Why You Might Be Missing Melanoma Skin Cancer

Melanoma is a deadly form of skin cancer. Catching it early is critical. The best way to find melanoma is to check your moles using the ABCDs. However, nodular melanomas can be trickier to find. A recent study from the Archives of Dermatology suggest that we might be missing these nodular melanomas which might be the reason why the death rate for melanoma has not improved in 20 years. How can we find nodular melanomas? Add “E” to your ABCDs.

  • Is the mole Asymmetric?
  • Does it have irregular Borders?
  • Does it have more than one Color?
  • Is the Diameter larger than 6 mm?
  • Is it Evolving (changing) or Elevated?
If it has any of the above and you have any concerns, then make an appointment to see a doctor. If a mole has 2 or more of the above, then it is by definition atypical and it must be checked by a physician.

In this video I’ll explain how examining your moles for the ABCDEs is the best way to catch melanomas as early as possible and to minimize the chances that it has spread.

New FDA Guidelines on Sunscreens

Life is really simple, but we insist on making it complicated. -Confucius

This is certainly true of sunscreens. “Broad spectrum, UVA, UVB, avobenzone, oxybenzone, parsol, sensitive skin, titanium dioxide, SPF 15, 30, 45, 50, 55, 60, 70, 75, 100, 100+, waterproof, sweatproof, spray, cream, lotion, antioxidant…”

We spend about $700 million in sunscreens every year, and many people don’t have a clue as to what’s good or bad, or a waste of money. The Food and Drug Administration has been meaning to help you out with this problem for a while now. Actually for over 30 years (who says nothing gets done in government?). The F.D.A. has made a final decision on sunscreen labels. They’ve sought to make labels simple and accurate to help you choose the right one:

1. The sunscreen must protect against both UVA and UVB rays; that is, it must be broad spectrum.

2. To be labelled as “protecting against skin cancer,” the sunscreen must be an SPF of at least 15. The labels will likely be capped at SPF 50 because SPFs greater than 50 seem to be of little additional benefit.

3. Sunscreens can no longer be labelled as “waterproof” or “sweat proof,” as neither is physically possible, therefore, rendering the claim “misleading.” Sunscreens will be labelled as effective in water for 40 minutes or 80 minutes which is accurate and much more useful.

This simple system should help consumers make better choices, but some say the F.D.A. didn’t go far enough. They did not comment on the safety of various sunscreen ingredients. They have also not loosened up enough to allow for other sunscreens that are widely used in Europe to be sold here in the U.S.

Do you think the F.D.A was too strict or didn’t go far enough?

Photo: Wandering Magpie, Flickr

10 Tips to Get The Most From Your Dermatology Visit

Having a high quality doctor’s visit takes effort on my part and on yours. Here are 10 tips to get the most out of your next dermatology visit with me or any other dermatologist.

1. Write down all the questions you have and things you want to discuss with me. Be sure to list any spots you’d like me to check or any moles that have changed. Have a loved one lightly mark spots on your skin they are concerned about.

2. Know your family history: Has anyone in your family had skin cancer? What type? Patients often have no idea if their parents have had melanoma. It matters. If possible, ask before seeing me.

3. Know your history well: Have you had skin cancer? What type? If you have had melanoma, then bring the detailed information about your cancer. Your prognosis depends on how serious the melanoma was, that is its stage, 1-4. You need to know how it was treated, if it had spread, and how deep it was. The answers to these questions determines the risk of your melanoma returning.

4. If you have a rash, there are a few things I’ll need to know: Have you changed any of your medications? Soaps? Moisturizers? Cosmetics? Do you have a history of eczema? Asthma? Hayfever? Does anyone in your family have a skin disease? Take a picture of your rash at its worst with your phone; the rash might be improved by the time you see me.

5. If you are seeing me for acne, come prepared. Keep a journal of when your acne is worse. Is it around your period? When you are stressed? In summer or winter? What products or cosmetics are you using? What treatments have you tried? Have you had dryness or burning with previous treatments?

6. If you are seeing me for hair loss, then collect your hairs that fall out and count how many you lose in one day. It’s normal to lose 100-150 hairs per day. Make a list of other symptoms or health problems that you think might be related to your hair loss.

7. Always be honest with me. I’ll never judge you even if you are an avid tanner or a picker. I’m here to help, and I can only help if I know the whole story.

8. Have you read something online that you’d like to discuss with me? Print it and bring it. Sometimes patients will tell me they saw something about their disease on the web; without knowing the source, I cannot say if the information is valid or helpful.

9. Am I leaving too soon? Stop me. My time with you is yours. If you see me heading for the door, then tell me that you still have things you’d like to cover. If we are out of time, then ask me if you can set up a follow-up appointment to continue the visit.

