MD Anderson Cancer Center
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Lisa Garvin: Welcome to Cancer Newsline, a weekly podcast series from the University of Texas, M.D. Anderson Cancer Center. Cancer Newsline helps you stay current with the news on cancer research, diagnosis, treatment, and prevention. Providing the latest information on reducing your family's cancer risk. I'm your host Lisa Garvin. And today our guest is Doctor Susan Chon, she is an Assistant Professor in the Dermatology Department here at M.D. Anderson. And Doctor Chon we're going to talk about skin cancer, obviously, is one of the most common cancers in the world, but we want to talk about this cancer in darker skinned people. Is it as prevalent with people with darker skin?
Dr. Susan Chon: It's actually not as common in patients with pigmented skin. It's definitely the most common cancer in Caucasians. However, with patients of different ethnicities, whether, you know, they are Asian, or African American, or Hispanic, I still discuss with them different cancer prevention techniques.
Lisa Garvin: Now let's talk about, obviously the fair, freckled people are the most likely to be at risk for skin cancer. Does; is there any change in people with darker, more melanin in their skin?
Dr. Susan Chon: So melanin is a protective pigment that's made by people of color. But what's interesting is no matter what racial group I look at, you know, they run the gamut of very fair to much darker. So even if you're Hispanic there are much fairer Hispanics and much more pigmented Hispanics. So the risk is different even if you're in the same ethnic group. So when I see patients who are Hispanic they often can have actually very, you know, light colored green or blue eyes, and they actually can have quite light hair. And in that sense their risk actually goes much higher up than other people of their same ethnicity.
Lisa Garvin: Do you find that some patients with darker skin may not be as proactive about protection, particularly sunscreen?
Dr. Susan Chon: Yes. I definitely see that with my patients of darker skin, they tend to not use sunscreen at all. They feel that their tan is protecting them, and so they often, you know, start off the summer with a mild burn or directly tan and then think that they're protected the rest of the summer. So I try to tell them that every time they get a tan it actually is an injury to the skin, and the skins response is to produce more pigment, and therefore you develop a tan.
Lisa Garvin: Now let's talk about sunscreen protection. Is it kind of a relationship where the lighter your skin the higher the SPF or Sun Protection Factor should be?
Dr. Susan Chon: Well, actually there's been some recommendations, both from the American Academy of Dermatology, but also nationally from The American Cancer Society. They've discussed that sunscreens should be, you know, basically broad spectrum. And broad spectrum means it covers both the UVA and the UVB radiation. In that sense the SPF actually is misleading, because SPF only measures the UVB protection. So now, you know, that that kind of a system it's somewhat antiquated, but we still recommend at this time, since it hasn't completely changed over, is to use SPF 30 or higher.
Lisa Garvin: Now is there a change in the works to maybe streamline the Sun Protection Factor and how they label sunscreens?
Dr. Susan Chon:Yes. There's been a move to make it more simplified, so that people can understand what to use. Because right now it seems like almost like an arms race. I have SPF 50, or 80, or 100. But actually at SPF 30 you can have actually 97% protection. So it's already fairly high. What's more important is that you use an adequate amount, and that you use it prior to being outdoors, and that you reapply if you're gonna be sweating.
Lisa Garvin: And there's the old shot glass rule that you should, like, have a shot glass worth of, you know, lotion.
Dr. Susan Chon: Yes. Correct. That's what people have used in the past. And it's kind of hard for people who don't know what a shot glass is or how much that is. So we try to tell them either like the size of a ping-pong-ball or something like that. But it's a significant amount. And really what's really important is that you use it, but you have to reapply. Most people just put it on once and think it's there for the rest of the day. But if you're out doing sports or any kind of, you know, by the water, it pretty much sweats off or washes off pretty quickly.
Lisa Garvin: And let's talk about the symptoms of skin cancer, generally. But now, and also too; do these symptoms; are they different in darker skinned people? Because a lot of it is moles and discoloration in the skin. Are those maybe harder to see if you have darker skin?
