SUSAN CINGARI: Hello, I'm Susan Cingari, and welcome to our webcast from Miami.
When it comes to spending time in the sun, we all know the basics: protect yourself or you're burned. But there's more to sun care than just that. For example, do you know the difference between UVA and UVB rays, or what SPF your sunscreen should really be? And what about the risk of melanoma or skin cancer, which will cause about 7000 deaths this year alone?
Joining me today to discuss these important sun car issues are two dermatologists from the University of Miami: Dr. Mariano Busso, sitting to my right, and Dr. Steven Shapiro, sitting to my left. Gentlemen, thank you for joining us.
I'd like to start off with our first question, how does sun cause damage to our skin?
MARIANO BUSSO, MD: We have two forms of sunlight, the visible one and the invisible sunlight. The invisible form has the ultraviolet light type A and type B, which are our major concern. What they can produce is suntan, sunburn, skin cancer, premature aging, also eye damage, like cataracts, damage to the immune system, and even allergic reactions.
STEVEN SHAPIRO, MD: I'd like to add something to that. We originally thought that UVB was the one that caused skin cancer, and we always remember B for bad. And later one, we found out that UVA also causes skin cancer, as well. So now that we know that both UVA and UVB cause skin cancer, they're both in tanning salons. And originally they used mostly UVB, they switched to UVA, and now we know that both rays cause skin cancer, and tanning salons contain both rays, so it can potentially cause skin cancer, as well.
SUSAN CINGARI: That brings me to my next question. Dr. Shapiro, what is the difference between UVA and UVB rays, then?
STEVEN SHAPIRO, MD: UVB is a much stronger radiation than UVA, and UVB is more absorbed by the epidermis than the deeper dermis where UVA is absorbed. In terms of your average daylight., around twelve noon is the strongest sun of the day, most of us know that, it's about 90% UVB at twelve noon. Earlier in the day it's more UVA, towards the end of the day it's UVA as well. So UVB is a much stronger radiation, however, UVA can cause skin cancer, as well.
MARIANO BUSSO, MD: Interestingly, they both product skin cancer. UVB is filtered from windows, whereas UVA not as much. And a perfect example of that is most skin cancers… take place on the left side of our body, because when we're driving, we have a lot of sun radiation from UVA rays. And so therefore, in Great Britain, it's on the right side.
SUSAN CINGARI: That's interestingly.
All right, Dr. Busso, how can we protect ourselves from burning, then? What's the best advice you can give us?
MARIANO BUSSO, MD: That's an excellent question. Everybody asks, "Well, what kind of sun protection should I wear?" But the most important concept is, nothing is more important than avoiding the sun. if you cannot avoid the sun, apply sunscreen, but nothing is going to be as good a protection. Sunscreen is never going to be as good as being outside from the sun. So the number one recommendation is avoid the sun, and on top of that, apply sunscreen.
There's a false sense, given a little bit by the media, that the tan is healthy. That's why when you have an ad on any sunscreen, you have a model that has a perfect suntan. So you have to question yourself: if the sunscreen is so good, why is the model tan?
STEVEN SHAPIRO, MD: I'd like to add something to that, too. I call something in my patients who can't avoid sun exposure, they always ask me, "How can I go out in the sun more safely?" And I tell them to use what we call sensible sun exposure. And sensible sun exposure is to be aware of the sun. Number one, as Dr. Busso said, use your sunscreen, make sure you put it on before you even go out in the sun, so it has a chance to dry and set first.
The second thing to understand is that the midday sun, of course, has the strongest sun. try to go indoors in the middle of the day as much as you can.
You get 85% of sunlight in up to three feet of water. Most people feel that if they're going to be in the water all day, they don't need their sunscreen. You still get your sun damage on those days as well, as well as a cloudy day. You get about 70% to 80% of the average sunlight on those days. So most people feel on a cloudy day they don't need their sunscreen. I actually see more sunburns in the office on Monday after a cloudy weekend than I do after a sunny weekend. And then I tell people who work outdoors, when they get their time off, they should try to do things in doors on their day off.
All of these principles just reduce the risk of skin cancer. They won't eliminate the risk of skin cancer, but being more sensible about the amount of sun that we get, that is a way to reduce your risk of skin cancer.
