Search for tag: "skin cancer"

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Interviewer: How mole mapping works and how to determine if you should do it. Dr. Julia Curtis is a board certified dermatologist in the Department of Dermatology at University of Utah Health. Let's start with the very first question. Who do you recommend that gets mole mapping done? Like what patients are better than others to do that?

Dr. Curtis: So, generally, what I tell patients is if they have a lot of moles, they should get mole mapped, or if they even have a lot of funny looking moles to them. They might not have a ton, but at the same time, they still might have enough that they are curious about them and they're hard to track, if they're hard to know if they're new or changing.

Interviewer: Let's talk about the benefits of having this procedure done because there are a lot of them. First and foremost, it can save lives.

Dr. Curtis: Yes, it can. It can save lives in the way that we can find melanoma earlier and thinner when it is the absolute most survivable.

Interviewer: And what are some of the other benefits as well?

Dr. Curtis: So you can catch new moles that could be just benign, not changing, that are not melanoma, which are important to know about. You can also tell if your moles are going away. As you get older some of your moles do go away and it can track that. So it gives you peace of mind. And it can reduce the number of biopsies as well on patients.

Interviewer: So that's a good thing, right? It's a lot better to have a picture taken then actually need to do biopsies . . .

Dr. Curtis: Yes.

Interviewer: . . . and less expensive too I'd imagine.

Dr. Curtis: Exactly.

Interviewer: Yeah, to have that kind of testing done. And I would imagine does it prevent like mistreatment as well?

Dr. Curtis: So it can in the sense that you do meet some patients who've had a dermatologist or primary care take a lot of their moles off and it can prevent that.

Interviewer: When you come in to have the procedure done, how exactly does it work?

Dr. Curtis: So first you meet with me and we go over your moles and talk about mole mapping, and then you go to our room, which is a very private room with one other person, and there is a camera on an automated track, and the camera goes up and down and you just stand in front of it for a front-side side and back and the attendant stands behind a big flash panel. So you feel like there is privacy there.

Interviewer: Yeah, because I would imagine some people are a little . . . first of all, they probably picture somebody with old-school Nikon camera snapping away, right? It's not that at all.

Dr. Curtis: It is not that anymore.

Interviewer: Yeah.

Dr. Curtis: And it is . . . it can be intimidating to stand there naked, but again we . . . you know, we protect patients' modesty. If they feel more comfortable leaving their underwear on, they can do that.

Interviewer: And you try to work around.

Dr. Curtis: And try to work around, exactly.

Interviewer: Yeah, exactly. And how often then, after you get that initial mapping, do you need to remap?

Dr. Curtis: So, generally, we don't remap patients because we don't want a moving baseline. So we want to establish just one baseline going forward in time and so that you don't have to be re-imaged. Occasionally, we may decide that there are so many different moles now or new moles that it would benefit the patient.

Interviewer: All right, and what do we know about mole mapping's effectiveness and its accuracy? Does it really make a difference?

Dr. Curtis: It does. So we've published research showing that it catches melanoma thinner and earlier at a much higher survival rate. For example, melanoma caught early has about a 98%, 99% survival rate of 5 years, whereas if you catch it a little bit later, that rate plummets to 60% at times.

Interviewer: And from a physician's standpoint that's pretty significant.

Dr. Curtis: Very significant.

Interviewer: Very significant but worth the effort.

Dr. Curtis: Definitely worth the effort . . .

Interviewer: And the time.

Dr. Curtis: . . . and the time.

Interviewer: Yeah, and maybe . . .

Dr. Curtis: And some embarrassment, maybe.

Interviewer: Yeah. A little bit embarrassment. Sure, yeah. So is this a procedure that can be done most anywhere, or is it just a select few places?

Dr. Curtis: So it's just a select few places to have this integrated automated system. So we have it at Huntsman and at our Murray location. And I don't know of any other providers in the Salt Lake basin that are doing it.

Interviewer: Got you. And in the region too, if somebody was in a smaller community, they would want to come here and get this . . .

Dr. Curtis: Correct. I have patients come down from Wyoming and Idaho and even Nevada.

Interviewer: And then a great thing about that is they have that map and they can return to their hometown and consult with their own dermatologists at that point. They don't have to keep coming here.

