Could It Be Skin Cancer? A Q & A with Dr. Michael Tomeo
Skin cancer is the most common form of cancer in the US with more than 3.5 million skin cancers in more than two million people diagnosed annually, according to the Skin Cancer Foundation. Additional stats on the site indicate that one in five people will develop skin cancer in their lifetime. As for indoor tanning, just one indoor tanning session increases users’ chances of developing melanoma by 20 percent, and each additional session during the same year boosts the risk almost another two percent. As Memorial Day, the official start of summer, draws near, protect your skin with this information from Dermatologist Michael A. Tomeo, M.D.
EverBeautiful.com: As you know, May is Skin Cancer Awareness Month, but this topic is pertinent all year round. So let’s start with indoor tanning. There’s still so much controversy about putting down a base tan. Is a base tan safe?
Dr. Michael Tomeo: There’s no such thing as a safe tan. When your skin is exposed to ultraviolet radiation, whether from the sun or a tanning bed, the UV light triggers a defense mechanism which increases the dispersion of melanin in the skin, or what we call a tan.
EB: Is a tanning bed less harmful than the sun?
MT: The tanning industry would have you think that developing a tan from a tanning bed is a healthier way to achieve that result. However, a tanning booth still exposes you to UV radiation and only provides a protection level of 4, which is so low that you could easily burn when you’re exposed to the sun. People who use tanning beds often don’t use sun protection while they are tanning. The difference between a tanning bed and the sun is that, in a tanning salon, they can control the amount of radiation. When you go to the beach, it’s as if you’re in an unregulated tanning bed. Regardless of the technique, the sensible approach is limited UV exposure and the use of appropriate sunscreen.
EB: What about if you use sun protection?
MT: SPF, sun protection factor, actually designates the amount of time you can be exposed to UV radiation. If it takes five minutes to develop redness from the sun without protection, then applying a #15 sunscreen would take 75 minutes to develop redness. If you think about it, sitting in a tanning booth or the sun is no different than cooking a chicken in an oven. If you’re exposed to radiation too long, you will burn, regardless of the level of sun protection.
EB: So basically, a tan is really a sunburn?
MT: A suntan is a response to UV radiation. If it’s too much, you’ll get a sunburn. Here’s the danger: There’s a fine line between getting a browning effect, like you do cooking meat versus getting a burning effect if that meat is cooked too long – but we don’t always know where that happy medium is. The radiation from tanning beds is primarily composed of UVA light, which is a slightly longer wavelength of light but that wavelength actually will not only contribute to the development of skin cancer long term but also causes premature aging of the skin. Sun rays that reach the skin are composed primarily of UVA and UVB rays. These rays in combination are even more damaging.
EB: I’ve read that the FDA is regulating indoor tanning to prevent minors from using tanning beds because it’s known that tanning in teens increases the chances of developing skin cancer later in life.
MT: Not only is the FDA involved, but more and more state governments are looking to regulate indoor tanning. The FDA Advisory Board recommended that teens should be barred from tanning salons or at the very least will need to get parental consent. However, it appears that what’s probably going to happen is that the FDA is going to just slap warning labels on the sun lamps themselves. The states have been a little bit more proactive. Some states have actually passed legislation to restrict the use of tanning beds by adolescents. Currently, California and Vermont ban the use of tanning beds for anyone under 18 years of age and many other states have enacted restrictive laws as well. Local governments are also legislating indoor tanning.
EB: What about the sun? Many of us are knowledgable about tanning beds but how can we protect against the sun?
MT: Sun safety is critical. A lot of women use SPF in their moisturizers or foundations as part of their daily routine. But, if you’re going to be outside in the sun for an extended period of time, you need to step that up a bit and use sunscreen. The sunscreen number is critical and dermatologists now recommend using an SPF of 30 or above. However, keep in mind that the very high numbers are not necessary as they only provide a 1 percent gain. The most important thing, once you choose your number, is apply, reapply and keep reapplying. Because if you don’t use sunscreen, water activities and sweat will remove that protection very quickly.
EB: How much sunscreen should you use?
MT: You only need a thin layer but you need to cover all exposed areas. There are now more products that are application friendly such as sprays, lotions, gels and sticks. Also keep in mind that the newer sunscreens are broad spectrum, covering UVA and UVB rays.
EB: What’s the difference between the two?
MT: Most sunscreens were very good at protecting us from UVB rays. UVB is the one that really gives you a tan and does a lot of damage. However, UVA also causes sun damage and aging of the skin. When we talk about skin cancer rays we talk about UVB usually. However, it’s becoming increasingly more evident that UVA can contribute to the development of skin cancer. The sun produces three bands of UV radiation – UVA, UVB and UVC. UVC, if we were actually exposed to it, is really toxic. But the ozone filters most UV radiation, particularly UVC. But, even still, we are exposed primarily to UVA and UVB. And those bands of UV radiation have their own negative effects.