SUSAN CINGARI: For either one of the doctors, when we talk about sunscreen, talk to me a little bit about oils versus screens, and the PABA thing, we all read about that on the back of the sunscreen bottle. Is PABA necessary and what is it?
MARIANO BUSSO, MD: Answering the first part of your question, there are three basic properties that you should look for in a sunscreen. It should be an SPF 15 or more; 30 is good enough, but more than 30 really doesn't add much. Second, it has to be a broad spectrum, as we had mentioned originally. It has to product from UVA sun exposure and UVB ultraviolet light. And also, I like to add that I like sunscreens that are waterproof. Therefore, if you're out in the sun and sweating, you're going to a swimming pool, it doesn't run off as easily. You still have to reapply a waterproof sunscreen every two or three hours, but you're going to get a lot more protection than if you didn't.
Therefore, any sunscreen that contains those three properties, it doesn't matter if it's gel, cream, or the lotion or the pad, will be good enough. Then based upon your skin type or special necessity, then you choose. So some people who have oily skin probably would prefer a water based or alcohol based product, it would be more like a gel or a lotion. People who have more dry skin possibly prefer a cream. … A gel may be more applicable for body surface, not so much the face, because that tends to clog the pores a bit more and produce more acne.
So there are so many sunscreens available in the market that are so good, that you will find that contains these three properties that I mentioned, broad spectrum, SPF more than 15 and waterproof, with all the desired properties that your skin will like.
STEVEN SHAPIRO, MD: I'd like to handle the second part of that question about the difference between sunscreens and PABA. PABA is a product that absorbs the ultraviolet radiation. The most important thing, though, as far as sunscreens, as Dr. Busso said, it's got to block UVA, UVB, and there are sunscreens that say All Day on the label. So All Day protection is much more protection than the older sunscreens which don't say that. Those have to be reapplied every two or three hours, which most people forget to do.
The other part of that question has to do with the difference between sunscreens in the way of the 15 versus a 30, for example. And I tell people a 15 is a 93% block from the sun, and a 30 is a 95% block. As you get into the higher numbers, you'll get the difference between 98% and 99%; as Dr. Busso said, that's not as big a difference.
I tell people the stronger the sun they're exposed to or the more sun exposure they get, the bigger the difference between sunscreens. So most people say there's no difference between a 15 and a 30 if you're not out in the sun, there's no difference between a 15 and a 30. The more sun you get, the bigger the difference becomes, and that's important to understand, as well.
MARIANO BUSSO, MD: One thing about PABA. PABA was one of the first chemicals that was used that showed protection against the sun, but it has a lot of allergic reaction. Therefore many sunscreens claim they don't have PABA as their main chemical for photo protection, so people would not develop an allergic reaction. So many will say PABA, and that was the reason.
Many people think they will develop an allergic reaction, but in general it is that alcohol-based sunscreen tends to irritate a little more of the skin, so some people develop an irritation not form the chemicals, but just from the vehicle itself, from the alcohol. A simple way to know whether you are allergic to your sunscreen or not is to apply the sunscreen here on the flexure of your elbow. You apply it twice a day for a week; if you don't develop an allergic reaction, then you can safely apply it on the face without any problems.
STEVEN SHAPIRO, MD: If somebody does have a problem with sunscreens, they should get into what's called a chemical-free sunscreen. Chemical sunscreens are ones where the chemicals sit on top of the skin and it does not get absorbed into the skin. And what happens for those patients is people how have had allergy to PABA or were afraid to try other sunscreens, if they use these chemical-free sunscreens, they're much less irritating, so there's much less chance of allergy with those.
SUSAN CINGARI: Any other tips as to how we can prevent ourselves from sun damage, quickly? Dr. Busso, would you like to start?
MARIANO BUSSO, MD: Protective clothing means a wide brimmed hat and long sleeves. And when people ask me what type of clothes, it doesn't matter the color or the texture, it has to be tightly woven cloth. If you take a look at the sun through the cloth, you should never see it; if you see it, it's not protecting you. And be aware reflective surfaces, as Dr. Shapiro pointed out. Sand, snow, that's why we had such a great suntan when we go skiing, because there's a lot of reflection from the light, from the sun.
