M. D. Anderson Cancer Center
Cancer Newsline Audio Podcast Series
Date: August 11, 2008
Duration: 0 / 13:11
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Welcome to Cancer Newsline a weekly podcast from The University of Texas Cancer Center M. D. Anderson cancer center in Houston, Texas. The aim of Cancer Newsline is to help you stay current with the news on cancer research and the rapidly changing advances in cancer diagnosis, treatment and prevention. We also hope to provide you with the latest information on reducing your family risk of being diagnosed with cancer. My name is Leonard Zwelling; I’m a professor of medicine and pharmacology here in M. D. Anderson and today we will be talking with Dr. Michael Ryting, an assistant professor and Dr. Anna Franklin also an assistant professor. Both from the division of Pediatrics and the Children Cancer Hospital at M. D. Anderson Cancer Center. And what we want to talk about today is teenagers and skin cancer. What are the risks? How do you help them understand those risk? And protect themselves? Melanoma the most deadly form of skin cancer. Is actually the second most common form of cancer in young adults 15 to 29. The effects of protecting your kids are not just short term. One blistering sunburn in childhood or adolescence more then double a person chances of developing melanoma later in a life time.
How are you today Dr. Rytting and Dr. Franklin. Lets start with Dr. Rytting I think. I would like to know is why we should be focusing on this particular age group when we're talking about skin cancer prevention.
Well I think you look at teenagers. It’s important to instill good habits in that group of patients there starting to develop some independence and to convince them to take protective measures is really helpful in that group of patients as opposed to younger patients who sort of have enforced habits from their parents.
Dr. Franklin anything you want to add to that?
The other thing is if they do develop skin cancer at this young age they have a long life ahead of them where they need to stay free of skin cancer.
Does finding it at a young age put them at an increased risk of developing other cancers later?
Not particularly, but they have patients in this age group that develop melanoma tend to do very well. But they have a long time where they need to maintain their disease free status and not risk the reoccurrence...
For a long period of time. There are really three essential forms of skin cancer. Is that right and why are we focusing so heavily on melanoma.
There is basal cell carcinoma, squamous cell carcinoma, and melanoma. Basal cell squamous cell carcinoma tend not to metastasize so you can remove them and they may can come back but you can remove again. But they are not life threatening cancers. Where as melanoma can spread to other parts of the body and that’s when it become life threatening.
It seems to me at this time of the year, I’m always talking about this because of the sun exposure. Sun exposure is the great risk here, is that correct?
Yeah, it’s by far the most prominent common link for all three of those cancers.
Now are all these, are melanoma common in kids? Are there a lot of cases in the country?
No it’s not common. Fortunately, most cancer are not common in children. But within the age group of 15 to 29 it’s the second most common cancer.
Are they treated differently then adults with melanoma?
No, they are not.
So the real question is what can people do to prevent this from developing. How can they protect their families? So lets go through the usual things. So one of the thing that you heard us hear talking about is there may be a need for some of degree of sun exposure to get adequate vitamin D levels in people. How much sun exposure do you actually need to get enough for vitamin D health?
Actually, several minutes a day.
Several minutes a day. So walking to your car will do it.
Ok, so that should not make anybody have to bathe in the sun to get enough sun for vitamin D. What about the differences in races are there ethnic differences in people risk of developing melanoma.
Yeah, the risk in African Americans are far lower then in Anglo Americans. Also the risk in more pigmented patients in general is lower then patients less pigmented.
So Caucasians are at higher risk for developing melanoma.
So they obviously have to take extra precaution when it comes to prevention. What about family history and genetics, does that pre-dispose people to developing melanoma?
It does. Most patients have melanoma has some first degree relative through parent, brother or sister. Or they have a family history of melanoma and it tends to be because it usually seen in fair skin people who are at the greatest risk. So again the family history and genetics do play a role.
Do we have known knowledge of specific genes at set up melanoma? Or do we?
There are a couple of genes that are seen in familiar melanoma that we do know about.
There has been one really exciting paper looking at either sun exposed or non-sun exposed melanoma showing that there are different genes involved in those two types of melanoma. And that may lead to further insight in the disease. One of the genes is BRAF and there is another cyclin dependent kinase gene.