Dr. Susan Chon: Yes. And there's two main types of skin cancers. There's a non-melanoma skin cancers like basal cell and squamous cell cancer, and then there's the melanoma cancers, which are actually more the typical pigmented lesions you're thinking about. So the non-melanoma skin cancers, they're usually small growths that appear and don't resolve. They don't have to be symptomatic, meaning they don't have to be painful. But occasionally they can be, you know, uncomfortable, or bleed, or crust, or scale. Melanomas are usually pigmented lesions. And so we kind of educate the patients on the classic A, B, C, D, E's of melanoma. And A is for the asymmetry. That means that if I put a mirror down the center they should be symmetric on both sides. B is the boarder. It should be smooth not angular, or jagged, or ragged. C is the color. It should be one color. Many patients say, well I have some that are kind of tan and some that are darker brown. It's okay to different types of colors of moles. But within one mole you want just one color. And D is for diameter. It should be relatively small and stable. Abut the size of a top of a pencil eraser, which is about 6 millimeters. But if it's expanding or growing then that's worrisome. And finally, E is for evolution. That means if it changes. Whether it's the shape, size, color, or if it's just the symptoms: if it starts feeling itchy, or burns, or scales, or doesn't heal, those are all signs that this should be evaluated.
Lisa Garvin: And I do know amongst a lot of African Americans, they have those kind of growths all the time, like skin tags and new moles that appear. How do they decide what looks good and what looks bad?
Dr. Susan Chon: This is really tricky. I mean it's very hard to know what's growing on your skin is normal or not. So what's nice it actually probably get a baseline skin exam, so that you can get educated about what's normal on your skin. And then also to get some education from a dermatologist regarding what to look for. But there are lots of common normal growths. And as you mentioned, skin tags that often occur around areas of friction: you know, around the neck, under the arms, in the groin area. And there's also other growths that are kind of crusty or scaly, it can be warts or even what we call Seborrheic Keratoses, [phonetic] which are just normal growths. So you really have to kind of go see someone in the specialty and be educated about what's normal.
Lisa Garvin: And then, of course, there's body awareness. No matter what the shade of your skin you should always be aware of your body.
Dr. Susan Chon: Yes, that's a really important point. I always talk to my patients about doing self-exams. Regardless if you come see a dermatologist, you probably will only see them maybe once or twice a year. And in between that time you need to perform self-exams. So I tell patients to, you know, just kind of get familiar with what's on your skin. Maybe check your skin over every month or two. And really take, you know, about 5 or 10 minutes to look. Because once you get more and more familiar with your spots, you'll know when something's different and you are changing.
Lisa Garvin: And with darker skinned people, you were saying that often the skin cancers will show up on the paler parts of their body, like the palm of their hand or.
Dr. Susan Chon: Yeah, for some reason, and it's not really known why, but there's a sub-type of melanoma, which accounts for less than 10% of melanomas in general. But in the pigmented population it can be up to 70% in African Americans and up to 45% in Asians. It's called an acral lentiginous melanoma. And for some reason it occurs usually on the palms, soles, and sometimes in the nail bed. So we ask patients to be particularly, you know, aware of those locations and to check them, because hardly no one ever checks the bottoms of their feet or in-between their toes.
Lisa Garvin: Are skin cancers in darker skinned peoples maybe diagnosed at a later stage, or is it kind of just the same as the general Caucasian population?
Dr. Susan Chon: Well based on incidents alone there's a lot less of them in that population. And I don't know if there's a delay in diagnosis, per say. But we really do recommend that, you know, patients have a skin screening at least for a baseline, just to kind of assess your risk.
Lisa Garvin: Also I know that amongst some friends that I have that are African American, they're afraid of any type of biopsy or surgery, because of keloid scaring. Do you find that that's maybe a barrier to getting proper treatment?
