Mar 11, 2014

Interviewer: How dangerous is skin cancer, really? We'll examine that next on The Scope.

Man: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Let's face it, we all love the feeling of the sun on our skin and maybe even a little bit of a golden tan, but then we hear things like skin cancer and you should wear long sleeves and big hats. We're with Dr. Glen Bowen at Huntsman Cancer Institute. How do I balance that kind of desire to want to be out in the sun and yet the desire to do what guys like you tell me I should do?

Dr. Glen Bowen: Well, the first thing I would say is somebody dies every hour in the U.S. from skin cancer. It is an epidemic problem, so you can't really minimize that fact, not to mention the fact that there are people every day that come to the Huntsman Cancer Institute. I'm removing either part of their nose or most of their nose or eyelids or lips or ears. It's very devastating for people. Almost all of them, not all of them, but almost all of them are avoidable.

Interviewer: Yeah.

Dr. Glen Bowen: So, yeah, the sun's okay, but, you know, people just aren't really exposing themselves to the sun in what I would say moderation.

Interviewer: Okay. So it's just a matter of people are trying to get too much, laying out there for hours on end or going into the swimming pool without any protection. Bad idea.

Dr. Glen Bowen: That's right. And a really, really bad idea are peeling sunburns. There's no question that peeling sunburns have a very big impact on our risk for skin cancer. The interesting thing about swimsuits is that they used to cover the torso. If you look at photographs of Saltair, the swimsuits for both men and women covered the torso. Well, most melanoma occurs on the torso.
So when the swimsuit style changed, there was an incremental jump in melanoma incidence because they tend to occur in areas where we get peeling sunburns, which is usually the torso. They're spring break cancers.

Interviewer: And it's really young people that really need to be the most careful, right?

Dr. Glen Bowen: Yeah. So it's thought that about 80% of the sun damage to our skin that causes skin cancer probably happened before we graduated from high school. And it doesn't mean that the sun after high school doesn't matter. It just means that most of the switches that were flipped to cause cancer happened when we were young. So it's critically important that young people try to avoid peeling sunburns.

Interviewer: Yeah. Tell me about the genetics of skin, because what the sun does is it actually genetically alters a cell, and these peeling skin cancers are some of the worst at doing that.

Dr. Glen Bowen: That's right. You could think in a way of the ionizing radiation from the sun like bullets from a machine gun. I mean they literally are. They pass through the skin, and they poke holes in the DNA. The DNA has a beautiful spellchecker like our word processors that can kind of correct for the mistakes, but the problem is you can simply overwhelm it, and that's exactly what happens particularly in light-skinned people, Caucasians. With chronic sun exposure, the spellchecker simply can't correct the mistakes in the DNA as fast as the mistakes are being made, and the result is skin cancer.

Interviewer: So tell me how do I balance then this desire to want to be out in the sun and maybe get a little color to my skin in the summertime versus the dangers of melanoma.

Dr. Glen Bowen: So what is it? Well, people don't dress like they used to, and if you want to do an interesting experiment, just look at the photograph of the Golden Spike when it was pounded in, and you look at the people in that photograph. They all have long-sleeved shirts. They all have trousers, and they all have hats. And that's how people used to dress.
Of course, the style of the swimsuit as it went from one piece to two piece, there's a very direct correlation of increased melanoma rates. So the trick is to go ahead and enjoy yourself outdoors but dress the part. You know, wear clothes. It's not a good idea to go trouncing around in a speedo with nothing else.

Interviewer: For a lot of reasons.

Dr. Glen Bowen: Yeah, it's a great idea to wear a hat, especially a hat with a brim. I remove a lot of portions of men's ears because we don't have hair that covers our ears. So hats with a brim on the side. A baseball cap won't help you in that regard, but a hat with a brim is hugely helpful, and, of course, sunscreen.

Interviewer: So what type of sunscreen should I be wearing?

Dr. Glen Bowen: Well, sunscreen, in general, if you get to a sun protection factor, SPF, 30 or higher, the incremental gains from a higher SPF are pretty small.

Interviewer: Okay.

Dr. Glen Bowen: But there's a huge difference between a 15 and a 30. So, in general, you want to be wearing something 30 or higher. The other problem with a sunscreen is people kind of see it as the seatbelt. It's not. It's the airbag.

Interviewer: Okay.

Dr. Glen Bowen: So clothing is really your seatbelt.

Interviewer: Okay.

Dr. Glen Bowen: But sunscreen in addition to that is very effective. It has to be reapplied, and that's another problem. People tend to put it on once. But golfing, for example, you need to apply it before the first nine, and then you want to reapply it after the first nine because after about two hours, the particles are pretty much dissipated on the skin and it's dilute enough where it's not working very well.

Interviewer: And that's very effective in preventing melanoma, is that correct?

Dr. Glen Bowen: Yeah, it's thought to be.

Interviewer: Okay.

Dr. Glen Bowen: The science is really difficult to do in that case, but we just think that it'd be like a filter on a cigarette, you know . . .

Interviewer: Sure.

Dr. Glen Bowen: . . . the more you filter out the tar and nicotine, the less likely you're going to get lung cancer, and the same with ultraviolet light. The less that gets through to the DNA within your skin cells, the less likely you are to get skin cancer.

Interviewer: Prevention's also important, meaning like to examine yourself. What would I be looking for?

Dr. Glen Bowen: Yeah, that's a great question, and the answer is you look for exactly two things. One is a sore that doesn't heal. So most of the skin cancer is not melanoma. It's called a basal cell carcinoma or a squamous cell carcinoma. Most people, especially young people, they will dismiss it as a zit.

Interviewer: Really?

Dr. Glen Bowen: So it's a little blemish on the skin that does not go away after about a month.

Interviewer: Okay.

Dr. Glen Bowen: So I just had three patients this morning that I operated on. They said, yeah, it was a sore that wouldn't heal. So little sores on the skin, especially the face, that don't heal after about a month, they could be a skin cancer.

Interviewer: Okay.

Dr. Glen Bowen: Sometimes they'll heal temporarily and then they'll break down again like a rollercoaster. So if a sore seems to get better but then it breaks down again, gets better, breaks down again, that's another warning sign that it might be skin cancer. The melanoma is almost always from a mole, and it's simply going to be an ugly duckling. So if you look at the moles on your skin and there's one that just stands out from the others, it's the ugly duckling, it's the black sheep, it doesn't look like the other ones, that's the one to be concerned about.

Interviewer: How important is early diagnosis? How big of a difference does it make?

Dr. Glen Bowen: It's everything. I mean, it's everything. Just to give you an example, I had a patient today with a melanoma that was what we call in situ, which means it's very superficial. Their survival is predicted to be close to 100%. Whereas another patient with one that, say, is down to the fat, they have less than 50% chance of surviving their cancer.

Interviewer: Wow.

Dr. Glen Bowen: So it's like Charles Dickens-it's the best of times and the worst of times. If it's caught early, it's one of the best cancers to have. If it's caught late, if not the worst cancer, it's certainly one of the worst cancers to have just because there are very few good treatments for melanoma that has got into the internal organs.

Interviewer: So it can spread to other organs?

Dr. Glen Bowen: Melanoma is a terrific hitchhiker. It's incredibly good at getting into the bloodstream or the lymph vessels and traveling to internal organs. A lot of cancers, they don't do well out of their neighborhood. Melanoma does exceedingly well. It can set up shop anywhere it wants to-bone, brain, liver, lungs, small bowel. I've seen it in every organ in the body. It's kind of amazing that way.

Interviewer: And once that happens . . .

Dr. Glen Bowen: It's very tough to treat. I mean, we do have some newer treatments at the Huntsman Cancer Institute that are very promising, but you just don't want to be one of those patients on experimental therapy.

Interviewer: Sure. And why go that way, because it sounds like this is a totally preventable cancer.

Dr. Glen Bowen: Well, you know, there are cancers out there, pancreatic cancer, for example. There are these terrible cancers out there that there's not much you can do. It's a little bit of the lottery. Most skin cancer is very easily preventable. That's the tragedy of it, but it's also the good thing about it. You could easily prevent most of the skin cancers that I operate on every day at the Huntsman Cancer Institute.

Interviewer: Is there a takeaway message that you would have our listeners leave with?

Dr. Glen Bowen: I would say for the parents, concentrate on your kids because it makes a huge difference. Those peeling burns we got as children, they make a huge difference for when we're adults and getting skin cancer.
Get a rash guard, you know, those little swimsuits that are spandex or Lycra that they just wear as a T-shirt. It'll protect their skin. It's got a tight weave. They're comfortable. They dry quickly.
So I would say, you know, just be careful to avoid those sunburns. And then it's a good idea for any person to just look at their birthday suit the first day of each month and make sure that there's not an ugly duckling or a nonhealing sore.

Man: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio.

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