10. Don’t leave empty handed — I’m not talking about the freebie hand lotion or drug samples. For every doctor’s visit, you should leave with printed or written instructions about what we discussed and what you should do next. Patients who receive hand-outs from their doctor are more likely to have positive outcomes.

Have you had an excellent or not-so-excellent dermatology visit you’d like to share? Do you have any tips for us?

Photo: Maggie Osterberg

Sunscreens Cause Skin Cancer? What?!

Just what you needed: another mixed message about your health. The top health story this Memorial Weekend was sunscreens might cause skin cancer.

The story originated from the Environmental Working Group (EWG), a nonprofit organization that “protect(s) the most vulnerable… from health problems attributed to a wide array of toxic contaminants.”

EWG announced their list of best and worst sunscreens last week. They also published a statement that claims creams which contain a vitamin A derivative, retinyl palmitate, increase the risk of skin cancer in laboratory mice. The creams studied were not sunscreens, but rather simple cream with retinyl palmitate. Because many sunscreens contain retinyl palmitate, the EWG is urging the FDA to study this further and is also urging people to avoid sunscreens with vitamin A derivatives in the meantime. Some sunscreens contain retinyl or retinols as a “wrinkle-fighting” ingredient in the sunscreen.

So what should you do? Here are my tips:

  • Ultraviolet light from the sun is radiation and is unquestionably the most important cause of skin cancer.
  • Sunscreens in general do not cause skin cancer.
  • No study has yet looked at retinyl palmitate when used in a sunscreen.
  • It is reasonable to avoid sunscreens that contain retinyl or other vitamin A derivatives until more studies are done, if you’re concerned.
  • Choose a sunscreen with an SPF of 30. Look for zinc oxide, titanium dioxide, avobenzone, ecamsule (Mexoryl) or octocrylene.
  • Reapply sunscreen every 2 hours.

Photo: James Justin (flickr)

What is your take on sunscreen safety?

What about sunscreens and vitamin D?

Why Tanning Is An Unsafe Way To Get Vitamin D

I made this video while at the Lance Armstrong Foundation Headquarters in Austin, TX to help people understand why tanning is an unsafe way to get your vitamin D.

  • Your skin needs UVB to make vitamin D.
  • Many tannning beds use little or no UVB, so they wouldn’t increase your vitamin D levels.
  • Tanning beds increase your risk for melanoma, squamous cell carcinoma, and basal cell carcinoma skin cancers.
  • Vitamin D3 supplements at doses of 1,000 to 2,000 IU are readily available.
  • Supplements have been proven to safely increase and maintain high levels of vitamin D.

Make a donation to the Lance Armstrong Foundation and win a chance to see Lance in France at the Tour de France.

Does The Sun Cause Melanoma?

Yes. Isn’t the answer obvious? Doesn’t everyone know that the sun causes melanoma? Not so fast.

There are many people who think we dermatologists are needlessly frightening everyone. They argue that the sun is good for you because it boosts your vitamin D levels and that dermatologists are subsidized by the sunscreen industry. They argue that melanoma can occur in places that are not sun exposed (like the bottom of your feet), that sunscreens have never been proven to prevent melanoma, and that people who get sun every day, like farmers, are actually less likely to get melanoma. They’re right.

So, then does the sun cause melanoma? Yes. Melanoma is a potentially deadly skin cancer. Like other cancers (breast, lung, colon), there are many risk factors. Think of melanoma as a destination — the hell of skin cancer. There are many roads to that destination even though the final resting place is the same.

People who have light skin or a family history of melanoma have a much shorter route to arrive at melanoma. It takes less time and less environmental factors for them to get melanoma. People who have very dark skin have a very long road to melanoma; it is unlikely that they will arrive there in their lifetime. Older people are much more likely to develop melanoma than younger people (they have been travelling the road for much longer). Sun exposure, especially sun burns, pushes you farther down that road.

Brilliant research from people like Dr. Michael Stratton in the United Kingdom has shown that most of the mutations found in melanoma tumors are unquestionably the work of ultraviolet radiation damage to the DNA. We also know that people who use tanning beds before the age of 30 are 75% more likely to develop melanoma that those who do not.

The sun does have health benefits, but unfortunately it also is the main driver pushing us down the road to melanoma. Each person has to think about how far along the road to melanoma he or she is starting at to determine how careful to be with the sun.

Everyday in dermatology we see people who unexpectantly find themselves in a place they did not think possible — they have melanoma. Many don’t understand how they got there; it has been a long road. Stop and think about where you are along that journey. What are your risk factors of melanoma? It is never too late to stop and turn around.

Photo: Eduardo Amorim