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Ask a Doc: Saving Your Skin

In our Ask a Doc series, we sit down with physicians and other clinical experts across our Highmark health plan networks, including at Allegheny Health Network, for a chat on an important health topic. In this edition, we're talking about sun safety with dermatologist Dr. Nicole Velez.

One in every five Americans will develop skin cancer in the course of a lifetime, and about 90 percent of the nonmelanoma cases are associated with exposure to ultraviolet radiation from the sun.

So it's easy to understand why Allegheny Health Network (AHN) dermatologist Dr. Nicole Velez is so passionate about teaching everyone she can reach about sun safety.

Amanda Changuris (AC): Dr. Velez, why is it so important for people to pay attention to sun safety and protect their skin?

Dr. Nicole Velez (NV): Skin cancer is on the rise. Each year in the United States, there are more cases of skin cancer than breast, prostate, lung and colon cancer combined. About one in every five Americans will develop skin cancer in their lifetime and one out of every 50 will develop melanoma, which is the deadlier type of skin cancer. It kills about 10,000 Americans each year. And what I think is particularly concerning is that it's on the rise in our young population. It is the most common cancer now in men and women in the 25 to 29 age range, so it's important to be aware of sun protection, even from an early age.

AC: We don't get a lot of bright, sunny days in Pittsburgh (we average 160 per year), so it's natural to want to get out and enjoy them. What should we be doing if we're going out to a ballgame or to the pool or just running around the backyard with the kids for the day?

NV: You want to make sure you apply enough sunscreen. I think that's a common problem — people don't put on enough. You really need about a shot glass volume of sunscreen. A teaspoon for your face, a teaspoon for each hand, a teaspoon for the arm, and then you want to make sure that you reapply. It really is only effective for about two hours, and if you're sweating or in the pool, you probably need to apply even more often than that.

girl putting on sunscreen

You want to remember areas of the skin that we often forget about, so the ears, the back of the ears, the neck, the back of the neck, even the back of the hands; these are all areas that get a lot of sun and we often forget about them and they're high-risk areas for skin cancer.

When possible, you also want to have physical barriers with you, such as sunglasses or a hat. They also sell sun-protective shirts now that have UV protective factored in them and provide day-long sun protection. It's important to seek shade and avoid being exposed during peak hours of the sun, when possible.

AC: What about sunscreen selection? What do people need to look at when they're selecting which sunscreen they want to pick up at the drugstore?

NV: Good question. You want to make sure you get something that's broad-spectrum, which means it protects against UVB and UVA rays. The sun protective factor — SPF — which we all look at really only refers to UVB protection. But the UVA rays are just as likely to be cancer-producing and they actually aren't protected by car windows or our office windows, so you want to make sure your sunscreen says broad-spectrum on it.

man applying sunscreen

As far as SPF goes, we recommend SPF 30 or greater. After 30, it's pretty much all the same, but you want to make sure you get at least SPF 30. You can also look at the ingredients. The physical blocking ingredients, zinc oxide and titanium dioxide, are best. These ingredients actually deflect the sun's rays, as opposed to chemical sunscreen ingredients that absorb the sun's rays. People are also less likely to have allergic reactions to zinc oxide or titanium dioxide. Those would be my recommendations.

AC: What about the other 205 days of the year when it's cloudy? Do we need to worry about sun safety then?

NV: I tell my patients summer is really important, but even in the winter with the cold and the clouds, UV radiation comes through, so wear sunscreen year-round on sun-exposed areas. And even if you're not somebody who burns, tanning is not good either. It still represents ultraviolet damage to your skin.

Be On the Lookout

AC: What are the best ways for us to catch possible skin cancer early?

NV: I think everyone should be familiar with the risk factors for melanoma. Risk factors are:

  • A first-degree relative with melanoma,
  • A personal history of melanoma,
  • Red hair,
  • Fair skin,
  • Past blistering sunburns,
  • Tanning bed use,
  • Or lots of moles.

If you have any of these risk factors, then you should make an appointment with a dermatologist for a full skin exam. I tell my patients to get comfortable looking at their skin. Be familiar with the moles you have and be aware of spots that are new or may be changing. Most melanoma is caught early, which is excellent because melanoma survival is great when caught early, and about 40 to 50 percent of melanomas are actually picked up by the patients themselves. So as long as you're looking at your skin and you're aware of the pattern of moles that you have, you should notice if something seems new, different or unusual. Be aware of spots that seem to be changing quickly or spots that don't heal, bleed or are always sore. You want to get these spots checked out sooner rather than later.

AC: And there's even a mnemonic device to help us remember the signs of melanoma, right?

NV: We teach the ABCDE's of melanoma, which are features to look out for in your moles. “A” stands for asymmetry; moles that are asymmetric. “B” — border irregularities, “C” — color; moles that have multiple colors or changing colors. “D” — diameter, which we refer to as anything larger than a pencil eraser, and then “E,” I think is the most important — that's evolving. If you have something that stands out — is the ugly duckling among all of your moles — that's what you really want to have checked out.

skin cancer detection chart

Courtesy: Lauren Savoy Olinde Foundation

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