Hi.

My name is Doctor Remy Hamel.

I'm a board certified dermatologist and surgeon, and I work as a surgeon here at my Michigan Health.

Today we're going to talk about skin cancer prevention and sun protection.

skin?

Cancer is the most common type of cancer in the US overall, skin cancer is caused primarily by sun damage.

For most people who have fair skin, that sun damage is cumulative throughout our lives so that the longer we live, the more sun damage we accumulate.

There are other risk factors too, such as having a compromised immune system.

And so for all of us, as we age, our immune system gets weaker.

But certainly anyone who has had an organ transplant or certain types of lymphoma and leukemia are also at higher risk for getting skin cancers.

there are a couple different common types.

The most common by far is basal cell carcinoma, followed closely by squamous cell carcinoma, and then one that most people have heard of is melanoma, and together those three make up the vast majority of skin cancers.

The risk for skin cancer increases after the age of 50 the common risk factors for skin cancer include having fair skin, light eyes, a history of extensive sun exposure.

So certainly anyone who has done a lot of work in construction or has been outside as a surveyor or has just accumulated a lot of sun exposure because of things they like to do outside boating, golfing, fishing, all those wonderful things that we enjoy doing.

Certainly add to that overall risk.

So again, skin color, eye color exposure, or certainly a family history of skin cancer would put you at a higher risk.

Not only fair skin people can get skin cancer.

Certainly anyone can get skin cancer.

And so while having fair skin is one of the major risk factors for developing skin cancer related to sun exposure, people with darker skin can also get skin cancer.

While it can be sun related, it can also be in areas such on the nails or the bottoms of the feet that are not traditionally sun exposed, and so anyone should keep an eye on their skin and if they notice something, they should let their doctor or other provider know so that it can be evaluated further.

Some of the more common presentations of skin cancer, for example basal cell carcinoma, is, for example, a pimple on the nose that started it looked like a pimple, but over several weeks it didn't go away, which a normal pimple would.

And then after that, they say every time I cleaned my face with a washcloth, it bleeds.

And it just didn't heal.

And so I became suspicious.

And usually that period after a few months is where we start to wonder, maybe we should evaluate it further.

So that's one common scenario for a basal cell carcinoma.

One type of skin cancer on the face, another common for basal cell carcinoma, but could be for any skin cancer would be, sore on the scalp.

For example.

And somebody may not have noticed it's there until they get some sort of trauma.

They hit their head on a tree branch, say so.

Actually, it happens not uncommonly, where they say, I hit my head on this branch and it just never healed.

And at which point there is further evaluation.

And that is then ultimately diagnosed as a basal cell carcinoma.

So certainly it could be any type of skin cancer or even not skin cancer.

But those are some common scenarios.

for squamous cell carcinoma.

One of the more common scenarios would be this volcano like growth that came up rapidly.

like this raised nodule or lump that has this central crater, these scaly or rough areas that don't go away.

But for squamous cell, that would be a classic presentation.

for melanoma.

that irregular dark spot that comes up.

So it can either be a mole that's been there for many years, and then all of a sudden it's growing or changing, or it could be just a new dark spot that's coming up.

And so most people when they hear melanoma, that's what they think about.

Certainly they can present as other types like a pink bump or even a scar like area or any of those types of skin cancer.

So there are multiple ways it's present, but classically a mole that's changing size or color or a new mole after the age of 50 certainly would be suspicious.

Okay.

The ABCd of melanoma are a acronym for what are the warning signs of melanoma.

So a would be asymmetry B irregular borders C uneven or multiple colors D a larger type lesion.

Generally bigger than a diameter of a pencil eraser or E evolution over time and for people who are hearing all of those, they might look at themselves and say, wait, that spot is meets 1 or 2 of those criteria.

And certainly it's reasonable to get additional evaluation.

In my experience, what has been the best predictor of a spot that is most concerning?

Or is the E, evolving over time?

So a spot like we talked about a mole that's changing over time or looking different than all the other spots, and that's sometimes called the ugly duckling sign.

So a spot that jumps out to you amongst all your other spots, because some people have many spots.

So that would be the things to look for of all those spots.

Certainly any.

It's always helpful to have a dermatologist take a look at the skin, but that changing over time or looking different than all the other spots are really two important things to keep in mind.

So who needs to see a dermatologist?

Certainly somebody who has had skin cancer in the past.

Or multiple skin cancers, certainly.

Or multiple risk factors.

So say somebody has had a couple basal cells and maybe a squamous cell.

That type of person would benefit from having somebody take a look at their skin.

At least once a year.

And again, this can be dependent on how frequent these spots are popping up, what their other spots look like.

But that's a discussion to have with the dermatologist people with risk factors.

So again, we talked about transplant patients or patients with leukemia, lymphoma, are at much higher risk for developing skin cancer.

And so those patients also could benefit from having somebody find and detect things earlier.

For many people, if they do not have a history of skin cancer and not risk factors, a lot of times they're primary care doctor, when they get them in a gown for their annual exam, can be a wonderful adjunct to their own examinations at home.

And everybody should be keeping track of their skin.

Certainly for those things that we talked about, spots that are looking different than the other spots or changing over time.

So again, for most people, checking your skin several times a year, and then for those with risk factors or history, certainly seeing a dermatologist would be recommended.

Skin cancer is diagnosed typically with a skin biopsy.

And so a skin biopsy.

Once that lesion has reached the suspicion that we need further evaluation is we numb it up.

So with local anesthetic after it's cleaned it's numbed up.

And then a portion usually or sometimes all of the lesion is removed.

And so it depends on how much of that lesion we need to get the diagnosis.

And it depends on what type of of skin cancer that we are suspicious for.

So that portion is removed.

That is usually left open.

A thin wound like a scraping is is there sometimes a suture is put in that is sent to the pathologist and that goes about a week or two, depending on what special testing they need to do, at which point then the results will either confirm skin cancer or say not a skin cancer, or we need additional information.

And then at that point, the dissenters decision is made is what is the next step There are several treatment options for skin cancers.

And so of course it depends on the type of skin cancer where on the body it is, and it is always an individualized discussion depending on all the other health considerations for each person.

And so most skin cancers do very well with local destructive methods.

So say for example, for a basal cell that you have on your arm or your back and it's a small area, something called electro desiccation and cutettage, which is where basal cell is scraped away because it feels different to the tool than normal skin.

And then that area is cauterized and left to heal by itself.

And that oftentimes has an excellent cure rate on the chest, back, arms, legs.

Sometimes, if it's a deeper skin cancer, it can be what's called an excision where it is marked with a margin.

And then that is cut out like a football shape and then sewn together.

That sample is then sent to the lab and confirmed the margins.

There on the what typically ends up being around the face and head and neck area, hands and feet, or in the groin area.

Areas that we want to conserve as much skin as possible.

Normal skin, but make sure that the margins are clear.

There is a technique called most surgery, but that is a margin controlled technique where after the spot is marked I or another, most surgeon would take a thin rim of normal skin around the skin.

Cancer This is all done under local anesthetic.

So while the patient is awake and comfortable, check the whole margin under the microscope.

checking that in the lab while they wait, at which point we get the result and if the margin is positive, we have a map so we know where to go back in and take additional tissue.

And that's repeated until everything's clear, at which point we can reconstruct the wound, usually the same day.

And so while they may be here for several hours, the benefit is tissue sparing or keeping the wound as small as possible, but also when they leave, they don't have to wait for results or come back for another procedure.

So again, most surgery usually on the head and neck and other areas where tissue sparing techniques are needed, Basic prevention tips for skin cancer include sun protection.

And so start with clothing a big broad brimmed hat.

And again you want your hat to have a solid brim.

The straw hats that let light through to a less effective job at blocking it.

They have wonderful sun protective clothing and so those fabrics fabrics advertised as sun protective or have the UPF label on it, the ultraviolet protection factor are good at blocking the light sunglasses to protect your eyes and the skin around the eyes.

So those are, from a clothing perspective, easy to have.

They're readily available and everyone should consider those.

Sunscreen, of course, is people always ask, what's the best sunscreen?

The best one is the one that you'll wear.

And so by and large, anything you get over the counter these days is going to meet the criteria of SPF 30 or greater.

Broad spectrum, water resistant.

Pretty much anything you'll find over the counter these days meets those criteria.

But putting sunscreen on exposed skin, reapplying if you're out swimming in the lake, or sweating a lot.

So sunscreen there and then being mindful about when you're playing golf or when you're out fishing so that you're not maybe doing it right at noon every day.

But if you can do it when the ultraviolet light is less intense, also is a good consideration.

some people will bring up to me, what about tanning beds?

And are tanning beds a safer way to get a tan to the skin.

And the contrary is true.

And that we know that you've from tanning beds is a carcinogen that several countries have banned tanning beds, and there are multiple movements in many states to try and limit access to tanning beds for good reason and have been successfully done, especially for minors who are at great risk for developing skin cancer from that exposure.

So again, we know that the UV from those tanning beds can lead to skin cancer, and we recommend for everyone to not use a tanning bed.

Another question that comes up is about getting adequate vitamin D. Most people can get the vitamin D that they need through a healthy, normal diet.

Ambient sun exposure.

You know, the minutes that we spent walking to and from our house and car and supplementation if needed.

The recommendation is not to go and seek additional sun exposure for supplemental vitamin D, or to try and maintain adequate vitamin D. So again, for most people, the recommendation is a healthy diet, supplementation as needed and not seeking additional sun exposure for vitamin D. the final takeaways from everything we discussed are early detection is important for skin cancer.

When found early it's very curable and can generally be treated very effectively with minimal downtime.

skin cancer prevention also improves the signs of aging.

skin cancer prevention or sun protection can be done as part of a healthy lifestyle that includes enjoying time outside.

Whether you like to ride your bike or play golf.

Taking into account some of the things we talked about while enjoying those activities, which can add to your health as well is very important.

when people ask me where they can go for more information about skin cancer, about skin health.

The American Academy of Dermatology is a wonderful resource.

The American Society for Dermatologic Surgery has great skin cancer, patient facing information, and the American College of Surgeons also, as well, have great patient resources that are reputable and well constructed and have a lot of good information.

If people want to know more, you