What about the location of the melanoma on the patients body. Does that have any affect on prognosis? And does that have any affect on treatment?
In younger teenagers and younger adults they tend to be seen on more on the extremities in the trunk where older adults it tend to be on the head and neck. One of the big prognostic factors is able to get a complete resection through surgery. At what’s called the wide local incision. In certain parts of the body particularly the head and neck that can be difficult. On the trunk sometimes the mole or cancer can be there for a longer period of time before it’s noticed. However, on the extremities they tend to be seen to be seen fairly readily.
And moles what we call moles black spots on the skin are they at risk of developing to become cancer?
They can. many, melanoma start off out as what’s called dysplastic nevus which is a pre-cancerous growth which can become a melanoma.
What should stimulate an individual to seek professional medical assistant’s when they see something on their skin? What are they looking for?
They should look for irregularity on the in boarder of the mole or changes in color. Those are the principle findings that you see with these more malignant type lesions.
Lets get to the information that we can give to everybody. What are the things that people can to protect themselves from sun exposed cancer?
The first and obvious thing is try to minimize your exposure to the sun. If you do need to be outside try to do it early in the morning before 10 o clock or in the late afternoon after 4 o clock.
Apply sunscreen and a lot of patients apply to little thinking with the high SPF sun screen that you could use less. And that protection might be actually worse than using a lower SPF where patients use a lot. So be generous with the sunscreen application. I think that if patients can be convinced to wear sun shirts they should wear them.
The sun shirts that cover their arm.
At least covering the trunk and there upper arms they make long sleeve and short sleeve shirts for the beach.
Now it matters what fabric it’s made out of. If you can see through it we assume the sun can too.
Yes and its looks. I think that a T-shirt while lots of teenagers I think that regard that as coverage only. Has SPF about 15. There are much better coverages and the clothing is pretty practical and comfortable.
And it gets. It not quite the same SPF once it gets wet as I understand it. So in the water you start to lose the protection because the fabric becomes wet. And hats of course I presume people need to wear hats. How often do people need to put on sunscreen when they are exercising let's say they begin to sweat?
They really should do it every 2 hours. Re-apply even with the waterproof sunscreens you do need to re-apply.
Ok now the question that really has become a bit of a controversy the whole issue of tanning salons and tanning beds. Are they as risky as being out in the sun, and cause it’s a 5 billion dollar industry right now and is it really a threat to the well-being particularly of young people who tend to use these things?
The data out there is conflicting right now. Theres is not a lot of good evidence either way. There is some studies coming out there right now one particularly Sweden showing patients that use the tanning beds regularly have a eight fold increase risk of melanoma and patients who use it occasionally have three fold increased risk. One on the concern with the tanning beds is that you are exposed all over your body at the same time. Where as if you are outside if your tanning laying at a beach you have only got one side at a time and if you in a tanning bed your whole body is exposed for the entire time.
Some people talk about getting a base tan in the tanning bed and going out into the sun for a final tan. Is that a really good strategy?
That’s still a misconception that just increases exposure to the radiation risk and does not seem not to be a helpful strategy at all.
Anything else you would like to pass on to our listeners before we close this session down on Skin Cancer, Melanoma and Teens because dealing with teens is always a challenge.
I think starting early is better starting with young children if you have them and instilling in them good practices now.
Setting a good example probably isn’t a bad idea either. [Laughs]
It’s hard to avoid exposure to the sun there is lots of fun activities out there in the sun. But purposely exposing your self as in sun bathing is just not a good idea. It’s the wrong thing to do.
Thank you Dr. Franklin. Thank you Dr. Rytting. Listeners if you have any questions about anything you heard today on skin cancer prevention or screening. Please contact M. D. Anderson at 1-877-MDA-6789 or online www.mdanderson.org/ask. Thank you for listening this episode of Cancer Newsline. Again this is a weekly series please tune in again next week for our next episode of this series. You can do so by visiting www.mdanderson.org/newsroom and selecting subscribe from the menu. Or subscribe for free through Apple iTunes and the M. D. Anderson iTunes University page you can get there directly by typing www.mdanderson.org/itunes . Thank You.
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