Dr. Curtis: Correct. We give them a password encrypted flash drive so that they can take it to their provider, whether it'd be a dermatologist or their primary care.

Interviewer: Yeah, that's great that's it's password encrypted because I would imagine some people will be a little anxious about having those type of photos available to everybody.

Dr. Curtis: Exactly.

Interviewer: And even as part of the medical record you don't put them in the medical record. But I don't know.

Dr. Curtis: Correct, they're not in the medical record. They're on a separate encrypted drive that only a few people have access to.

Interviewer: Got you. Is there anything else that a patient would want to know about this mole mapping procedure?

Dr. Curtis: It's short, it's painless, and it saves your lives.

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Interviewer: This is actually from several listeners with describing in detail their moles. Some have different colors, some have different shapes, some are in weird places. The basic question is, should I get this checked? What should we be looking for, and when should we go to a dermatologist?

Dr. Smart: That's a great question. I think a lot of people struggle with this because sometimes you'll go into your dermatologist, he'll look at it for two seconds, and say, "Nothing to worry about. What are you doing here?" Or that's how you feel, but you're still doing the right thing.

That's why dermatologists go to medical school, and years of training because sometimes it does take years of training to be able to identify that is nothing to worry about, and this, this one is. But unless you spend that five seconds in front of a dermatologist, you will never know. So any time, you're really noticing a mole or a spot that's growing or changing to the point where you are noticing it, then it's legitimate to have that chat.

Now if it's something that's been present for many, many years of your life, and it's changing very minimally, the chance that, that's something truly concerning is exceedingly low, nevertheless, it can be. So whenever you are noticing something like that, there's never a wrong answer, there's never a time when you should say, "Oh, I shouldn't go to my dermatologist for this because you don't know.

Interviewer: So you're saying if it's growing in size, if it's something that you notice, what about color, place?

Dr. Smart: The very classic things that every dermatologist will tell you this, there's the A, B, C, D, E's of growing and changing lesions. And A is asymmetry, B is border, C is color, D is diameter, and E is evolution. So if any of those things are happening to any given spot, if one side is getting bigger than the other, or its starting to get little projections, so that it's not symmetric, that's concerning. If the border is starting to become funny rather than smooth, then that's a possible issue.

If the color is changing. It used to be tan, used to be just this normal beige, and now all of a sudden now there's a little bit of red, and a little bit of dark brown, well that's an issue too. And then diameter, if it's getting past a certain size, or measurements, so if it's getting big then that's something to change. And evolution is just thrown in there just for a cover-all. If it's changing, then come get it looked at. But I think it's really simple, if something's concerning you, then there's no reason to lose sleep over it. It's easy to come get it checked out.

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Interviewer: Mole crowdsourcing: it's an innovative way to discover and identify melanoma and that's coming up next on the scope.

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Interviewer: You know, it sounds a little gross. Take a picture of what you suspect to be a cancerous mole and then post it to the Internet for others to see, but it turns out that might be a really effective way to screen for melanoma. Jake Jensen is from the Department of Communication at University of Utah and he won a $2.2 million grant, part of the 2015 and NIH New Innovator Grant to look at that. So first of all, is that an accurate way to screen for skin cancers, take a picture and have non-trained people look at it?

Jake: Well, a dermatologist might quibble with the phrasing of that. Whether it's a form of screening or not, we could debate. What it is is it's a really effective way to potentially move people to go to a dermatologist.

Interviewer: So let's talk about the way things are and why that's not necessarily getting the job done and the way that you hope your research points to the way things could be.

Jake: What happens right now? Well, right now, we say to people, "You should engage in monthly skin self-exams where you look at your body and look for strange moles, strange growths. And when you see them, you should make note of them and you should go into a dermatologist for a clinical skin examination." That's our basic game plan.

There are lots of problems with that game plan. The first problem with a game plan is skin self-exam is not very effective. People are very bad at finding odd-looking lesions and moles on their body. And so I spent the better part of a decade doing research on skin self-examination, trying to improve the technique. And study after study, people were horrible at it. No matter what we did, they were horrible. The only consistency in the research was no matter what we did, people were horrible at skin self-examination and that's what other researchers were finding as well.

