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HOUSE CALL WITH DR. SANJAY GUPTA
Preventing Skin Cancer
Aired July 9, 2005 - 08:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
SANJAY GUPTA, HOST: Good morning, welcome to HOUSECALL. I'm Dr. Sanjay Gupta. And today, we're showing you how to beat the most common cancer in the world.
More than one million cases of skin cancer are diagnosed every year in the United States. And about 10,000 people will die of it.
Now many of those deaths can be prevented, but as Christy Feig tells us, it's something we need to start thinking about now because much of the damage may already be done.
CHRISTY FEIG, CNN CORRESPONDENT (voice-over): AS a child, 29- year old Linda Noggle spent a lot of time in the sun.
LINDA NOGGLE, SKIN CANCER SURVIVOR: I was on the swim team. And all my friends and I hung out at the pool all day long, I mean, probably for six, seven years of my life.
FEIG: Because she had fair skin and a lot of moles, she started seeing a dermatologist regularly. Last summer, one of those moles turned potentially deadly.
NOGGLE: He shaved it off and it turned out to be melanoma.
FEIG: More than one million new cases of skin cancer are diagnosed each year. And melanoma is the most serious. According to the American Academy of Dermatology, excess sun is the number one cause. Experts say by age 18, you've already had most of the sun exposure that causes skin cancer.
UNIDENTIFIED FEMALE: Beyond 18, there are a lot of people who still can change their fate, if you will, by protecting themselves from the sun, wearing a sunscreen that's going to give you an SPF or sun protection factor of at least a 15.
FEIG: And be diligent about doing self exams.
UNIDENTIFIED FEMALE: Any mole or lesion on your body that's changing. It may be changing because of the shape, size or color. It may be changing because now it's begun to bleed or itch. Those are all red flags for us. And we'd like to get those lesions evaluated sooner rather than later.
FEIG: Doctors say it's important to start protecting yourself early because it's not just sunburn. Even sun tanning damages skin cells.
In Washington, I'm Christy Feig.
GUPTA: Christy, thanks.
And as she pointed out, sunburns are just one of the many risk factors for skin cancer. Having fair skin that doesn't tan easily and spending a lot of time in the sun, especially if you don't wear sunscreen will also put you at risk.
Plus, if you've had severe sunburns as a child, and if you've had multiple or atypical-looking moles. We're going to talk more about that, your family history is also a factor along with working with environment hazards, such as coal tar or arsenic compounds.
Here to answer all of our questions on the topic of skin cancer is Dr. Darrell Rigel. He's a dermatologist. He specializes in skin cancer. And he has literally written a book on this topic. He's written a textbook on this topic.
Good morning, doctor.
DR. DARRELL RIGEL, DERMATOLOGIST: Good morning.
GUPTA: Thanks for spending some time with us. But the woman in Christy's piece got melanoma from being out in the sun when she was a child. If you get lots of sunburns as a child, but then as an adult, you try to be good, you stay out of the sun, use sunscreen, are you still at risk of getting cancer? A lot of people ask about that.
RIGEL: Well, that's a question that a lot of people do ask because they've sort of seen the light. They had a lot of exposure when they were young, but then all of a sudden they realize maybe they should be protecting themselves.
Unfortunately what happens is the damage you get, you don't see for 10 or 20 or more years. So a lot of that damage you had as a child, you can't undo.
On the other hand, it's like cigarette smoking. It always pays to stop. So you can protect yourself prospectively, but you really can't get rid of some of the damage you've had in the past.
GUPTA: And that's an important message. Nobody is saying at all that, look, it's too late ever, right?
RIGEL: It's never too late to start having the right behavior in terms of protecting yourself from getting skin cancer.
GUPTA: All right, doctor, it is summertime. Lots of viewer questions coming on this topic. Let's start with one right away. John in Louisiana asks this. "Is it possible to get what malignant melanoma in an area that is not exposed to sun?" Dr. Rigel? RIGEL: Well, you can. You're obviously more likely to get melanoma where you do get the sun. But there have been studies that have been done on animals that show if you take one square centimeter and -- of an animal's abdomen, a little mouse, and you hit it with ultraviolet radiation, they will get more melanomas at that site, but they'll also more melanomas elsewhere. And the reason for that is the theory is your body is constantly being bombarded with ultraviolet radiation. And microscopic melanomas are popping up. And your body's immune system are correcting it.
