 But joining us now to talk about your health is Dr. Zaneb Maksoumi, Assistant Professor of Dermatology at the University of Maryland School of Medicine and Dermatologic Surgeon at the University of Maryland Medical Center. Dr. it's great to see you again. Thank you for having me back. Live and in person. That's right, no zoom. You would be so proud of me. I was at an outdoor high school graduation over the weekend. It was a bright sunny day and I remembered sunscreen. Ah, I'm touched. It wasn't necessarily the best sunscreen because I remembered it right when I got to the event. So it was the little travel size thing that I've kept in my car. May have degraded a bit, but I'm sure it was better than nothing. Better than nothing. Better than nothing. Well, I'm very proud of you. Let's skip straight to sunscreen for a second because the solstice is what, 10 days away, something like that. The brightest day on the calendar and there's a direct relationship between sun exposure and skin cancer. That's right. And we know skin cancer is not a mystery anymore. I mean, there are some elements that we don't know about, but for the most part we know what causes skin cancer and that's the sun. It's ultraviolet. It's damage over time from ultraviolet radiation that actually changes your DNA. It changes the cells and over time causes enough mutations to develop into cancer. And we know how to prevent that. There are several ways to do so. One of the easiest things to do is sunscreen. And as a dermatologist, I think one of the most common questions that I get in the office is patients come in and they want to know what number and what brand and should it be spray or should it be cream? And for the most part my answer, which might be frustrating for patients, is my favorite sunscreen is the sunscreen that you wear. So when it comes to brand, when it comes to formulation, when it comes to the actual SPF, the sun protective factor, number, I don't want people to get lost in the details because it turns out that we now know that a lot of that stuff is just not as important as just wearing the sunscreen. You probably would not approve of the stuff that I used to wear many, many decades ago in my lifeguarding days, which I think was like an SPF of four, something ridiculous. It was more about tanning than protection. Right. And you know, as a Mohs surgeon, I unfortunately have a lot of patients who say that when they were kids, their parents had them out there in baby oil to actually enhance the tan. But in terms of the number, it now turns out that once you get above 30, 35, the actual effectiveness of that sun protection factor is sort of approaches a constant. So it's not so much, you know, when you talk about why we're SPF 100, it's more just for drama. You know, you say that it turns out that the effectiveness is not linked to the number. Once you get above 35, but rather the frequency of application and the surface area. So it turns out that most patients do not use enough, nearly enough. They say that to cover, right? I tell my patients to cover your body. You want a shots glass worth, which is, I don't know. It's been a long time. That would have been the entire container of this travel size I had. It is. I mean, it's about a ounce and a half. It's a lot. So you want to use a whole shots glass worth to cover your body. And if you're going to be outside at a graduation, you want to make sure that you're reapplying every few hours. The other thing you see on the label sometimes is broad spectrum or UVA UVB, different kinds of ultraviolet light. Yep. Does it matter? Well, it doesn't. I mean, it doesn't, it doesn't. What they're talking about is they're talking about chemical blockers and physical blockers, the sort of the physical blockers and the more inert substances, they kind of just sit on your skin and they physically block their broad spectrum blockers. That's like your titanium, your zinc oxide. You know, when you think of like the chalky white stripe people used to wear on their nose, those are the physical blockers. Chemical blockers are going to be a little bit more sort of reactive in that they rely on inactivating the ultraviolet radiation. And those are the ones that have been a little bit more in the news recently about in terms of safety and effectiveness. The physical blockers are typically my favorite for patients and that's what I tend to recommend. How does it go getting that stuff on, say, five-year-old boys? Well, I have two. And just hypothetically, if you have two five-year-old boys, a lot of times it can be a little bit of a struggle. And that's where I like to use some protective clothing, rash guards, you know, hats with the flaps in the back. And when all else fails, just kind of holding them down and smothering them with the sun. Not the spray stuff? I don't like the spray as much. As long as you're doing the spray inside, it's fine. Where we have run into trouble with patients is patients who are applying that spray outside on the beach at the pool where ambient, you have a lot of ambient wind that's going to take the aerosolized because they put the sunscreen into aerosolized particles and it's really hard to make sure that you're getting direct application where outside the wind takes it all over. Let me remind our viewers if you have a question for the doctor about skin cancer, give us a call. We'll have the number up on the screen. You can also email a question to livequestionsatmpt.org. We've been having fun talking about sunscreen, but let's talk about the serious side of this. You operate on people who have varying kinds of skin cancer. Melanoma is the most feared, right? Correct, correct. How does somebody, if they're looking at their own skin and everybody's got some blemishes of different kinds, what should people look out for? That's a great question, yeah. And in terms of skin cancer, there are a whole host of types of different skin cancers, but we typically lump them into two big buckets or baskets, non-melanoma skin cancer, which encompasses a whole host of different skin cancers, and melanoma. So yeah, we separate out melanoma because as you said, Jeff, it is the most deadly, it is the most feared. It's the melanoma that if not caught early, unfortunately, can spread very rapidly to first the lymph nodes and then to distant organs, such as the brain, the liver, the lungs. And so in terms of what patients can do, there are some criteria that one of our governing bodies, the American Academy of Dermatology, has come out with, and that's the ABCDE rule. That's a mnemonic that they came up with. So for people to take those letters, apply them to a mold that's changing. And if it fits three, maybe even two of those criteria, you should call your dermatologist. A stands for asymmetry. So typically a benign mole, a friendly mole, you should be able to kind of do a line down the middle and they should be symmetric on both sides. If you have something that's very uneven, it has one circular on one edge and jagged on the other, that's a warning sign for melanoma. The B stands for border. So safe moles, healthy moles have a nice smooth, even border. If you're looking at the spot and it's not smooth, it's kind of jagged or you can't see where it starts and stops, it doesn't have a defined border, that's another warning sign. The C is for color. So safe moles should be one color. They can be pink, they can be red, they can be brown, but they should be one color and they should stay that one color. Once you start to get two, three, four different colors together, that's another warning sign. The D is for diameter. So anything greater than about a pencil eraser you should have looked at by a board-certified dermatologist. And E is for evolving. Anything that's changing, you know, you say, oh, well, this is getting darker or this is elevating or all of a sudden this is bleeding or painful, definitely warrants a call to, again, a board-certified dermatologist. Because it makes a huge difference if you catch it early. Huge. The cure rates from, yeah, I mean, we could, you know, I won't bore you with the statistics, but the cure rates for melanoma when caught early, we're talking 99.5, 99.6%. I mean, so that, you know, in terms of medicine, it doesn't, you know, it doesn't get much better than that. You're basically cured. Melanoma, unfortunately, when it has spread and metastasized the five-year survival, you know, we talk about survival in months, really, unfortunately. It's something like 20% of Americans will have some sort of skin cancer, generally not melanoma, basal cell or whatever. Those more treatable. Exactly, yeah, one in five. That's exactly what it is. That's impressive. One in five Americans will develop skin cancer by the time they reach the age of 70. The lion's share of those people will develop non-melanoma skin cancer, which is mostly basal cell and squamous cell. And it's not, you know, I always tell people when they're coming for most surgery that, you know, when they have a basal cell, I say, look, if you're going to get a skin cancer, this is the one you want because this is the one that just sits on the skin and it can be quite indolent. Once we remove it with most surgery or a basic surgical technique, the cure rates are over 99%. And, you know, people go on to live normal, happy, healthy, full lives. You know, Jim Palmer, the Orioles' great picture, Hall of Famer, talked publicly about having had most surgery recently, spent a lot of time at his youth outdoors in the sunshine. And so tell us more about the procedure because on camera, doing the Orioles game on Mastini looked great. That's right. And this was something near as I believe. Yes, that's correct. The process of most surgery, the procedure that I specialize in called most surgery is a unique sort of technique whereby one person acts as not just surgeon but pathologist. So you have one person who removes the tumor and that same person actually looks at the tumor under the microscope and they're able to see on a cellular level if that tumor has any roots or traces and if they do, then the surgeon goes back, takes a little bit more and goes and examines that under the microscope. And that process simply repeats itself until the most surgeon comes in and says definitively that on a microscopic level the tumor is gone and then the focus of the most surgeon shifts to reconstruction. And nowadays, with excellent training, we have amazing techniques to make scars. You know, hopefully invisible, you know, that certainly is our goal, is to make the scars look as good as possible. But our, you know, our primary goal, the most important part of what I do is to remove the cancer. It's just, it's a bonus that we get to make people with these techniques look really good. A viewer wants to know even with a sunscreen or a block of 35 or greater, is there a limit on the maximum amount of time during the day that you should be out in the sun? Some people, occupationally, you need to be out there, but if you have a choice. For sure. Ideally, we typically tell people to try to avoid being outside during what we say is peaks on hours, peaks on hours typically being between 10 and 2, which as you said, sometimes is unavoidable for people who have an outside profession. They have to be outside during those times. So that's when we say frequent reapplication typically every 120 minutes. You told me something before that that that I didn't know the world's skin cancer capital is. Australia. Australia. Because of the latitude. The latitude and the the skin type. Okay. Very fair skinned on a lot of sun exposure at a very intense level. Does it matter if you get a sun burn rather than, you know, just having some amount of sun exposure that makes you tan? If you get a bad burn at some point, is that a bad thing? Absolutely. There are two separate tracks that kind of follow you through your life. There is intense sun exposure, which is sunburn, that's the risk associated with melanoma. So if you have five sunburns in your life, you have already doubled your risk of melanoma. So melanoma is associated with sunburns. This kind of slow chronic exposure, you know, year after year, you know, five minutes here, 10 minutes there of this low grade sun exposure is linked to basal cell and squamous cell. So you do. It's very interesting that you have these two parallels. All right. Big long summers ahead of us. Everybody should be good. Dr. Zaynab Maksuni University of Maryland Medical Center. Thank you so much for joining us. My pleasure. Thanks for having me. Your health segments are a co-production of Maryland Public Television and the University of Maryland Medical System.