We were all frustrated in one day, in my frustration, I walked into one of my colleague's offices because he has a wonderful couch in his office. And I flop myself down on his couch and I said, "I'm so tired of skin self-examination research. No matter what I do, it won't work. There is no solution." And we talked about it for a while as I vented and eventually, he said something that forever changed the way I thought about this. He said . . . keep in mind, he's not a health researcher. He's somebody who studies new media so he was a good person to vent to in that he was like, "I don't know what you're talking about, but I know you're angry." And he said, "Well, is it that individuals are bad at skin self-exam or is it that groups are bad?" And I thought, "Individuals are bad so groups are bad. So I don't understand the question."

Interviewer: Yeah. Because if one person's bad, how are 20 of those people any better?

Jake: I said, "I don't understand the question." He goes, "Well, there's this thing called collective effort that says sometimes a group is good at something when an individual is not. You can take a group of individuals who are bad at a task, but as a group, the group somehow can be used and mobilized to be good at a task." And I said, "Okay. Rather than, 'Are individuals good,' here's what I want to ask." I took a rock or a curve. It's a type of statistical analysis. I said, "Is there a rock curve that fits to this data?"

And there was, at the group level. And here's what it looks like, for most moles that people look at, they're not suspicious. Take a photo of any mole on your body or any mole that you encounter. Take any mole imagery and you show it to people, generally, they say, "That looks fine." However, when more than 19% of people say a mole looks suspicious, now we're in a different world. If you use that as a cutoff, you can find 90% of melanomas because there's something there that the group picks up on. Here's why I kept missing it: because when you're thinking about the individual level of ability, you're saying, "Well, I want individuals to find it 90% of the time." But individuals can't do that. Groups can when we use a cutoff and we say, "Well, if it's more than 19% of the group that's concerned, let's use that as an indicator."

Huge implications for that. It doesn't matter whether you train people. In a sense, the best group is a group where you say, "Just tell us whether you think that's a weird image or not. Is that a weird mole? Just yes or no." Sometimes, people would say to me, "Can we have laypeople doing this?" It's risk factor. They're not trained. When it comes to laypeople, I see no evidence that training them makes them better at this intuitive, sort of "Is it weird or not" because I'm only going to look at them on the group level. I'm not going to look at them as individuals. So I just want to know if the herd finds it weird. And the answer is when they do, we kind of find melanoma.

Interviewer: Let's go back to the original problem. The original problem is individuals aren't good at self-screening. So they see a mole and maybe they might not think it's a problem. Is that the problem? Or is the problem that they don't do anything about it?

Jake: Yeah. Well, chicken or the egg in some ways.

Interviewer: I guess what I'm asking is will this solve the problem that you've laid out?

Jake: So here's what we want to do. I want to tell a real quick story because it'll help you to understand where we want to go with this. Imagine there's a farmer and the famer's name is Joe. Joe is out in the field and Joe sees that he has a weird mole on his arm. He comes home that night and he tells his wife, Martha, "Hey, I've got this weird growth on my arm." Martha says, "You need to go in to a dermatologist."

Joe is reluctant to go to the doctor for any reason and Martha knows this. So she rails on him for the rest of the night. But Joe, "Eh, it's harvest." He'll go later. Eighteen months pass by before Joe eventually goes in. By the time he goes in, he has late-stage melanoma. There's very little they can do for it at that point in time. Joe passes away within the next few months.

I'll give you an alternative ending to that story. Everything is the same about the story, except this: when Joe comes in from the field and shows Martha the mole, Martha pulls out her phone. She snaps a photo of the mole. She doesn't even bother arguing with Joe because she knows Joe will not listen. The next morning at breakfast, Martha slides the phone across the table and says, "Ten thousand people have looked at your mole and 47% of them think it looks weird." And that's such a high score that it was flagged in the tele-dermatology system and a dermatologist who does rural rounds, who will be within 40 minutes of us next week, wants to see you at 9:00AM next Tuesday because she's looked at the mole and she is suspicious as well."

Joe goes in next Tuesday. It's pre-cancerous. The dermatologist chops it off. Joe lives. Now, that cell phone system I just described is what we're trying to build.

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Interviewer: What exactly is mole mapping, and what can it do for you? We'll explore that next on The Scope.