For some reason or another, that stops and a melanoma slips through. Ultraviolet radiation from the sun actually lowers the body's immune response. And therefore, melanomas can pop up not just where it hits it, but anywhere on the body.
GUPTA: That's really interesting. So it's not just the sun exposure, but actually possibly making you more -- less immune to them as well. Keeping on topic there, skin cancer is a primarily disease of Caucasians, but do people with darker complexions have to worry?
RIGEL: Well, the fairer skinned you are, the easier you sunburn, the more poorly you tan, the higher your risk. But anybody can get skin cancer. The risk of a Hispanic American roughly getting melanoma is about one-sixth that of a Caucasian. African Americans about one- twentieth that. But the reality is, anybody can get skin cancer.
GUPTA: And doctor, as we know, melanoma is deadly. A lot of people have heard that. And it's striking young women at an increasing rate. It's now the most common cancer in women between the ages of 25 and 29 years old we found out. I know there was some hope for a vaccine for treating this disease. And others have found some statins, for example, that might help in preventing some melanomas. Where do we stand in terms of new therapies?
RIGEL: Well, melanoma's probably the most clear cut case of a cancer, where if it's early and it's treated, it's treatable. It's done, virtually.
If it's advanced, nothing works. So there's been a lot of work on trying to treat advanced melanoma. The problem is that people are so advanced sometimes that are tested in these therapies and these protocols that, in fact, they're so far gone that nothing's going to work and the protocol may not work.
Other cancers, you have a more continuous spectrum of people from good prognosis, medium prognosis, poor prognosis. In melanoma, it's either good prognosis or bad prognosis. So it's hard to do those tests.
RIGEL: Hopefully at some point, we will have a vaccine if we can identify those at high risk for developing melanoma, vaccinate them, and perhaps protect them from developing melanoma later in life. GUPTA: OK, let's get to another e-mail as well now. Deborah in Illinois asks this. "How often should I see a dermatologist to have a full body check for melanomas and other skin cancers? At what age should I begin these kinds of exams?"
RIGEL: Well, we as dermatologists obviously see this problem every day. And one of our suggestions is on your birthday, have your birthday suit examined. If you do that, basically once a year, almost anything that pops up will be at a point where it's still pretty much treatable. So it's a good idea to do that.
In terms of skin cancer, usually unless you have a very strong family history of other skin cancers or melanoma in particular, we recommend coming in when you're about age 21. As a child or a teenager, it's really not necessary, unless you're concerned about a spot that's changing.
GUPTA: And that is if you can actually get an appointment with the dermatologist. One I understand that's very difficult, Dr. Rigel. We'll talk more about that as well.
Melanoma is the most deadly, but thousands suffer from other forms of skin cancer as well. You need to know about them. Stay tuned.
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UNIDENTIFIED FEMALE: It was a cancer cell. They weren't sure how bad it was.
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UNIDENTIFIED FEMALE: What you need to know about the most common forms of skin cancer. It may save your life.
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UNIDENTIFIED FEMALE: I had sunburn all on my neck and tops of my shoulders, and on my cheeks.
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UNIDENTIFIED FEMALE: Find out why this woman got burned and how you can avoid it.
First, take today's quiz. What are the two most common sunscreen mistakes? A, choosing the wrong SPF and missing spots? Or B, using too little and waiting too long to reapply. That answer coming up.
UNIDENTIFIED FEMALE: Before the break, we asked, what are the two most common sunscreen mistakes. Choosing the wrong SPF and missing spots, or using too little and waiting too long to reapply? The answer? B. A study of beach-goers in Texas found most people who used sunscreen came home with a sunburn anyway, thanks to those two mistakes.
GUPTA: As your mother always told you, reapply. Really important.
We've been talking about melanoma, but that only accounts for less than 5 percent of skin cancer cases.
Christy Feig is back to fill us in on the most common types of skin cancers and what to look for.
CHRISTY FEIG, CNN CORRESPONDENT (voice-over): The symptoms began two years ago for Patricia Smeltzer.
PATRICIA SMELTZER, SKIN CANCER PATIENT: It was like a scab that would break over and over again. And every time I got sick, it got bigger.
