Skin cancer prevention: Q&A: An ounce of prevention...

We caught up with Trevan Fischer, MD, surgical oncologist at the Center for Cancer Prevention and Treatment, Providence St. Joseph Hospital, to hear about how to lower your odds of getting skin cancer—just in time for the summer.

Is there anything new to know about cancer prevention?

The ways of protecting yourself from the sun have persisted over the decades. They work for melanoma [the most severe kind of skin cancer] as well as basal cell and squamous cell cancers. Use of sunscreen to avoid blistering sunburns is very important, as is an absolute
avoidance of tanning beds. I think the research will show us soon that this practice is the biggest risk for melanoma. We are seeing more and more women with melanoma in their forties who have a history of using tanning beds. It is especially bad for teenagers.

What is important to know for teenagers and young adults?
The majority of sun exposure in a person’s life happens before you are 25 years old—basically the first two decades of life. It is important to have good sun protection habits from the start; I like to tell people to make it part of their daily care habit—brush your teeth, put on deodorant and put on your sunscreen.

What are some other protections?
• Use a broad-spectrum sunscreen—at least SPF 30—every two hours when you are in the sun. And reapply more often if you are perspiring. If you are just going in and out of the car, you can reapply every four hours; if you are in direct sun, every two hours; and in direct sun and perspiring, every half hour. It is important to avoid a sunburn at all costs.

• Wear sun protection clothing. Rash guards have gotten more and more popular and are a great protection for kids. If you are doing gardening or are in the sun for a long time, wear a wide-brimmed hat.

• Try to stay out of the sun between 10 a.m. and 4 p.m., when the sun’s rays are the strongest.

• Get yearly skin checks.

When should a person start doing skin checks?
I encourage all adults to get a skin check once a year; unlike screenings such as mammograms and colonoscopies, there is no universal protocol about when to start. Use common sense: If you are fair-skinned with red or blond hair, you are at higher risk for UV damage and might want to see a dermatologist in your late teens or early twenties.

Doctors have different approaches to this—some use dermoscopy, serial photography and newer techniques like confocal microscopy, while others rely on sight, touch and a clinical history.

What can people look out for themselves?
There are the tried-and-true ABCDEs of cancer prevention.

A = asymmetry: Does one side of a mole match the other side?

B = border: Is it ragged?

C = color: Is it many different colors?
D = diameter: Anything above 6 millimeters (the size of a pencil eraser) can be—but isn’t necessarily— worrisome.

E = evolution and everything else: Are there any changes in color, size or look of the mole?

And what are the treatments for skin cancer?
Early detection really makes a big difference in prognosis. If you find a skin cancer in the very early stages, we can do a wide local excision to remove it, and that might be all that is needed.

For deeper and more advanced skin cancers, we check lymph nodes that are close to the cancer and remove them, and for more advanced cancers we do CT scans or other imaging to check lymph nodes that are farther away. In the last few years, there is really good news for people with more advanced cancers. Immunotherapy, which uses your own immune system to fight the cancer, can unlock the brakes of your immune system to allow it to fight off and kill the melanoma cells. Stage 4 melanoma often used to be fatal, but it isn’t anymore. This treatment is so revolutionary that the team that developed it won the Nobel Prize in medicine in 2018. It is a real game changer.

Don’t put off important cancer screenings. Contact the Center for Cancer Prevention and Treatment to learn more by calling 714-734-6200.