 We begin tonight with new developments in the fight against skin cancer, which will affect one in five Americans at some point in their lives. Joining us for our Your Health segment tonight is Dr. Zena Maksoumi, assistant professor of dermatology at the University of Maryland School of Medicine and Moe surgeon at the University of Maryland Medical Center. Dr. Thank you for being here. Thanks for having me, Jeff. So this disease is so common, yet it's also preventable. How does it happen? That's right. It's it's currently the most common cancer period is skin cancer and with it being so prevalent, it's it's it's frustrating that it's it's so easily preventable and skin cancer comes from ultraviolet radiation, either natural ultraviolet radiation from the Sun or artificial ultraviolet radiation from tanning beds. And what happens is the Sun accumulates decades and decades of damage from ultraviolet and exposure, eventually developing enough mutations to cause the development of skin cancer. So it doesn't happen immediately. I mean, if you're out in the sun too long, you come in at the beach or whatever. And you know, within an hour or two that you've gotten a sunburn, the skin cancer process is totally different. It is. And it's it's so aside from that sunburn actually does even one blistering burn doubles your risk from melanoma. So that one isolated event of a burn is not innocuous. I mean, it does have damages and consequences down the road, but that is down the road. It takes about 10 to 20 years for skin cancers to develop. So it's little bursts of sun exposure that cause skin cancer over time. And it's it's also chronic accumulation of sun that does cause cause cancer. But studies have shown that even one blistering sunburn doubles your risk from melanoma. So some people think that, oh, it's just one burn. It's not a big deal. Well, that that's not the case, actually. Even one burn can put you at rest down the road. Is there anything you can do after that one burn other than do a better job of protecting your skin in the future? Good question. So acutely, when we manage sunburns, most of that treatment is going to be for palliative for making the patient more comfortable. So we can do topical steroids to prevent that sloughing off the skin. You can do aloe gel can help sort of the cooling sensation helps with the actual pain of the burn. But there's nothing you can do once that damage is done once on a cellular level. The cells have absorbed the ultraviolet and they they've burned. Truly, there's nothing you can do to mitigate the risk at that point. We have a couple of pictures because I imagine everybody has got a couple of bumps on their skin and you wanted to be checked out by a professional. So let's ask a professional to identify these couple of things. And this, if you can see it up there, is obviously a problem. Yeah, that mole is definitely a problem. So when I counsel patients and when we talk to patients about what spots should be concerning, what spots should be worrisome, the American Academy of Dermatology, which is our governing body, has come out with ABCD rule. And that is sort of what we can use as a general rule for moles which should be worrisome. And the A stands for asymmetry. So any mole that you would bisect down the middle and they're not true mirror images of each other should be concerning. B stands for border irregularities. So any mole that's not a perfect circle that has scalloped borders or that has an extension on one side should be concerning. The C stands for color variation. So when we look at that mole, there are many colors. I mean, I see pink, I see red, I see dark and light brown. And so really benign moles should be an even color. Very even distribution of pigment. So any variation in that should be concerning. And D stands for diameter. Any mole with a diameter over six millimeters, which is for reference for everyone about the size of a pencil eraser. Any mole greater than that is concerning and should be evaluated by a board certified dermatologist. There's another picture. Also melanoma, I think. What are we looking at here? Yes, absolutely. That would be very suspicious to me for melanoma. And another interesting point with this photo, Jeff, for everyone to look at at home is there's a central area of scarring in the middle of that mole. And so and this is a phenomenon we see in melanoma called regression, where with extremely aggressive and invasive melanomas, the body will actually start to develop a scar within that melanoma, which can portend a worse prognosis. So any mole where you see scarred areas in the center should be evaluated immediately by a board certified dermatologist. Let me remind our viewers if you have a question about skin cancer, its treatment and prevention, give us a call. We'll have the number up on the screen. You can also email your questions. The email address is livequestionsatmpt.org. Tell us what you do. You are a Moe's surgeon, which is a specialty dealing with skin cancer. It is. I'm a Moe's surgeon. So and which is not an acronym, everyone thinks it's an acronym. It's actually named after Dr. Frederick Moes, who discovered and invented this technique in the 1930s. And what I do is I am specialized in the removal and reconstruction of non melanoma skin cancer, typically on the face. So depending on where skin cancers are, that dictates the type of treatment you have. And whenever you have a skin cancer on an area, which is, you know, what we call prime real estate, typically the face and the neck, you want a procedure called Moe's surgery where I remove a skin cancer. While the patients are waiting in the room, I'm looking under the microscope at all of the routes and traces under on a microscopic level. I'm able to map out if there's tumor where it is. And I keep going. I keep removing tissue until the tumors out, at which point I do the reconstruction for the patient. So it's sort of an all in one technique, which encompasses surgery, oncology, pathology and plastic surgery. So this is largely the, I don't want to say less serious, but the non melanoma skin cancers. What, how's melanoma dealt with? And how is a basal cell dealt with on some non prime real estate? Right. Okay. So first part of that question is how's melanoma dealt with melanoma is dealt with a little bit differently. Moe's surgery is typically reserved for those less aggressive, less virulent cancers where we're able to maximize tissue preservation, minimizing scar. With melanoma, Jeff, because Jeff, because they're so invasive, they're so aggressive, we tend to do a wide local excision where we don't typically try to preserve margin. We try to take as much as we possibly can, because melanomas are much more likely to metastasize. And so they get standard, standard excision with a basal cell. Let's not on the face. Most of the time that can be dealt with with less invasive methods, typically with general dermatologists can do a regular excision. Or we can even do even less invasive procedures like a scrape and burn called an electro desiccation and curatage, whereby you're able to take almost what looks like an ice cream scoop and just scrape out the cancer and the cancer is essentially cured at that point. Let's get to the phones. Allegheny County. This is Lisa. Thanks for the call. Go ahead. Yeah, I was wondering if you could compare and contrast the difference between laying in a tanning salon versus sunbathing at 2,200 feet above sea level in western Maryland. Great question. Thank you very much. Which would you choose? That is a good question, Lisa. And I would choose neither. It does turn out that the FDA has basically classified tanning beds as a carcinogen. The same way the FDA has classified cigarettes as a carcinogen. So truly tanning beds are carcinogenic in the very same way that the sun and the ultraviolet radiation from the sun is carcinogenic. So it's worse? I mean, is it worse than the sun? It's the same. It's that same ultraviolet radiation that it's there's no difference in the evolution of skin cancer. Whether the ultraviolet comes from natural or artificial sources, it's the same exact ultraviolet. It causes the same damage on a cellular level, which leads to the evolution of skin cancer. And so let's stop and think for a minute why people are doing that. People are paying money to go expose themselves because you look better or people think you look better when when you've got a little little flush, a little color, whatever it is. Right. I think it was, you know, Coco Chanel in Paris in the 40s, 50s, 60s, where it was that bronze goddess look that unfortunately we as dermatologists have spent decades trying to reverse. I tell my patients that pale is in. Pale is the new tan. And there was a time when pale was it. Right, right. That's true. It was a sign of effluence. Exactly. And I tell patients if they're if they're really, really set on having a tan, if they're really set on achieving that bronze look, that's fine. That's what self tanners for. That's what all these spray tans are for. I tell them, you know, go crazy in the spray tanning booth or get the self tanner, the self tanner lotion. The only harm with that is some people get a contact dermatitis to that. If people really want that tan, there are safe ways to achieve a tan that don't include putting yourself in a tanning bed or, you know, laying out and exposing yourself to those carcinogens. Let's go out to Frederick County. This is Tom. Tom, thank you for calling. Go ahead. You know, what about black people and tan? So I'm not one of those people that lived in the sun most of my life from the time I was about five years old up until the time I was well into my 40s. And I never once used a suntan lotion to I never knew existed until I was somewhere in my mid to late 20s. Can you give me something on that? Tom, glad you called. Thank you very much. Skin tone. You still need sunscreen. Absolutely. You absolutely do. It's the same. Again, you absorb the same amount of ultraviolet radiation. And over time, if you're even if you're not genetically predisposed, given, you know, your, your skin type, you definitely are still putting yourself at risk for the development of skin cancer. And I tell my patients that sunscreen should just be a part of your daily routine. You just make it part of your daily routine, particularly on your face and hands. Those are areas that we tend to see the development of a lot of skin cancer. There was a study on fair skinned people to go the opposite direction in terms of skin tone where sunscreen wasn't enough. That's right. Or it was ineffective. That's right. It was actually sort of counterintuitive. It was a study out of the NCI, National Cancer Institute down in Bethesda, which is a highly, you know, well respected institution. And what they found was that individuals who only wore sunscreen had the highest likelihood or probability of a burn. And what they found was it was those individuals that employed multiple layers of protection or levels of sun protection that had the lowest level of sunburn. And so that's why the AAD, the American Academy of Dermatology, has come out with what they call a comprehensive sun protection plan, which not only includes sunscreen now, but it also includes seeking shade whenever possible and wearing sun protective clothing. And it's not just sunscreen. And so and a lot of the times people aren't applying sunscreen correctly. They're not reapplying every two hours. They're not putting enough on. And so there's multiple levels of protection that you want to employ. Do you have a preference on the type of sunscreen, UVA, UVB, and what the SPF number ought to be? Great questions. And it's a question I get all the time in my practice. And you always want to go with broad spectrum. So UVA and UVB do different things. UVA is mostly associated with aging the skin and UVB with burning the skin, but both of them cause cancer. So you always want to go with a broad spectrum sunscreen. And in terms of the sun protection factor number, patients, you know, get really into the weeds on the number and 30 and 35 and 40 and 45. And it's not once you get above 30, you're not really achieving any more of sun protection. So you want to just make sure that you're using something above 30 and you're reapplying. That's the key. The key is when you're outside, you're applying every two hours and you want to make sure that you're applying to everywhere exposed to the sun. And that means the tops of the feet, the tops of the hands. I do a lot of surgery on the ears. Everyone forgets their poor ears. So you just want to make sure that you're applying to all those areas. A call from Howard County. This is Chuck. Chuck, thanks for the call. Go ahead. Hello. I have a question about something that happened to me when I was in some heavy brush. I got bit by something. There are two little spots and they look like they could be from a snakebite, but it's not certain. And as they've healed, they've gotten sort of knobby, the little beads of something under the skin. I wonder if you have any optimization about that. I doubt the fits into the skin cancer discussion. Might want to get it checked out. I agree. Who want to check out? So many people watching have got to have a couple of moles or something that they're at least in the back of their mind. A little bit worried about, can your internist, your family doctor take a look? Oh, definitely. And I think that that's where a lot of our referrals come from is from primary care providers, whether it's pediatricians who are seeing strange moles in the pediatric population or primary care family medicine doctors or internal medicine physicians who are finding moles of concern. That's where a lot of our referrals come from. And I must say that I have seen a lot of melanomas come through because of a really astute family medicine practitioner or a very astute internist who sends them our way. I think if you have access to that wonderful, you can also always find a board certified dermatologist on the AAD website is an easy way also to find one of us. There's no app for this yet. You can't you can't take your phone and take a picture of it. Just the eyes so far. Just the eyes of well trained eye. Prince George's County. This is Anna. Anna, thank you for calling. Go ahead. Yeah, what is, you get a melanoma on the bottom of your foot. Thank you very much. How does that happen? Question, Anna said that there are four major types of melanoma and acral antigenous melanoma is one of the least common types, but also can be one of the most aggressive and deadly types. Melanoma, for some reason, has a predilection for reasons unbeknownst to us yet for acral site. So that's the palms of the hands and the soles of the feet. That's why a full, thorough skin examination is required for anyone who's visiting a dermatologist for the first time or anyone who has a history of melanoma. You always want to look in between the toes on the bottoms of the feet and then the soles of the hands. Email question. This is Gwen wants to know if he can get a sunburn through glass. You're driving, you know, your arms in the sun. Is it in danger? That's a really good question. So UVB is the type of ultraviolet wavelength that's responsible for burning the skin and UVB is filtered out by window glass. So you're safe. Last call. Carol County, this is Lynn Lynn. Thank you for the call. Go ahead. Yes, I've been diagnosed with cutaneous lymphoma and I receive light therapy or phototherapy. And I'm wondering if that puts me at a greater risk for developing a melanoma. Lynn, thank you. Best of luck. Yeah, best of luck, Lynn. CTCL or cutaneous T-cell lymphoma is unfortunately a very aggressive condition and for which phototherapy is indicated a lot of times. I would say that you are at risk, Lynn, for skin cancer. And that's why it's it's important that you continue to see your dermatologist and they have a very low threshold for biopsy of any suspicious lesions. That's sort of an unfortunate where we have to treat the lymphoma, which unfortunately does put you at risk for the development of skin cancer. Dr. Zaynab Maksumi, University of Maryland Medical, message is sunscreen and get checked out. Absolutely. Thank you very much. Your health segments are a co-production of Maryland Public Television and the University of Maryland Medical System.