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Interviewer: Dr. Doug Grossman is an expert in early diagnosis and treatment of skin cancers at Huntsman Cancer Institute and also head of the Mole Mapping Program. That name intrigues me. What is mole mapping?

Dr. Grossman: This is a unique program that we've offered at the Huntsman Cancer Institute for the past ten years, and essentially it involves taking full-body photographs of your skin. This is for patients who are at high risk for melanoma. Either they've had melanoma, it runs in their family, or they have lots of moles or what we call atypical moles. The most sensitive indicator for early melanoma is a change. The only way we can know that a lesion is changing is if I compare it at two points in time. So patients come in and we get the photographs just once. That serves as a baseline, and then at future visits we can refer to these and confirm that given moles are stable and detect changing moles.

Then we educate patients and family members to use these photographs, and then we provide them to them to use at home. So patients are checking at home and they're also seeing us, and we've detected a lot of melanomas at an early stage. I think equally important, we've avoided a lot of unnecessary biopsies and surgeries because we can confirm spots aren't changing; we don't need to remove them.

Interviewer: Before mole mapping, what did you do?

Dr. Grossman: Well, when I first came here and we didn't have total body photography, I used to take photographs of individual areas of the skin where there were moles, again with the idea being that I'm trying to monitor individual moles. At the same time, we started taking high resolution photographs of individual moles, although about ten years ago we realized that wasn't the best approach.

Our studies have shown that most melanomas in fact don't evolve from moles. They develop in the normal skin. Only about maybe 30% of melanomas will arise from moles. So if you're only checking the moles, you're going to miss a lot of the new melanomas that are arising in the normal skin. So we really needed a total body approach, so we switched to full body photography and we've been doing that ever since.

Interviewer: If somebody took that tool away from you, would you be seriously hindered in what it is you are able to do for your patients, do you think?

Dr. Grossman: I would. Having a photograph gives me a huge advantage when I'm examining a patient. If I don't have a photograph, then really one is just guessing about which mole might be changing or be particularly suspicious.

Interviewer: You said it's a unique program to Huntsman Cancer Institute. Why aren't other places doing it? It seems pretty simple to take a picture of the body.

Dr. Grossman: It is simple, but it's expensive. We have to have someone available to take the pictures who's trained to do that, we have to have the equipment to take the pictures, we have to have the IT support to securely archive all the photographs from thousands of patients, and so it's not something that one could provide in an office space practice and have it be profitable. But through the support from the Cancer Institute, we're able to provide this to patients who come here.

Interviewer: How many lives do you think it has saved?

Dr. Grossman: Well it's hard to answer that question.

Interviewer: Sure.

Dr. Grossman: I do know that we've detected a lot of melanomas that patients were not aware of when they came in, and we were able to tell that from the photography. As I said earlier, also avoiding unnecessary procedures. Hundreds of thousands of lesions we avoided having to biopsy because I was able to confirm from the baseline photograph that there was no change.

Interviewer: Yeah. I think that's one of the big discussions in medicine right now: how do we avoid some of these unnecessary procedures that cost thousands of dollars.

Dr. Grossman: Right.

Interviewer: If somebody's looking for more information on mole mapping, to decide if it's something they're interested in, where can they get that information? We provide some basic information on the Huntsman Cancer Institute's website. If you go to that website and search "mole mapping," you'll find information we've provided.

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updated: May 21, 2019
originally published: September 9, 2014

Interviewer: Suntans. Do they offer protection from skin cancer? We're going to examine that next on The Scope.

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Interviewer: We're with Dr. Doug Grossman. He's an expert in early diagnosis and treatment of skin cancer at Huntsman Cancer Institute. So I need this answer from a professional, from the guy that knows. I've always been under the impression if my skin starts tanning it's the natural response to the sunlight to let less sun in so that actually is giving me more protection. Is that accurate or not?

Dr. Doug Grossman: Well it's true that the suntan is a natural response of the skin trying to protect itself from the damaging UV rays and so actually the UV exposure generates a signal response in cells in the skin that causes more pigment to be made and this ultimately does protect the skin and so if you do have a suntan then you're going to be more resistant to future sun burning.

