Boss lady Mollie sat down with local skin expert Dermatologist Dr. Bailey Lee, MD, to talk about melanoma, sunscreen, and if a “base tan” is a real thing.
M:What is melanoma and why should we care?
B: Melanoma is a serious cancer that arises from cells in our bodies called melanocytes. These are the pigment producing cells and are predominantly found in the skin, but are also present in the brain, eyes, ear. Melanoma awareness is important because it is a cancer that can be cured with early detection, but left undetected, late stage cancers are fatal in greater than 80% of patients.
M: How serious is melanoma and is prevention really something all of us need to be mindful of?
B: As I mentioned above, late stage melanoma can be very serious. Survival rate for people diagnose with late stage melanoma after 5 years is only 15-20%. These numbers have been improving with new therapies, however, it is still a devastating prognosis if not caught in an early stage. The good news is that early detection has become more common as awareness is expanding. Although we are diagnosing more melanomas than 5 years ago, they are being diagnosed at an early stage that carries a much better long term survival rate. Skin checks are as important as breast exams, colonoscopies and other routine cancer screening tests simply because of the potentially lethal consequences of late detection.
M: Who needs to worry about melanoma? Are certain ages and skin types more prone to skin cancer?
B:The short answer is everyone. Although extremely rare in children under the age of 10, and less common in darker skinned individuals, melanoma can strike anyone regardless of age, gender, race. There are definitely groups of people who have more risk factors including fair skin and hair, history of severe sunburns or tanning bed use, and first degree relative with melanoma. Geography also plays a role with higher incidences of melanoma in the southern United States. Melanoma is currently the most common malignancy in women ages 24-29 and accounts for 7000 deaths annually.
M: What if I have olive skin and don’t get sunburned, do I need to wear sunscreen? Why?
B: All skin types can benefit from sunscreen, even those who do not burn easily. It is true that melanin, which is the pigment in our skin, confers a small layer of protection, however, even those with heavily pigmented skin are at risk for sun related skin cancer. If I can't appeal to your sense of skin health, I have no problems appealing to your vanity: sunscreen is the single best anti-aging product out there.
M: What are your top tips to protect your skin?
B: Find a good sunscreen you love that is broad spectrum, spf 30 or higher and wear it everyday on sun-exposed skin. I prefer physical sunscreens with zinc and titanium dioxide. If you make it a habit, like brushing your teeth, it doesn't have to be such a chore. For most of us, our morning sunscreen ritual isn't the hardest step, it is the re-application. Wearing hats and sun protective clothing (it doesn't have to be fancy, a simple long sleeved cotton shirt will do) are a helpful way to avoid a situation where you forget to re-apply your sunblock. I keep a hat and powdered sunscreen brush in my car at all times so that I am never caught without protection.
M: How important is sunscreen and how often should it be applied?
B: Very important!! It should be re-applied every 2 hours during sun exposure. A shot glass full is typically enough to cover an adult body.
M: What about when it’s cloudy or during the winter time, do I need to apply sunscreen?
B: When I tell my patients to apply sunblock daily, I often get the response that "I don't really go outside" or "but it's winter". I have to remind people that sun exposure happens every day driving in your car, sitting by windows, and walking into the grocery store or work. You can get double the sun exposure in the winter with the reflection of the snow. It is actually the small, daily exposures that really add up, which is why I tell my patients not to leave home without it.
M: Other than preventing skin cancer, what other benefits are there to wearing sunscreen daily?
B: As I mentioned above. Sunblock the single best anti-aging treatment, period. Don't like your brown spots? Use sunscreen. Don't like your wrinkles? Use sunscreen. Solar damage is the single biggest contributor to our skin aging and if you don't believe me, look at your butt. The skin on your face would be that color and texture if it never saw the sun.
M: Are all sunscreens created equal? (follow up question: for example, what ingredients should you look for or avoid? Should it protect against both UVA and UVB?)
B: Not all sunscreens are created equal, but generally speaking there are 2 broad categories: physical blockers and chemical blockers. Both can be broad spectrum which means they cover a broad range of light wavelengths in the UVA and UVB spectrum which are damaging to the skin. I prefer physical blockers because they are safe for all skin types unless there are a lot of added ingredients such as botanicals. Chemical sunscreens are often easier to wear and have a more elegant feel, but can contains ingredients that some people have allergies or sensitivities to. Another common question involves spray sunscreens. My response to that is that is it better than not applying, however, they are often inappropriately applied and can lead to inadvertent burns.
M: How do you answer a patient who says they need to get a base tan in a UV bed to prevent burning while on vacation?
B: First of all I avoid judgement because they have the right idea...they don't want to get a sunburn! They are just going about that in an undesirable way. I gently remind them of the following: 1) You can still get a sunburn even after prepping with a tanning bed 2) >90% of melanomas I have diagnosed in patients 25 and younger have been directly correlated with tanning bed use 3) Using tanning beds just 1-2 times per year can increase your risk of developing a melanoma up to 10 times that of a similar person who does not use tanning beds 4) Tanning beds are a sure way to make you look older than your years
M: Moles. We all have them. When should we be concerned about them?
B: I tell my patients to rely heavily on the "ugly duckling" rule. We all have our own special flavors of moles, and it is important to become familiar with moles you have. That way, you will better be able to detect when you have a new mole that looks like it doesn't fit in with the rest of your mole family, or if one of your previously Plain Jane moles has started to change. Dark black moles, moles with several colors or shades, changing moles, moles with asymmetry or funny borders should all be looked at. The ABCDE's are a nice little tool to help you remember as well: A = asymmetry (you should be able to fold your mole in half and it would look the same on both sides), B = border (smooth borders are a sign of a healthy mole) C = color (we like our moles all one color) , D = Diameter (moles that a larger than a pencil eraser should be check, especially if growing) , E = evolving (any significantly changing mole should be evaluated). Also, if you have more moles than you can keep track of, it's probably time to find a good dermatologist to help you with that.