EB: Uh oh. The ozone layer filters out essentially all UVC rays and many UVA and UVB rays – but we’re destroying the ozone layer! So let’s talk about skin cancer because it’s becoming increasingly more prevalent.
MT: Ok. Well, the big three are basal, squamous and melanoma. That trio comprises the majority of skin cancers. Melanoma is, of course, the most deadly or lethal form of skin cancer. Squamous cell carcinoma is more intermediate and basal cell is the most common and typically the most easily treated.
EB: What makes melanoma so deadly?
MT: Melanoma has the particular quality of being able to metastasize as a small lesion [or spread to internal organs]. Squamous cells can metastasize too but usually only do so after the tumor has reached a considerable size. However with melanoma, the tumor can spread in a much thinner state and it does so quickly and at a very microscopic level.
EB: Let’s say I find something funky on my skin. How can one distinguish between the different types of skin cancers?
MT: Melanoma is usually a very dark freckle or a slightly elevated skin lesion that may have different colorations within it (what dermatologists term variegated). Melanoma lesions can appear anywhere on the body because melanoma is not as linked to chronic sun exposure as are most of the other skin cancers. What’s more important when we talk melanoma risk is heredity, skin coloration, history of sunburns and immunosuppression. The typical, blue eyed, red haired individual is most at risk. There is something called “the flag sign” for melanoma – when a particular lesion has the colors of the flag. Always look for the ugly duckling mole – which is a mole that looks totally different and you kind of know that something is not right. The longer you let these things sit, the better chance there is of them becoming lethal. Early detection and treatment are key.
EB: What about the other types of skin cancer?
MT: Squamous cell carcinoma is also a potentially lethal skin cancer. However, in most cases it’s detected, treated and cured. Squamous cell carcinoma, out of the three, is probably the one most linked to direct and chronic sun exposure. The precursor lesion is a red, scaly flat patch referred to as actinic or solar keratosis. And that is why, typically, we see squamous cell carcinoma in sun exposed areas. Squamous cell carcinoma typically develops as a red, scaly, hard bump. The most common type of skin cancer is basal cell carcinoma which makes up approximately 80% of all skin cancers. Although it is induced by chronic UV radiation, it also has a hereditary component. Most basal cells are on the head and neck areas, but in 20 percent of cases they can be on the arms, hands, legs and feet. They typically can appear as red or pearly bumps that can develop into sores. It’s important to note that any skin lesion that appears suspicious and is growing could be a skin cancer.
EB: When is it time to see a dermatologist?
MT: The time to see a dermatologist, number one, is when you see any lesion that is new, growing or bleeding spontaneously. While this is not always indicative of skin cancer, you still want to see an expert to see whether that lesion should be treated or, If indeed you do have a skin cancer, the key is early detection and complete removal. If you catch it early, your chances of cure are very, very high. The thickness and size of the lesion are the most important factors in determining prognosis or chance of cure. With melanoma, we’re talking fractions of millimeters. If you have a strong family history, you should be checked by a dermatologist on a routine basis. If you have a personal history, you should also be checked regularly.
EB: What happens during the examination?
MT: The first thing is to take a history to determine whether any new moles have presented. You may not even know that something has changed, but the dermatologist will notice anything that appears unusual. The next step is for the dermatologist to examine you fully. If you’re modest, you have the right to restrict the amount of examination that you have but keep in mind that you could potentially miss a problematic mole or lesion because melanoma can occur anywhere. However, most melanomas tend to occur on the trunk or extremities. Some dermatologists choose to map moles. However, in my practice, I examine the skin surface and look for any moles that look abnormal and it’s my preference to remove those particular lesions or to follow them very closely. I think that skin mapping is important for those few individuals who have many atypical moles and/or a strong family or personal history of melanoma. My premise is that, if I see an abnormal mole, I suggest removing it. When in doubt, cut it out.
About Dr. Michael A. Tomeo
Michael A. Tomeo, MD is a Fellow of the American Academy of Dermatology (FAAD). He is the former Chief of Dermatology at Holy Redeemer Hospital in Meadowbrook, PA and is a Clinical Instructor at Hahnemann University Hospital in Philadelphia. His practice, Advanced Dermatology Center, 215-938-8771, is located in the Holy Redeemer Medical Office Building located in suburban Philadelphia. Dr. Tomeo’s website address is http://www.doctorderm.net.
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A great article as we get ready for summer and a valuable reference for when you notice something on your skin and are unsure of what to do.