The problem is that you're also damaging the skin in this process and in fact the sunburn or suntan response is actually an indicator of damage to the DNA. What happens is the UV rays interact with the DNA and initiate this response that signals the cells to make more pigment but it's actually a reflection of that damage that you're incurring. And so even after a few weeks if the sunburn, the tan has resolved, that damage has still been done. And it can accumulate and persist for many years.

Interviewer: So gradually building up my suntan to prevent skin cancer, it could prevent a sunburn.

Dr. Doug Grossman: Right.

Interviewer: But the damage is still happening to the skin that could cause skin cancer. I'm getting no protection from it from what I understand. Is that correct?

Dr. Doug Grossman: Right. That's correct.

Interviewer: So what does that mean?

Dr. Doug Grossman: The tan is going to protect you against some future UV exposure but it would be better to not incur that exposure and damage in the first place.

Interviewer: And also, like wear long sleeves or wear some sort of a sunblock or something of that nature would be much better, right?

Dr. Doug Grossman: Right. Well, I tell patients if they want to have a tan and look tan the safe way to do that is to apply topical products or a spray tan and they can look quite realistic and that's totally safe. Artificial tanning in that way doesn't provide any protection against future exposure but that's the safe way to look tan. We really discourage patients from using tanning booths. We know that tanning booths increases skin cancer risk, it at least doubles melanoma risk and so we definitely discourage that.

Interviewer: I seem to remember at a tanning place one time the guy was telling me, "Oh no, this is okay because the damaging rays aren't in the suntan booth."

Dr. Doug Grossman: Well, generally in the tanning booths they use longer UV wavelengths that are lower energy so it doesn't cause sunburn but does initiate the tanning response and you get delayed tanning.

Interviewer: Which goes right back to what you said earlier is that that's an indication that you're getting cell damage.

Dr. Doug Grossman: Correct.

Interviewer: And that cell damage, so we all love our tan so much let's get into this cell damage a little bit more because I feel as though maybe if people heard what's really going on and how damaging it can be they might, you know, make a different choice. I've heard it described as bullets to the DNA.

Dr. Doug Grossman: There are different ways that UV can damage the skin. The UV can directly interact with the DNA and damage it in that way. This could result in mutations and so that when the cells divide-

Interviewer: Which all cells do. That's what cells do.

Dr. Doug Grossman: That's right. That's right. Particularly in the skin because the skin is always turning over and so you can introduce mutations that way. UV radiation also generates what we refer to as oxidative damage. These are chemical species that are generated in the skin upon UV exposure that damage all parts of the tissues: the proteins, the cell membranes. So there's that type of damage as well.

Interviewer: Somebody might think, "Well, I've damaged my skin. It dies. It sloughs off." But what happens is when that cell divides now you've got these mutations that could lead to skin cancer. Am I making...

Dr. Doug Grossman: Right. And so again the skin does turn over. Many of the cells that are dividing will ultimately die and be shut off. Changes in those cells are not going to result in skin cancer. However, there are what we call skin stem cells that are very long-lived that give rise to the cells that ultimately continue to grow in the skin and you generally don't lose those cells. And so if those cells accumulate this damage and these mutations they can ultimately give rise to skin cancer.

Interviewer: And how bad is skin cancer?

Dr. Doug Grossman: It's a range. It's a spectrum. Many skin cancers if they're detected very early are quite easy to treat and they are very localized in the skin and we can remove those with a small surgical procedure.

Interviewer: And I'd imagine once you start getting that it's going to continue because those cells are damaged.

Dr. Doug Grossman: If you get skin cancer in one location then your risk for getting it in another location increases because you have all these both genetic environmental risk factors that have led to the first skin cancer. We know that patients that have a skin cancer generally about half of them will get another one within the next couple of years.

Interviewer: Yeah.

Dr. Doug Grossman: That's primarily non-melanoma skin cancer. The melanoma skin cancer which is much more serious...

Interviewer: More on the other end of the spectrum.

Dr. Doug Grossman: Because it can spread can be a lot more unpredictable. That can occur in young patients, it can occur without much warning. About a third of melanomas are not related to sun exposure. And so we advocate all patients to monitor their skin on a monthly basis. Anything new or changing should be looked at. But we do know that over two-thirds of melanomas are related to sun exposure.