SUSAN CINGARI: Dr. Shapiro, any final thoughts?
STEVEN SHAPIRO, MD: Absolutely. Get the sunscreen on before you even go out in the sun so it has a chance to dry and set first. Make sure you cover the ears, that's a common place to get skin cancer and a very tough place to treat them. Other locations, people feel if it's good enough for their face, I tell people it's also good enough for the rest of their body, so they need to use it on all sun exposed areas.
SUSAN CINGARI: So, Dr. Shapiro, it's very important to discuss moles, many people are concerned about their moles. So let's have a brief conversation about moles. If you have a mole, does this really increase the risk of skin cancer?
STEVEN SHAPIRO, MD: There are different types of moles, to begin with. There are moles that people are born with or come up in their first ten years of life. The average mole has about a one in two hundred chance of changing and turning into skin cancer. And what you have to do is look for changes in size, shape and color. Other types of moles, which are the birthmarks, have a slightly increased risk, but nobody knows exactly what that increased risk is.
I tell my patients the best way to do is to do a self-examination every month. And the way you could do it is to be in front of a full-length mirror with a hand held mirror behind you, or you could have a family member examine your back. And they're looking for changes in size, shape and color of moles. If a mole every month has a regular border, a uniform color, it doesn't change, those are all signs that it's benign. If all of a sudden it starts to change in size, shape or color, that's when you should bring it to our attention.
There's another way to remember it, too. We talk about the A, B, C, and Ds of moles. A stands for asymmetrical. If something has normal or regular growth and you put a line through the middle of it, both sides will match up, that's symmetrical, and that's something that's a sign that it's benign.
B stands for border regularity. If it's got an irregular border, it looks like someone took a bit out of it or it's got a notch in it, that's a sign of irregular growth going out, that's a warning sign that it may be turning into skin cancer.
C stands for variation in color. The average mole has one uniform color throughout, a sign of normal color formation, that's benign. Melanomas tend to have multiple colors within the same mole, that's a warning sign and that should be brought to our attention.
D stands for diameter greater than six millimeters, that's basically the head of a pencil eraser. So if it's larger than that, that's a warning sign, as well.
Basically with moles is just because it's always been benign doesn't mean it will always be benign. So these need to be watched, once a year a full skin examination done by a dermatologist, and then once a month at home, family members should check each other.
SUSAN CINGARI: Dr. Busso, what else should we know about moles?
MARIANO BUSSO, MD: As Dr. Shapiro pointed out, it's very important to do a full skin exam, because moles can take place anywhere on the surface of the skin: on the scalp, inside the mouth, in between the buttocks, in between the toes, places that we routinely don't look for, and when we see them, it's already late. So a full skin exam is very important.
Actually, the American Academy of Dermatology recommends at least every single person should have a full skin exam done in their lifetime. At that point, the dermatologist would tell you your risks and how often you need to come back for future consultations.
If you have had one melanoma, the chance that there will be a second melanoma is five percent. If you have had a basal cell melanoma… the chance of having a second one is about 40%, so it's very, very high, so you need to know your risk factors. If you've had more than 100 moles and any of those are a little bit atypical, your chances of melanoma over a lifetime is 10%, so it's very, very high.
STEVEN SHAPIRO, MD: I'd like to add one thing. As far as the different types of skin cancers, there are three general tapes. We call it basal cell carcinoma, the word basal means common, about one in five people develop them. They grow in one area, they don't spread around the body, they're very easy to treat as long as you catch them early.
The second type is a squamous cell type, which grows a little bit more aggressively or a little bit quicker than the basal cell type, very rarely can they spread. Again, you find them early, they're very easy to treat.
The third type, of course, the melanoma is the one with the bad reputation. It could grow very quickly and potentially spread around the body and even be fateful. What's important to understand with the melanoma, just like the other skin cancers, if you find them early, it's a 100% survival rate. So with all skin cancers, the basal cell, the squamous cell and the melanoma, you find them early, they're easy to treat, not difficult, 100% survival.
SUSAN CINGARI: Dr. Shapiro and Dr. Busso, thank you for your time, some good information. So remember, if you want to save your skin, wear sunscreen.
For Webcast, I'm Susan Cingari reporting.