FEIG: She did not spend a lot of time in the sun and was totally unprepared for the diagnosis she got from her dermatologist.
SMELTZER: It was a cancer cell. They weren't sure how bad it was. It was very deep. And it bled constantly.
FEIG: Patricia's skin cancer, like 80 percent of those diagnosed, was a basal cell carcinoma. Another common skin cancer is squamous cell carcinomas, representing 15 percent of all new cases.
The main cause is exposure to ultraviolet radiation from the sun. But the good news is that both basal cell and squamous cell carcinoma have a better than a 95 percent cure rate if they're detected and treated early.
UNIDENTIFIED FEMALE: Look for lesions that don't heal, persistent sores, rapid growth of a lesion, a shiny or red patch that does not seem to match any other location on the body, a wart-like growth.
FEIG: Surgery is still the standard treatment, but there are new treatments on the horizon.
UNIDENTIFIED FEMALE: For the first time, we have a cream to treat a skin cancer.
FEIG: It's called Aldara cream, approved by the Food and Drug Administration last year to treat superficial basal cell cancer. The cure rates are high, between 80 and 87 percent.
Patricia's doctor used Aldara to treat her skin cancer with striking results. But experts caution this cream is not for everyone, like those with a recurring large or invasive skin cancer. For those people, a surgical technique called Moe's micrographic surgery has a higher cure rate.
Christy Feig, CNN, Washington.
GUPTA: Christy, thanks again.
Moe's surgery is generally reserved for larger, recurring cancers, which often are basal or squamous cell cancers. This allows doctor to remove layers of a cancer without having to take an excessive amount of the surrounding tissue.
Our guest Dr. Darrell Rigel knows all about Moe's surgery. He's a dermatologist who specializes in skin cancer.
And doctor, let's jump right back into our e-mail folder. Mike in Massachusetts asks this. "Last year I had a Basal cell cancer removed from either side of my nose. How likely is it to return?"
RIGEL: Well, first of all, the most common site for skin cancer is the nose. One-third of all skin cancers occur on the nose. That's why it's important to protect yourself in that area. If you've had a basal cell cancer on the nose, and it's been treated with Moe's surgery, the chance of it coming back are only maybe 1 or 2 percent. And that's why most Moe's surgery is done, in fact, on the nose.
GUPTA: That's good news for Mike from Massachusetts. Let's get some really practical advice here. Up to this year, the gold standard for discovering skin cancer has been to check your ABCs. A lot of people have heard that, but this is what it means.
A means asymmetrical shape. Look for that. B, pay attention to see if it has an irregular border. C stands for color. If a mole has different shades of color, beware of that. And also, D is diameter. Most moles are no bigger than a pencil eraser. So if yours changes in size, check with your doctor.
And now just recently our guest, Dr. Darrell Rigel, along with other dermatologists at NYU added to that checklist. And doctor, you've gone into recommending an E. What does E stand for?
RIGEL: Well, Sanjay, E stands for evolving. And when you're looking at moles on your skin, if one is evolving or changing at a rate different than the other moles, that's a warning sign. That's when you should see your dermatologist and have the mole checked.
It's easy to check a mole. A skin biopsy takes about three minutes to do. We can look at it under the microscope and find out right away if you need more treatment.
GUPTA: And this is some of the most important advice we may be giving people all summer long. Get those moles checked out. While the UV rays from the sun are dangerous to our skin, the sun also provides us with much needed Vitamin D. And this sometimes causes confusion for some people, like Ann from Virginia who writes this. "We've been told to use sunblock and stay out of the sun as much as possible to avoid skin cancer, yet there is also evidence that we need vitamin D from sun exposure to help prevent osteoporosis and other conditions. How do we balance the two?"
And doctor, you know, is there an easy answer to that?
RIGEL: Well, that's a question I'll tell you that a lot of my patient do ask because it's certainly been in the news recently. And there's a lot of benefits to vitamins -- vitamin A, vitamin C, vitamin D involved in the skin and other things.
It turns out that vitamin D is actually converted from the form that you take it into its useful form by being in your skin and getting a little bit of sun. But all it takes to convert a reasonable level of vitamin D in your skin is maybe 10 to 20 minutes a week just to be exposed to the sun. So just in your day-to-day activities, walking in and out of your car, in and out of the supermarket and whatever, you get plenty of exposure to convert the vitamin D in your skin.
GUPTA: All right, good point there. So you don't need to be out in the sun, certainly not to the point where you could potentially put yourself at risk for skin cancer.
GUPTA: Good advice. We're talking to Dr. Darrell Rigel. Really important topic. Coming up on HOUSECALL, how do you know which sunscreen is best? Tune in next to find out.
UNIDENTIFIED FEMALE: Ah, the choices, haba, zinc, creams and gels, which sunscreen is right for you?
And from baking your skin to grilling with friends. Find out what your favorite treats really cost you.
But first, this week's medical headlines in "the pulse."
CHRISTY FEIG, CNN CORRESPONDENT (voice-over): If you're a woman taking vitamin E for health reasons you may want to reconsider. A long-term clinical trial by the Women's Health Study has found the supplement does not help prevent heart attacks, stroke or cancer. Nearly 40,000 women aged 45 and older were followed for approximately 10 years. They were randomly given 600 international units of vitamin E or placebo.
The study found no significant difference between the two groups in the number of nonfatal heart attacks or strokes.
Christy Feig, CNN.
ROB MARCIANO, METEOROLOGIST: Good morning again. I'm Rob Marciano on the CNN Weather Center. We are watching closely Hurricane Dennis, which overnight last night, went into Cuba, decreased in intensity somewhat into the Gulf of Mexico as a category 1 storm, now back to category 2 status with winds of 105 miles an hour and heading towards the northwest.
But tornado watches are out for much of the state of Florida. We've already one tornado touch down just south of Tampa. So this is a serious situation, even though it's not going to make landfall along the lower Florida peninsula.
As far as the forecast track is concerned, off towards the northwest at 15 miles an hour, that brings it towards the Florida panhandle very close to where Ivan made landfall last year as a 2 or 3 category storm, sometime tomorrow afternoon. More of this throughout the morning. Now back to HOUSECALL.
GUPTA: Well, it's been drilled into you how important it is to wear sunscreen. Hope we've gotten that point across. But could your lotion be better? Some experts say our sunscreens are inferior to those found in other countries. And it all has to do with an ingredient called Mexoryl.
DEBORAH ABRAHAMS, HIGH RISK FOR SKIN CANCER: I have had pre- cancerous moles, atypical removed surgically, about three or four of them.
GUPTA (voice-over): Not surprisingly, she wants the best product available to help. Problem is this, she can only get it on the black market. It's called Mexoryl.
DR. JOEL KAUFMAN, DERMATOLOGIST: Mexoryl is believed by most to be the best mid-range UVA blocker that we have available today. Unfortunately right now, it's not available in the United States.
GUPTA: It's been available in Europe for over a decade. But only a few here in the United States know about it, or can even get their hands on it. That's because...
KAUFMAN: Selling a medication that is not FDA approved is illegal in the United States.
GUPTA: Now the truth is the FDA is unlikely to track you down and prosecute you. In fact, what is actually illegal is the promotion and marketing of the product.
So what is the magic of Mexoryl? Many of the sunscreens today may do only half the battle. That is, they may only fight UVB rays. What is missing, and this is important, is the fight against UVA rays.
UVB can cause a sunburn. But UVA rays are easy to forget. After all, they skip right past the skin's surface, and go straight to your collagen. That is a set-up for cancer.
So if you're not comfortable breaking the law, here are some things you can do besides avoiding the sun or investing in that stylish wide brim hat.
Read the label. You're looking for Parsol 1789. Write that down. It is one of the only UVA blockers approved currently. Make sure to combine it with a good UVB blocker.
Also, zinc oxide and titanium dioxide protect the skin by physically blocking both UVA and UVB.
GUPTA: No matter what kind of sunscreen you wear, it's important to remember the SPF formula. Take this example. It normally takes a fair skinned person 15 minutes to burn. If that person puts on an SPF 30 sunscreen, multiply 15 by 30 and that person technically should be protected for 4 hours and 45 minutes.
Of course, experts will still tell you should reapply every two hours.
And our expert this morning is Dr. Darrell Rigel, a dermatologist and professor at NYU Medical Center.
Doctor, we receive lots of questions about sunscreen specifically. Let's get to one of the best. David in California writes this.
"Since I live in a beach city, applying an effective sunblock is important to me. I would like to know which type of broad spectrum sunblock is the most effective."
And doctor, I mean, there are so many choices out there when you go to the store. How do you pick the best sunscreen?
RIGEL: Well, it's hard in a way because there are so many choices out there. My general rule of thumb is that you want to have at least an SPF 15 or higher. You want to pick a sunscreen that protects both against ultraviolet A and ultraviolet B rays, the rays that burn you as well as all ultraviolet rays that age you, but they both cause skin cancer.
The problem is that the word broad spectrum doesn't mean anything. It's a marketing term that they put on sunscreen. And that's where people get stuck. So the trick is try to pick sunscreen with a few of the different sunscreening agents that are in there to try to give you the broadest possible coverage.
GUPTA: Do you wear sunscreen every day, doctor?.
GUPTA: All right. The dermatologist does it, you should at home as well. Grab a pen. When we come back, find out how to find skin cancer screenings in your own neighborhood. Stay tuned.
UNIDENTIFIED FEMALE: Coming up on HOUSECALL, could your medicine make you sick this summer? We're checking your medicine cabinet, after the break.
UNIDENTIFIED MALE: Lunch is ready!
HOLLY FIRFER, CNN CORRESPONDENT (voice-over): Hot dogs, hamburgers, steaks on the grill, all the usual summer barbecue favorites. But over-filling your plate here could mean extra pounds when the dog days of summer are long gone.
Consider the high caloric content of some of your grilled favorites. A regular hot dog with ketchup equals 310 calories and 13 grams of fat. Classic backyard burger is 470 calorie with 29 grams of fat. Add cheese and add 50 calories and 10 more grams of fat.
Now this doesn't mean you can't still enjoy summertime cookouts. Instead of an all you can eat feast, experts recommend watching portion sizes. So say no to seconds. And opt for low-fat sides and condiments. And remember fresh summer fruit makes a light and healthy dessert.
Holly Firfer, CNN.
GUPTA: Thanks so much. And if you're not broiling in the sun and wearing enough sunscreen, you're safe, right? Well, not necessarily. Elizabeth Cohen says check your medicine chest before you leave the house this summer.
ELIZABETH COHEN, CNN CORRESPONDENT (voice-over): It's beach time and of course, we all know how important it is to protect our skin from the sun's harmful rays. For most people, sunscreen usually does the trick. But not for Annamarie Decarlo, an avid boater, Anna Marie always used skin protection. She usually never burned. But a few weeks ago, she woke up with a serious burn and couldn't understand why.
ANNAMARIE DECARLO, SUNBURNED: I had sunburn all on my neck, on the tops of my shoulders, and on my cheeks. And just really didn't believe that it happened because I'd had so much sunscreen on.
COHEN: Doctors told Annamarie it was her medication. She'd been taking an antibiotic for her bronchitis. And that caused her to have a phototoxic reaction.
LYNN MCKINLEY-GRANT, DR., DERMATOLOGIST: It's a combination of having the medicine and then being exposed to the sun. And it can be after minimal amount of sun. And suddenly, you're just very, very red.
COHEN: Medications that can increase sunlight sensitivity include antibiotics, blood pressure medicines, over the counter anti- inflammatory drugs, anti-wrinkle creams like Retin A, acne medicine, and even birth control pills and certain vitamins.
Doctors recommend that patients on medication read the labels carefully before venturing outside for long period of time.
Elizabeth Cohen, CNN, Atlanta.
GUPTA: Elizabeth, thanks. And for more information on skin cancer, go to the American Cancer Society at Cancer.org. And to find out if there's a free screening near you, click on the American Academy of Dermatology. That's at www.aad.org. Or you can call them at 1-888-462-3376.
Unfortunately we're out of time for today. I want to thank Dr. Darrell Rigel. Really important stuff. Thank you so much for your time.
RIGEL: My pleasure.
GUPTA: And thank you at home as well for all of your great e- mails. I hope you learned something today. Tune in next week as well for another edition of HOUSECALL. That's at 8:30 Eastern on Saturday and Sunday.
Remember, this is the place for the answers to all of your medical questions. Thanks for watching. I'm Dr. Sanjay Gupta. Stay tuned now for more news on CNN.
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