Dr. Susan Chon: Well that is, that is also another uniqueness about having pigmented skin is that I tend to find that all the ethnic groups with more pigment will tend to form keloids more easily, but also more in specific areas of the body, usually on the upper chest or upper back, and around the neck area. So, you know, but these skin biopsies that we perform in the clinic are actually very small. And, you know, even if they do keloid, they tend to be very small keloids that we can actually treat as well.
Lisa Garvin: So in the nutshell, what would you say to people who may think, because of their skin color that they are not at risk for skin cancer. What would be your message to them?
Dr. Susan Chon: My message is, your risk is probably lower, but no one's immune. Especially if you are tend to be a fairer type within your ethnic group, and also because you live, you know, if you're from this region, the sun belt, you have a lot of sun exposure more than average. So those are just environmental and genetic factors that, you know, you are already predisposed to. So I think everyone deserves at least, you know, a skin screening to see if there's anything that's already changed, but also to kind of discuss and educate yourself about your risks.
Lisa Garvin: And it sounds like pretty much every human being on the plant should be using sun screen.
Dr. Susan Chon: Yes. You know, sunscreen is really important. But I actually am a more proponent of seeking shade. You know, sunscreen is, to me it's actually one of the last things. It's like the last resort. You're much better off, you know, avoiding the mid-day sun, which is much more intense. And you're better off seeking shade or making shade for yourself. And that means either getting underneath something. But also you can wear a hat, you can wear sunglasses. And what's really nice now is sun protective clothing is available in a lot of mainstream stores, but also lots of online markets. And that works so well, because you don't have to, quote, reapply. And it works weather you're sweating or not. And it's just easy.
Lisa Garvin: And let's talk about clothing, because I think we've gotten conflicting messages over the years. I mean some say it should be loose and light colored. Other say it should be black. I mean, what is the standard for wearing cloths that aren't special sun protective clothes?
Dr. Susan Chon: If you're just wearing your normal cloths they should be tightly knit. Which means that if you were to take that shirt and look up at it and try to look at the light on your ceiling, you shouldn't be able to see through it. If you can see through it the suns coming right through as well. Also it's been noted that darker clothing is better for sun protection. So you want a tight knit darker shirt.
Lisa Garvin: With modern technology there's a lot of clothing and other, you know, accessories that give you a protective factor. Let's talk about what's available, what's out there.
Dr. Susan Chon: So there's been a lot of changes, probably over the past 10 years as far as sun protective clothing. And the clothing is special, not because there's a chemical in it, it's actually the fabric, which is a nylon, but it's a tightly knit nylon. And the irony is actually its quite cool and not as hot as you would think traditional long sleeve shirts would be, because the material's so light. There are websites, such as coolabar.com [phonetic] and sunprecautions.com that carry this kind of clothing. But you can also find it in REI, [phonetic] Target carries some. I mean there's a lot of different places where you can actually purchase this clothing. The clothing has a different rating factor; it uses a UPF rating. So a UPF 50 gives you significant sun protection while you're out doors. The nice thing is if you sweat in this clothing it doesn't change the protective level of the clothing.
Lisa Garvin: Such as sunscreen, because you can sweat off the sunscreen. Do you foresee more of this type of clothing being available in the future?
Dr. Susan Chon: Oh yeah. I see it more and more all the time. I mean you can see it at, you know, different golf shops. It's kind of infiltrating lots of different sports. I see, you know, tennis clothing, golf shirts, some of the runner's shirts they wear and the shorts. So it's really becoming much more mainstream. And it's actually easily and readily available for the public already.
Lisa Garvin: So in closing, I guess we can say that no matter what the color of your skin, cancer is a risk.
Dr. Susan Chon: Yes, everyone is potentially at risk for skin cancer. And if there's anything suspicious, you know, please see a dermatologist.
Lisa Garvin: Great. Thank you.
Dr. Susan Chon: Your welcome.
Lisa Garvin: If you have questions about anything you've heard today on Cancer Newsline, contact Ask M.D. Anderson at 1-877-MDA-6789, or online at www.MDAnderson.org/ask. Thank you for listening to this episode of Cancer Newsline. Tune in next week for the next podcast in our series.
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