of tanning beds used out there, and the World Health Organization actually categorizes tanning beds as carcinogens. So I think the message isn’t completely out there.
Melanie: Are there certain people that are more predisposed to skin cancers—lighter-skinned, red-haired people? Are dark-skinned people still at risk?
Dr. Schoellhammer: The answer is yes, definitely, there is sort of a skin type that is more at risk. And actually, what you mentioned is absolutely true. People with lighter hair or red hair, people with fair skin who sunburn easily or sunburn instead of tanning, definitely those people are at risk. People with darker skin also are at risk. And in fact, melanoma can occur in any ethnic group and also on parts of the body that did not receive substantial sun exposure. And in fact, Bob Marley passed away much too early, in his thirties, from melanoma. It can affect anyone.
Melanie: That’s fascinating. I didn’t know that. Tell us what we can do to protect ourselves from skin cancer, and then we’ll get into some of the treatments of the more serious types.
Dr. Schoellhammer: Sure. Even though sun exposure and solar damage is only part of the story in terms of risk factors for melanoma, definitely part of protection involves being very smart about sun exposure. For my melanoma patients, I recommend daily use of a sunscreen, at least SPF 30. I just recommend to find a brand that you like. Some of them are essentially sort of similar, but at least SPF 30. As much as possible wearing long sleeves and long pants when being out in the sun for a prolonged period of time. Unfortunately, that can get a little hot here in Southern California, but trying to literally protect your skin from the skin. And then also just use of a hat with a brim that goes all the way around, sticks out at least three inches all around. These are some of the things that you can do to protect yourself. Also, the use of tanning beds definitely is a huge no-no, and I could never recommend for anyone to take part in that.
Melanie: If somebody has one of these moles with the ABCDE moniker and they notice something changing, they get in to see somebody, they come to see you, you determine that this is a skin cancer, what are some of the treatments? And start with some of the easier treatments right off the bat. And what do you do for them, and then does it have a high risk of coming back?
Dr. Schoellhammer: Sure, I think the first step is when there’s a suspicious pigmented lesion, optimally, it should be biopsied. There’s many ways of biopsying it. You can do a punch biopsy, where you sort of -- like using a hole punch. You take a full-thickness punch of the skin. You can even do a shave biopsy, where dermatologists will shave part of it. And that gives the pathologist something to look at underneath the microscope to make a diagnosis. An important part of melanoma is how deep it is growing into the skin, and that sort of determines the next steps in how it should be treated surgically. Various skin early melanomas can just be treated simply with surgery to take them out with a wide margin of normal skin around them. More advanced or deeper melanomas have a risk of even going to lymph nodes that are near that part of the body. Further surgery then is needed not only to take out the area where the melanoma was but to check the lymph nodes that are closest to it to see if those melanoma cells have moved.
Melanie: What about scarring? Do patients ask you about that and the whole vanity thing of whether or not this is going to affect their self-esteem or their looks?
Dr. Schoellhammer: No. Absolutely I think anything anytime that is on the skin, that’s of paramount concern. Definitely, scarring and the effects of surgery is pretty chief in the minds of patients. Actually, widely taking out a melanoma, the optimal treatment can potentially leave a relatively large incision, one that is even centimeters long. I think while the cosmetic concerns, definitely I try to be very sensitive to them, that is also balanced with appropriately treating the cancer. And certainly melanoma actually is a skin cancer that can be very deadly. It comes from minority of the skin cancers that are diagnosed here in the US every year, but it is the one that causes the most stats. And in fact, about 10,000 people every year here just in the United States die from melanoma. So definitely, balancing the cosmetic effects versus taking out the cancer. That being said, on certain types of the body that are cosmetically sensitive, like the hands, feet, face, incisions can be smaller, and there are also a number of techniques that can be used to ultimately make the incision smaller and to improve the cosmetic outcome. So it is a balance in treating what is potentially a very deadly cancer.
Melanie: Dr. Schoellhammer, in just the last few minutes, if you would, please give the listeners your best advice on performing regular skin self-exams, how to do it, and why they should come to City of Hope for their skin care.
Dr. Schoellhammer: Well, that is exactly right. I think being very cognizant of your skin is very important in taking an active part in one’s health care. As I said earlier, every tiny little pigmented black nevus is not melanoma. But at least once a week, once every two weeks, or at the very minimum, once a month, one should attempt to look at all of their skin and look for any of these ABCDEs, things that are changing. If ever a diagnosis of melanoma or any other skin cancers is made, people, in my personal opinion, receive the best care when they are in a multidisciplinary cancer center setting, where there is the input of surgeons, medical oncologists, potentially even radiation doctors. And that is exactly the setting that we have here at City of Hope, where we treat cancer in a multidisciplinary way with the latest techniques and also medications for more advanced melanomas. I think that’s a perfect reason, in my opinion, for people to come to City of Hope for their cancer care.
Melanie: Thank you so much. It’s great information. You’re listening to City of Hope Radio. For more information, you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening.
What You Need To Know About Melanoma & Other Skin Cancers
Melanie Cole (Host): City of Hope is a leader in the diagnosis and treatment of skin cancers and precancerous conditions. The multidisciplinary team of healthcare professionals take an integrated approach to treating this disease by combining the latest research findings with outstanding patient care. My guest today is Dr. Hans Schoellhammer. He’s a surgical oncologist at City of Hope. Welcome to the show, Dr. Schoellhammer. What are some of the warning signs of skin cancer? Would we know? Do we look all over our bodies every year? How would we know?
Dr. Hans Schoellhammer (Guest): Well, there are some warning signs, yes, definitely. But not every small mole or pigmented dark lesion is worrisome. Specifically for melanoma, I talk to my patients about the ABCDEs of melanoma, which is a useful mnemonic for people to know about the warning signs of what to look for. A meaning asymmetry, so any mole that’s looking asymmetric on the skin. B for borders that look ragged or rough, borders of the mole that don’t look smooth. C for color, colors that are different or strange, even a mole that looks like it has red or blue pigment in it. D for the diameter. Usually I say that something that is larger than the eraser of a pencil is worrisome. E for things that are evolving. Any mole that is changing or has any of the other characteristics, those would be things to watch out for. Those would be things that then I think need attention and should be biopsied.
Melanie: Dr. Schoellhammer, is skin cancer becoming more common, or are we becoming more aware of UVA, UVB, and its effect on our skin?
Dr. Schoellhammer: I think the answer to both questions, unfortunately, is yes. Specifically for melanoma, the rate of melanoma continues to go up actually pretty dramatically. Even for a period from 2002 to 2006, the rate of melanoma for men went up 33 percent. I think in general, people are becoming more cognizant of the effects of UVA, UVB. But that being said, there still is quite a bit of tanning beds used out there, and the World Health Organization actually categorizes tanning beds as carcinogens. So I think the message isn’t completely out there.
Melanie: Are there certain people that are more predisposed to skin cancers—lighter-skinned, red-haired people? Are dark-skinned people still at risk?
Dr. Schoellhammer: The answer is yes, definitely, there is sort of a skin type that is more at risk. And actually, what you mentioned is absolutely true. People with lighter hair or red hair, people with fair skin who sunburn easily or sunburn instead of tanning, definitely those people are at risk. People with darker skin also are at risk. And in fact, melanoma can occur in any ethnic group and also on parts of the body that did not receive substantial sun exposure. And in fact, Bob Marley passed away much too early, in his thirties, from melanoma. It can affect anyone.
Melanie: That’s fascinating. I didn’t know that. Tell us what we can do to protect ourselves from skin cancer, and then we’ll get into some of the treatments of the more serious types.
Dr. Schoellhammer: Sure. Even though sun exposure and solar damage is only part of the story in terms of risk factors for melanoma, definitely part of protection involves being very smart about sun exposure. For my melanoma patients, I recommend daily use of a sunscreen, at least SPF 30. I just recommend to find a brand that you like. Some of them are essentially sort of similar, but at least SPF 30. As much as possible wearing long sleeves and long pants when being out in the sun for a prolonged period of time. Unfortunately, that can get a little hot here in Southern California, but trying to literally protect your skin from the skin. And then also just use of a hat with a brim that goes all the way around, sticks out at least three inches all around. These are some of the things that you can do to protect yourself. Also, the use of tanning beds definitely is a huge no-no, and I could never recommend for anyone to take part in that.
Melanie: If somebody has one of these moles with the ABCDE moniker and they notice something changing, they get in to see somebody, they come to see you, you determine that this is a skin cancer, what are some of the treatments? And start with some of the easier treatments right off the bat. And what do you do for them, and then does it have a high risk of coming back?
Dr. Schoellhammer: Sure, I think the first step is when there’s a suspicious pigmented lesion, optimally, it should be biopsied. There’s many ways of biopsying it. You can do a punch biopsy, where you sort of -- like using a hole punch. You take a full-thickness punch of the skin. You can even do a shave biopsy, where dermatologists will shave part of it. And that gives the pathologist something to look at underneath the microscope to make a diagnosis. An important part of melanoma is how deep it is growing into the skin, and that sort of determines the next steps in how it should be treated surgically. Various skin early melanomas can just be treated simply with surgery to take them out with a wide margin of normal skin around them. More advanced or deeper melanomas have a risk of even going to lymph nodes that are near that part of the body. Further surgery then is needed not only to take out the area where the melanoma was but to check the lymph nodes that are closest to it to see if those melanoma cells have moved.
Melanie: What about scarring? Do patients ask you about that and the whole vanity thing of whether or not this is going to affect their self-esteem or their looks?
Dr. Schoellhammer: No. Absolutely I think anything anytime that is on the skin, that’s of paramount concern. Definitely, scarring and the effects of surgery is pretty chief in the minds of patients. Actually, widely taking out a melanoma, the optimal treatment can potentially leave a relatively large incision, one that is even centimeters long. I think while the cosmetic concerns, definitely I try to be very sensitive to them, that is also balanced with appropriately treating the cancer. And certainly melanoma actually is a skin cancer that can be very deadly. It comes from minority of the skin cancers that are diagnosed here in the US every year, but it is the one that causes the most stats. And in fact, about 10,000 people every year here just in the United States die from melanoma. So definitely, balancing the cosmetic effects versus taking out the cancer. That being said, on certain types of the body that are cosmetically sensitive, like the hands, feet, face, incisions can be smaller, and there are also a number of techniques that can be used to ultimately make the incision smaller and to improve the cosmetic outcome. So it is a balance in treating what is potentially a very deadly cancer.
Melanie: Dr. Schoellhammer, in just the last few minutes, if you would, please give the listeners your best advice on performing regular skin self-exams, how to do it, and why they should come to City of Hope for their skin care.
Dr. Schoellhammer: Well, that is exactly right. I think being very cognizant of your skin is very important in taking an active part in one’s health care. As I said earlier, every tiny little pigmented black nevus is not melanoma. But at least once a week, once every two weeks, or at the very minimum, once a month, one should attempt to look at all of their skin and look for any of these ABCDEs, things that are changing. If ever a diagnosis of melanoma or any other skin cancers is made, people, in my personal opinion, receive the best care when they are in a multidisciplinary cancer center setting, where there is the input of surgeons, medical oncologists, potentially even radiation doctors. And that is exactly the setting that we have here at City of Hope, where we treat cancer in a multidisciplinary way with the latest techniques and also medications for more advanced melanomas. I think that’s a perfect reason, in my opinion, for people to come to City of Hope for their cancer care.
Melanie: Thank you so much. It’s great information. You’re listening to City of Hope Radio. For more information, you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening.