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Melanie: Welcome to Back To Health, your source for the latest in health, wellness, and medical care, keeping you informed so you can make informed healthcare choices for yourself and your whole family. Back To Health features conversations about trending health topics and medical breakthroughs from our team of world-renowned physicians at Weill Cornell Medicine.

I'm Melanie Cole. And today, we are discussing skin cancer awareness. Joining me is Dr. Andrew Alexis. He's an Assistant Professor of Clinical Dermatology at Weill Cornell Medicine, Dr. Alexis, it's a pleasure to have you join us today. This is a great topic, but before we jump into it, you're new to Weill Cornell Medicine. Tell us a little bit about yourself and how this came about and what are your interesting specialties.

Dr Andrew Alexis: So I'm new to Weill Cornell as a faculty member, but by no means new to the organization. I actually did my training here to be a dermatologist about 18 years ago. So it's nice to be back home after 18 years. I've spent most of those 18 years working in another institution in New York City, but being focused on the unique needs of the very diverse and broad population that would be characterized as having skin of color. So these are the richly pigmented populations that would generally self-identify as belonging to one of the non-white racial ethnic groups.

Melanie: Such an interesting specialty. Thank you for sharing that, Dr. Alexis. So now, UVA, UVB, we hear these terms thrown around. These rays, what do they do to our skin? Tell us a little bit about how skin cancer develops and even can it be prevented.

Dr Andrew Alexis: So when we think about the sun and the potential risks from sun exposure, there are two ultraviolet rays that are particularly important in this context. That's UVB and UVA. And UVB is the wavelength of ultraviolet radiation from the sun that contributes to the sunburn, to redness, the redness that one can get or other features of a burn come from UVB. And it's easy to remember, UVB for burning. UVA can penetrate the skin deeper and can also contribute to risk of skin cancer. And it's responsible for the tanning response primarily.

So we have UVA, which can contribute to increase pigment or tanning, and UVB, which is associated with burning. Both of these ultraviolet radiation spectra are damaging to the skin and are associated with increased risk for skin cancer when there's repeated and sustained damage from prolonged or excessive sun exposure over one's lifetime.

Melanie: Well, thank you for that. So let's talk first a little bit about sunscreen, reapplying, what SPF means. Tell us a little bit about prevention. And because of your specialty, can you clear up for us about sunscreen and skin color? Because that has been covered in the media. It's been on TV shows. Clear that up for us a little bit.

Dr Andrew Alexis: So the first part of your question, which is, you know, what can we do to prevent skin cancer and sun protection, which includes not just sunscreens, but it's a package of sun-protective behaviors as I like to call them. One key component to that is wearing a broad spectrum sunscreen that protects against both UVA and UVB and reapplying that sunscreen every two hours, if we're going to be doing prolonged outdoor activities.

But in addition to the application of sunscreen, other measures that are very important include wearing a broad-brimmed hat, seeking the shade when planning outdoor activities, doing your best to plan them before 10:00 in the morning or after 4:00 PM in the afternoon. And this way you get to avoid the sun when it's at its peak as far as its intensity. So these are all helpful tips to have safe sun habits and minimize risk for skin cancer.

Now, your second question about what about darker complexions or skin of color? And the question of whether do darker skin tones also need to practice safe sun habits? The answer is absolutely yes. Individuals of any background, any complexion, any racial ethnic descent are at risk for skin cancer.

Now, there are differences in the level of risk and the incidence of skin cancers between populations. And it does turn out that melanin in the skin does provide some natural protection against the damaging effects of the sun. And so we do see lower rates of skin cancers in darkly pigmented or melanin-rich populations. But by no means is anyone completely immune to the effects of the sun and the risk of skin cancer.

This is particularly important in populations of color because when skin cancers do occur in populations with skin of color, we tend to see that the diagnosis is made later at later stages, and so that the skin cancer is more advanced and, therefore, the prognosis is often worse. So this really speaks to the need for everyone to practice safe sun habits and be vigilant about surveying one's own skin. So you can be in a position to detect early any new or changing spots, growth, or other changes in the skin that might be a warning sign for skin cancer.

Now, Melanie, I would also like to mention that in people of color, people with richly pigmented skin, we see a great deal of disorders of hyperpigmentation as we call it, in other words, uneven skin tone. And it turns out that the sun can be a major exacerbating factor for these disorders with hyperpigmentation. So this is yet another reason where sun protection is important and where we leverage the benefits of sunscreens and other sun-protective behavior.

Melanie: Well, I think that leads us very well into the next question. What are we looking for, Dr. Alexis? Tell us about those ABCDs that we're looking for for skin cancer or anything unusual. And if we see something, say something, tell us a little bit about those signs.

Dr Andrew Alexis: I'm sure many listening to this have heard about the ABCDs of melanoma. And again, melanoma is just one of the three major skin cancers that we see. The other two include basal cell carcinoma and squamous cell carcinoma. But in the context of ABCDs, if we're talking about melanoma, which is the most serious of the three common skin cancers.

And, without going through what each letter stands for, I'll just at a high level describe some of the key things we're looking for. So brown spots or moles that are not symmetrical, don't have a sharp border, that have variations in color or have a diameter that's greater than six millimeters, which is approximately the size of an eraser on a number two pencil. These can be warning signs for melanoma. It doesn't mean that if you have one of these specific criteria, you automatically have melanoma. But these are just helpful tools to help in early detection of spots that might be melanoma.

Melanie: So older folks were never really aware of the risks. I'm in my late fifties and we used to sit out there with baby oil and tinfoil right? So if we use sunscreen now, is it too late? Are we kind of past the point where we can protect ourselves?

Dr Andrew Alexis: No, it's never too late to practice safe sun habits and protect yourself from the potential damaging effects of the sun. So while we can't go back in time and erase those periods of time where maybe we weren't as cautious or as knowledgeable, it's still important going forward to protect the skin from the sun. And with respect to past exposure, if we have that experience of sunburns and prolonged sun exposure in our past, it's really an indication for frequent and regular surveillance of the skin. And I recommend surveying your skin the first of every month as a routine, for example, so that you're in a position to detect anything new, anything that's changing in color, size, shape, something that suddenly becomes itchy or scabs or bleeds easily, all of these would be potential warning signs that should be evaluated by a dermatologist.

Melanie: Well, how often should we see a dermatologist about our skin and to kind of help us check over everything, look at the spots we can't see, all of that?

Dr Andrew Alexis: Great question. And the answer to that question is different for different folks, because there are individuals at higher risk than others. But as a general rule, once a year, full body skin examination is the ideal. And by full body skin examination, I mean, head to toe because, whilst the sun is the most important or most common risk factor for most of the skin cancers we see, there are instances including in patients of color where skin cancers can occur in places that don't get much sun exposure at all. So we have to look at everything from the hand to the toes, bottoms of feet, between the toes, and areas that are typically covered up by clothing.

Melanie: That's such great information, Dr. Alexis. Such usable information. And before we wrap up, I'd like you to do a few things if you would. I'd like you to talk from a dermatologist perspective, if we do get sunburned, if our children get sunburned, if any of that happens, what you recommend we do about it. And then reiterate about sunscreen. Give us a little of your best advice about how often we should reapply it, any SPF information you would like to share. Kind of really give us your best advice, because we all need to hear this.

Dr Andrew Alexis: Sure. I'd be happy to. So the first question, the scenario of despite one's best efforts, you ended up or a family member ended up with a sunburn, what do you do? Well, a sunburn is if the skin's response to injury from the ultraviolet rays from the sun. And part of that response is inflammation, and so using a topical corticosteroid like hydrocortisone as a starter, but you might need a prescription for something stronger, depending on the severity of the burn can help to relieve some of that inflammation and give you some immediate or quick relief.

Then, just good moisturization with products that are moisturizing creams and lotions. Aloe is a traditional therapy, which can be helpful. And you're basically just trying to allow the skin to heal from this injury, which will go through stages. From redness to peeling and then ultimately, healing with usually with a tan, if your skin is capable of tanning. In more severe cases, blistering sunburns, this is something far more serious and would warrant getting a dermatologic care urgently.

So just to reiterate my recommendations for sunscreen, looking for a sunscreen that is a broad spectrum sunscreen. That means it protects you against UVA and UVB. What SPF should you use? That's a common question. Well, I recommend an SPF of 30 or greater as a general rule. If you're going to be in more intense sun areas, areas with more intense sun or the activity you're going to be doing is particularly prolonged, nothing wrong with going much higher than SPF 30, to get that extra protection.

But you do need to reapply, no matter how high the number is after two hours, you will start to lose some of the effects. So you want to reapply every two hours, if you're outdoors for a prolonged period of time.

You also need to reapply if you're swimming. So once you come out of the water, you got to reapply. And family's going on vacation with their children. this can be a challenge of getting that sunscreen on your children, but finding that formulation of sunscreen that is the easiest for you to get you on yourself or your family members is key. And luckily, we have so many different options from creams to lotion sprays that's okay. Any of them, as long as they are broad spectrum on the label, and have at least an SPF of 30 are suitable.

You touched on other reasons why we might want to protect our skin from the sun and use sunscreens. And think that's a great question. It turns out that a lot of the features of aging of the skin that we associate with aging, these are caused by or accelerated by sun exposure. So fine lines, wrinkles, brown spots, laxity of the skin, these features that we associate with aging are worsened and accelerated by the sun. So we're going to see these happen at an earlier age and worse if one has extensive sun exposure. So this is yet another reason to use, sunscreen and practice safe sun habits from an early age.

Melanie: That's such great information. Thank you for wrapping that all up for us, Dr. Alexis. Thank you again for joining us.

And Weill Cornell Medicine continues to see our patients in person as well as through video visits, and you can be confident of the safety of your appointments at Weill Cornell Medicine. And that concludes today's episode of Back To Health. We'd like to invite our audience to download subscribe, rate, and review Back To Health on Apple Podcast, Spotify and Google Podcast. For more health tips, go to weillcornell.org and search podcasts. We have so many interesting podcasts in the library. And parents, don't forget to check out our Kids' Health Cast. I'm Melanie Cole,  

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