Interviewer: Any final thoughts on this topic?

Dr. Doug Grossman: I think my main message would be, be aware of your skin. It always surprises me how often we pick up melanomas in patients that had no idea that something was on their back or somewhere else on their skin that just because they weren't monitoring. I recommend again once a month that patients look at their skin, have someone else look at your scalp, look at your back, the areas that you can't monitor well on your own. Anything new or changing or that looks different from other spots on your skin would be something to get checked out.

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Interviewer: All sunscreens are not created equal. There are actually some that are better than others. We're going to find out more about that next on The Scope.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: Dr. Doug Grossman is an expert in early diagnosis and treatment of skin cancer at Huntsman Cancer Institute. All sunscreens are not created equal and I think I'm a little stressed out because I don't think I'm using the right sunscreen. Let's talk about that for a second. From my understanding, there are two different kinds of sunscreens.

Dr. Doug Grossman: There are actually a variety of products. A lot of patients like the sprays because they're easy to apply. The problem is you don't get enough of the material on the skin and so I also worry about if you're spraying a lot and inhaling.

Interviewer: I know. I was at the pool the other day and somebody was spraying and I was getting more in my lungs. My lungs were not sunburned after that.

Dr. Doug Grossman: Right, and some of these that have alcohol could also potentially be flammable, so that could be a risk as well. So I don't like the spray-ons. I do like the lotions that can be applied and as you indicated there are two basic types. The first are the mineral containing products that have either zinc oxide or titanium dioxide and these work as a physical UV blocker. The UV rays just bounce of these minerals and they stay on the skin, so they're very long lasting.

Interviewer: So kind of like a mirror?

Dr. Doug Grossman: Yeah and they block the entire UV spectrum. The other class of products which tend to be more popular because they tend to be less expensive and not leave as much of a white-ish residue on the skin are the chemical sunscreens and these work by absorbing the highest energy UV rays, so they prevent sunburn but some of the lower energy rays still get through and cause damage and they work again by absorbing so one they get saturated, then they loose their effectiveness, so they wear off very quickly, so you have to keep reapplying them.

Interviewer: So that's why you have to keep reapplying? So it's like if I tried to mix a lot of salt into water, eventually it can't absorb anymore. Is that kind of like the same thing?

Dr. Doug Grossman: Yeah.

Interviewer: Interesting. So if I don't know what kind of sunscreen I have, likely I have the chemical kind.

Dr. Doug Grossman: Yeah, most products in stores are the chemical base. There are a few products that contain the minerals that I recommend. My favorite product is Blue Lizard, it contain 15% zinc and titanium dioxide. I think that has the highest concentration of any product that I've found. It's made in Australia where they have the highest rates of skin cancer and it goes on a little white, but then it turns clear and I find that to be the most effective. There are several other products, Vanicream that has these sun blockers as well. And I know this from personal experience, these are the products that I use and I don't have any financial interests in these products?

Interviewer: You don't have stock, huh?

Dr. Doug Grossman: Correct.

Interviewer: I find that fascinating that the Blue Lizard that you talked about is from Australia where they have the highest incidences of skin cancer, so obviously they know what they're doing I guess.

Dr. Doug Grossman: I think so.

Interviewer: Yeah, so the other advantage to this from what I understand is you don't have to apply it as much either. It's like once on and you're good.

Dr. Doug Grossman: Right. Unless you're perspiring a lot and the skins getting wet and you're toweling it off, it stays on the skin and so you don't have to apply it nearly as often as the chemical based products.

Interviewer: So at the end of the day, these mineral based products may be a little bit more expensive, but you think they're well worth it.

Dr. Doug Grossman: Right, they definitely are more expensive, but you get what you pay for.

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Interviewer: How dangerous is skin cancer, really? We'll examine that next on The Scope.

Man: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Let's face it, we all love the feeling of the sun on our skin and maybe even a little bit of a golden tan, but then we hear things like skin cancer and you should wear long sleeves and big hats. We're with Dr. Glen Bowen at Huntsman Cancer Institute. How do I balance that kind of desire to want to be out in the sun and yet the desire to do what guys like you tell me I should do?

Dr. Glen Bowen: Well, the first thing I would say is somebody dies every hour in the U.S. from skin cancer. It is an epidemic problem, so you can't really minimize that fact, not to mention the fact that there are people every day that come to the Huntsman Cancer Institute. I'm removing either part of their nose or most of their nose or eyelids or lips or ears. It's very devastating for people. Almost all of them, not all of them, but almost all of them are avoidable.

Interviewer: Yeah.

Dr. Glen Bowen: So, yeah, the sun's okay, but, you know, people just aren't really exposing themselves to the sun in what I would say moderation.

Interviewer: Okay. So it's just a matter of people are trying to get too much, laying out there for hours on end or going into the swimming pool without any protection. Bad idea.

Dr. Glen Bowen: That's right. And a really, really bad idea are peeling sunburns. There's no question that peeling sunburns have a very big impact on our risk for skin cancer. The interesting thing about swimsuits is that they used to cover the torso. If you look at photographs of Saltair, the swimsuits for both men and women covered the torso. Well, most melanoma occurs on the torso.
So when the swimsuit style changed, there was an incremental jump in melanoma incidence because they tend to occur in areas where we get peeling sunburns, which is usually the torso. They're spring break cancers.

Interviewer: And it's really young people that really need to be the most careful, right?

Dr. Glen Bowen: Yeah. So it's thought that about 80% of the sun damage to our skin that causes skin cancer probably happened before we graduated from high school. And it doesn't mean that the sun after high school doesn't matter. It just means that most of the switches that were flipped to cause cancer happened when we were young. So it's critically important that young people try to avoid peeling sunburns.

Interviewer: Yeah. Tell me about the genetics of skin, because what the sun does is it actually genetically alters a cell, and these peeling skin cancers are some of the worst at doing that.

Dr. Glen Bowen: That's right. You could think in a way of the ionizing radiation from the sun like bullets from a machine gun. I mean they literally are. They pass through the skin, and they poke holes in the DNA. The DNA has a beautiful spellchecker like our word processors that can kind of correct for the mistakes, but the problem is you can simply overwhelm it, and that's exactly what happens particularly in light-skinned people, Caucasians. With chronic sun exposure, the spellchecker simply can't correct the mistakes in the DNA as fast as the mistakes are being made, and the result is skin cancer.

Interviewer: So tell me how do I balance then this desire to want to be out in the sun and maybe get a little color to my skin in the summertime versus the dangers of melanoma.

Dr. Glen Bowen: So what is it? Well, people don't dress like they used to, and if you want to do an interesting experiment, just look at the photograph of the Golden Spike when it was pounded in, and you look at the people in that photograph. They all have long-sleeved shirts. They all have trousers, and they all have hats. And that's how people used to dress.
Of course, the style of the swimsuit as it went from one piece to two piece, there's a very direct correlation of increased melanoma rates. So the trick is to go ahead and enjoy yourself outdoors but dress the part. You know, wear clothes. It's not a good idea to go trouncing around in a speedo with nothing else.

Interviewer: For a lot of reasons.

Dr. Glen Bowen: Yeah, it's a great idea to wear a hat, especially a hat with a brim. I remove a lot of portions of men's ears because we don't have hair that covers our ears. So hats with a brim on the side. A baseball cap won't help you in that regard, but a hat with a brim is hugely helpful, and, of course, sunscreen.

Interviewer: So what type of sunscreen should I be wearing?

Dr. Glen Bowen: Well, sunscreen, in general, if you get to a sun protection factor, SPF, 30 or higher, the incremental gains from a higher SPF are pretty small.

Interviewer: Okay.

Dr. Glen Bowen: But there's a huge difference between a 15 and a 30. So, in general, you want to be wearing something 30 or higher. The other problem with a sunscreen is people kind of see it as the seatbelt. It's not. It's the airbag.

Interviewer: Okay.

Dr. Glen Bowen: So clothing is really your seatbelt.

Interviewer: Okay.

Dr. Glen Bowen: But sunscreen in addition to that is very effective. It has to be reapplied, and that's another problem. People tend to put it on once. But golfing, for example, you need to apply it before the first nine, and then you want to reapply it after the first nine because after about two hours, the particles are pretty much dissipated on the skin and it's dilute enough where it's not working very well.

Interviewer: And that's very effective in preventing melanoma, is that correct?

Dr. Glen Bowen: Yeah, it's thought to be.

Interviewer: Okay.

Dr. Glen Bowen: The science is really difficult to do in that case, but we just think that it'd be like a filter on a cigarette, you know . . .

Interviewer: Sure.

Dr. Glen Bowen: . . . the more you filter out the tar and nicotine, the less likely you're going to get lung cancer, and the same with ultraviolet light. The less that gets through to the DNA within your skin cells, the less likely you are to get skin cancer.

Interviewer: Prevention's also important, meaning like to examine yourself. What would I be looking for?

Dr. Glen Bowen: Yeah, that's a great question, and the answer is you look for exactly two things. One is a sore that doesn't heal. So most of the skin cancer is not melanoma. It's called a basal cell carcinoma or a squamous cell carcinoma. Most people, especially young people, they will dismiss it as a zit.

Interviewer: Really?

Dr. Glen Bowen: So it's a little blemish on the skin that does not go away after about a month.

Interviewer: Okay.

Dr. Glen Bowen: So I just had three patients this morning that I operated on. They said, yeah, it was a sore that wouldn't heal. So little sores on the skin, especially the face, that don't heal after about a month, they could be a skin cancer.

Interviewer: Okay.

Dr. Glen Bowen: Sometimes they'll heal temporarily and then they'll break down again like a rollercoaster. So if a sore seems to get better but then it breaks down again, gets better, breaks down again, that's another warning sign that it might be skin cancer. The melanoma is almost always from a mole, and it's simply going to be an ugly duckling. So if you look at the moles on your skin and there's one that just stands out from the others, it's the ugly duckling, it's the black sheep, it doesn't look like the other ones, that's the one to be concerned about.

Interviewer: How important is early diagnosis? How big of a difference does it make?

Dr. Glen Bowen: It's everything. I mean, it's everything. Just to give you an example, I had a patient today with a melanoma that was what we call in situ, which means it's very superficial. Their survival is predicted to be close to 100%. Whereas another patient with one that, say, is down to the fat, they have less than 50% chance of surviving their cancer.

Interviewer: Wow.

Dr. Glen Bowen: So it's like Charles Dickens-it's the best of times and the worst of times. If it's caught early, it's one of the best cancers to have. If it's caught late, if not the worst cancer, it's certainly one of the worst cancers to have just because there are very few good treatments for melanoma that has got into the internal organs.

Interviewer: So it can spread to other organs?

Dr. Glen Bowen: Melanoma is a terrific hitchhiker. It's incredibly good at getting into the bloodstream or the lymph vessels and traveling to internal organs. A lot of cancers, they don't do well out of their neighborhood. Melanoma does exceedingly well. It can set up shop anywhere it wants to-bone, brain, liver, lungs, small bowel. I've seen it in every organ in the body. It's kind of amazing that way.

Interviewer: And once that happens . . .

Dr. Glen Bowen: It's very tough to treat. I mean, we do have some newer treatments at the Huntsman Cancer Institute that are very promising, but you just don't want to be one of those patients on experimental therapy.

Interviewer: Sure. And why go that way, because it sounds like this is a totally preventable cancer.

Dr. Glen Bowen: Well, you know, there are cancers out there, pancreatic cancer, for example. There are these terrible cancers out there that there's not much you can do. It's a little bit of the lottery. Most skin cancer is very easily preventable. That's the tragedy of it, but it's also the good thing about it. You could easily prevent most of the skin cancers that I operate on every day at the Huntsman Cancer Institute.

Interviewer: Is there a takeaway message that you would have our listeners leave with?

Dr. Glen Bowen: I would say for the parents, concentrate on your kids because it makes a huge difference. Those peeling burns we got as children, they make a huge difference for when we're adults and getting skin cancer.
Get a rash guard, you know, those little swimsuits that are spandex or Lycra that they just wear as a T-shirt. It'll protect their skin. It's got a tight weave. They're comfortable. They dry quickly.
So I would say, you know, just be careful to avoid those sunburns. And then it's a good idea for any person to just look at their birthday suit the first day of each month and make sure that there's not an ugly duckling or a nonhealing sore.

Man: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio.