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The Dose Transcript for May 3, 2023

Host: Dr. Brian Goldman

STORIES FROM THIS EPISODE

BRIAN GOLDMAN: Hi, I'm Dr. Brian Goldman. Welcome to The Dose. Melanoma is the deadliest form of skin cancer, and rates of melanoma in Canada are on the rise. People who live in southern and coastal areas of the country are at the greatest risk. And I can tell you, as a fair complexioned guy who got lots of sunburns as a kid and at least one blistering sunburn, I'm the poster boy for someone who should be very concerned about getting melanoma. So this week we're asking how can I prevent and when necessary, detect melanoma? Hi, Julia. Welcome to The Dose.

JULIA CARROLL: Hi, Brian, and very excited to be here.

BRIAN GOLDMAN: I'm excited to have you on the show. What is your sunscreen routine?

JULIA CARROLL: Well, I am very diligent. I wear sunscreen every day, every morning. I don't even look outside, for example. It's a bit of a blustery day here in Toronto. And first thing I did this morning was get up in the dark and put on my sunscreen.

BRIAN GOLDMAN: Wow. And what do you use?

JULIA CARROLL: I have a variety. So I have a SPF 42 that I like to use during the day. So it's just I like the way it makes my skin Look, if I'm you know, I'm a I'm a sailor. So if I out on the water, then I'm going to grab my SPF 60. I've got a whole collection.

BRIAN GOLDMAN: Wow. And that sailing bit probably puts you at increased risk because you're getting a lot more sun exposure than a lot of other people.

JULIA CARROLL: For sure, as someone who grew up on the coast and loves, you know, being outdoors, you know, winter or summer, I'm definitely at higher risk.

BRIAN GOLDMAN: Okay. Let's get into our discussion in a moment. But before we do that, can you give us a. Hi, my name is tell us what you do and where you do it. Just ad lib.

JULIA CARROLL: Absolutely. I'm Dr. Julia Carroll. I'm a dermatologist based out of Toronto. And so I practice dermatology and I also have the privilege of serving on the board for Melanoma Canada.

BRIAN GOLDMAN: Okay, here we go. First question, what is melanoma as a as a diagnosis, as a form of cancer?

JULIA CARROLL: So melanoma is a cancer of the melanocytes. So those are the cells that create the pigment in our skin.

BRIAN GOLDMAN: How does melanoma compare to other kinds of skin cancers, like squamous cell and basal cell cancers?

JULIA CARROLL: Right. So those are the non-melanoma skin cancers. And melanoma tends to be from one severe hit of sun. So one of the risk factors is if you've had more than two sunburns before the age of 20 and it's much more deadly than, say, a basal cell skin cancer, basal cell cancers and squamous cell cancers come from chronic sun exposure over the years. They tend to be a little bit more slow growing. Basal cells tend not to be deadly, but squamous cells can also be deadly as well.

BRIAN GOLDMAN: Yeah, I've certainly had family members who've dealt with one or two of the other kinds of cancers. Who is most at risk of melanoma?

JULIA CARROLL: Well, so it tends to be people who've had, say, a severe blistering sunburn before the age of 20. If you have skin that that tends to burn. If you have a lot of moles, if you have more than 50 moles on your bo- on your body, if you tend to make weird looking moles, which we call dysplastic nearby, people that, as you mentioned, are fair and freckly and those with a family history, those would all be factors that would put you at higher risk.

BRIAN GOLDMAN: So clearly, you know, it's interesting because I've got I've got at least two of those risk factors. I you know, I'm fair I'm fairly fair complexioned. I had multiple sunburns as a young child well before the age of 20. I remember one blistering sunburn on my shoulders when I was a pre-teen. So so those are some some environmental risk factors. But clearly, there must be a genetic component for sure.

JULIA CARROLL: So 85% of melanomas are caused very clearly by ultraviolet radiation or the sun. But we do definitely see a genetic component. And so, you know, just because someone in your family has had a melanoma, it definitely means that you should be more on high alert. But if someone in your family hasn't had a melanoma, you're certainly not free and clear.

BRIAN GOLDMAN: I also know that rates of melanoma are higher for men. So why is that?

JULIA CARROLL: Right. So our best, you know, thinking on that is that men are probably not as diligent with their personal care products. So using sunscreen and then also just traditionally over the years, they've tend to tend to have more outdoor jobs. So outdoor workers would tend to be men. Now, we might see that changing, as I think both of those things are probably changing in society. But from the stats that we have, that's what we've extrapolated.

BRIAN GOLDMAN: Melanoma is often found by checking your moles. We've started to talk about that, the importance of of of doing that. What should people be looking for?

JULIA CARROLL: So we tried to make it really simple. We call it the ABCDEs, but we've also added an E and F. But so as for asymmetry, if one side of a mole doesn't look like the other, it's not symmetrical, then that can be a concern. B is the border. So if you can very clearly see where the mole starts and the skin ends, then that border is well defined. But if it's smudgy at the border, then that can be an issue for color. So if the color is changing, particularly if it's getting darker. Diaz for diameter and we use six millimeters as a cutoff or for visual, it's larger than the end of a pencil eraser and used for evolution. So anything that's changing. So those are all signs that they should be brought to your family, doctor's attention or dermatologist, if you have one. And then more recently, we've thrown in this one called F, which is families. So if you take a look at, say, your upper leg, you're sitting with your shorts on and you and you're looking at your moles. You want to see do they all do everyone in that family look like each other? If there's one that stands out, doesn't look like the other moles around it or what we call the ugly duckling sign, then then that could be a sign that needs to be checked.

BRIAN GOLDMAN: Are there more unusual places where we should be checking for moles? I mean, there's obvious areas that are that are the most skin exposed, but are there unusual areas that we should be checking as well?

JULIA CARROLL: Yeah, I mean, I think hair is always an issue. So it's not, you know, depends on how much hair you have, but it's not an often exposed area. But I always recommend that my patients get their hairdresser to take a look through their hair when they're doing it and just let them know if there's anything in there and then they can bring it to me to show touch to the ears as an area that you can't see, where we often see skin cancers, butt bottoms of the feet between the toes. Skin cancers in those areas are more common in people with more darkly pigmented skin. So it's a good idea to check. And then tops of the feet is one as well. And along the hairline, that's an area that sometimes you don't see as easily. And people aren't so great at putting sunscreen into those areas.

BRIAN GOLDMAN: And I have certainly heard of patients, you know, in my kind of many years practicing medicine who've had who've had melanoma in the eye.

JULIA CARROLL: Right. So that's uveal melanoma. So that one I leave to my ophthalmology friends. But there are pigment cells in in the eye as well. So anywhere where you can have those melanocytes, you can have a melanoma.

BRIAN GOLDMAN: You know, there's an app for everything these days. Are there apps or websites to help people check their moles?

JULIA CARROLL: You know, one of the ones I really like is checkyourskin.ca And it's a it's a project from the Canadian Dermatology Association. It gives you a step by step on how to do a skin self-check and and what to look for as well. But yeah, there are so many great apps out there, lots of free apps. And and you know, you can even just do it yourself. You can create a little reminder in your phone. If there's something that you're concerned about, you can take a picture and and then you've got a record of what that looks like. So it's really quite easy to do with these little mini computers we carry around all day.

BRIAN GOLDMAN: And you are actually part of a campaign with Melanoma Canada on a mobile mole screening unit. Can you tell me about that?

JULIA CARROLL: Yeah. So we are launching that this week. It's actually Melanoma Awareness Month and Skin Cancer or Sun Awareness Month. And so we have a in partnership with Canadian Dermatology Association. Melanoma Canada has the first that we know of mobile skin cancer screening unit. So we are going around Ontario to underserviced rural indigenous areas as well as cities with long wait times for a dermatologist. And we're going to be screening patients all summer long. So we'll be at major events and going into, like I said, more remote areas. People can sign up online at molemobile.ca So there's appointments available and there's also walk ins. And then, you know, as we know, the two key things are prevention and early detection. And so we're going to be doing a lot of educating as well on how people can prevent skin cancer by protecting themselves from the sun.

BRIAN GOLDMAN: So you've you've kind of set the ground for the next question. I want to ask you what's behind the urgency in the prevention and early detection message when it comes to melanoma?

JULIA CARROLL: Well, the big thing with melanoma is if we catch it early, it doesn't have to be deadly. I mean, there are some cancers that, you know, even when they're caught early, they don't do well. But traditionally melanomas, if they're caught early, they do well. So what happens with the melanoma is, you know, when you first start to see those changes, it grows along the surface of the skin. And then over time, it starts to grow down. And that's when it then metastasizes and can become deadly. So time is really of the essence when it comes to a melanoma diagnosis.

BRIAN GOLDMAN: You're not only presenting messages to prevent an early detection, you're with patients at the diagnostic stage of melanoma. So what happens after that? When you when you assess a patient and you say, yup, you've got a melanoma.

JULIA CARROLL: Right. So the first thing is, you know, as a dermatologist, I don't have pretty magic eyes, but not entirely. So the first thing I'm going to do, when I see something that I suspect is a melanoma, is I'm going to do a biopsy. And depending on how big it is, it might be I might take the whole thing out and then send it to the lab. Or if it's large, I may just take a sample. And then once we get that back and we do discover that it's a melanoma, I actually say to my patients, you know, this is actually not the worst news. It would be worse if it was on you and we didn't know. So now at least we know and we can move forward and do something about it. So it's not entirely bad news. And then depending on the size and the depth of the of the melanoma, we may remove it in our office. So some dermatologists do surgery in their offices and remove the melanoma. But sometimes when it's gotten to be too deep, then we may send them more to a surgical center to remove it, and then they'll go on to immunotherapy or molecularly targeted therapies with the help of one of our oncology colleagues.

BRIAN GOLDMAN: So. Melanoma is usually caused by sun exposure. We want to talk about preventing that. How can we protect ourselves from the sun?

JULIA CARROLL: So I always like to talk about a three pronged strategy for my patients. The first one is just choosing when you're going to expose yourself to the sun. So if you're planning an outdoor activity, whether it's a sport or a family outing, try to choose one that is outside of those peak sun hours. So the peak hours are 11 a.m. to 3 p.m.. Or if you do want to be inside, look for shades. So you know, shade structures and encouraging shade in public places and has become a big trend as well. And then if you are going to be out in the sun, you can cover up. So you're looking for broad brimmed hats, wide brimmed hats, sunglasses with wide arms to protect the eyes, sun protective clothing. There's great options available for sun protective clothing now as well. And then your third line of defense is going to be your sunscreen. So for me, I recommend an SPF 50 plus. But, you know, I'm okay if people want to use an SPF 30, but it's just about protecting yourself. So it really is that that three pronged approach to prevent yourself from getting that sun exposure.

BRIAN GOLDMAN: And the idea here is to is to block your skin from being exposed to UV radiation.

JULIA CARROLL: Ultraviolet radiation. Exactly. And I think it's important to use that word radiation, because that's what the sun is.

BRIAN GOLDMAN: Some people with darker toned skin are more likely to tan than to burn. So how does tanning also damage our skin?

JULIA CARROLL: So tanning is a sign that your skin is damaged. So I always say to my patients, if I gave you a cream and you put it on and all of a sudden your skin turned a different color, would you not be concerned about what that cream is doing to your skin? So it's the same thing we've been normali It's been normalized to think that a tan is a is a good thing, but it's actually your skin increasing the pigment in it to act like a kind of a sombrero or an umbrella to protect itself from the sun. It knows it's being damaged and it's putting up a defense. And that's what a tan is.

BRIAN GOLDMAN: Oh, I never thought of it that way. Can people with darker skin still get melanoma?

JULIA CARROLL: They can. It tends to be in in the darker skin types, which we call like type five, Type six skin. It doesn't tend to be from the sun. It's probably random or from some genetic predisposition. And those tend to be one of the more common areas is on the extremities. So it's called accrual indigenous melanoma. So with the with darker skin types. Melanoma from the sun is not as much of an issue, but it's not. So you can't get a melanoma. So if you see a spot and it fits those ABCDs. You still need to get it checked.

BRIAN GOLDMAN: Got it. You've mentioned SPF 50. Is one sunscreen better than another in terms of the products that are out there?

JULIA CARROLL: You know, there's a couple of things to look for. And we like to keep it simple. We want something that says has broad spectrum coverage. I like it, SPF 50, but I'm okay with an SPF 30. And really, you're just looking for formulation that works for you. So, you know, there's physical blockers, there's chemical blockers, there's combinations. But really the best sunscreen is the one you're willing to wear. And there are sprays, there are lotions, there are sticks, there are powders. You know, there really is no excuse. There's one out there and they're really well formulated these days. And a lot of my patients have been now educated to wear sunscreens every day. And it's just part of their normal routine and and they like it.

BRIAN GOLDMAN: How often should you apply sunscreen if you're trying to reduce your risk of melanoma?

JULIA CARROLL: So sunscreens, particularly the chemical sunscreens, they work like a sponge. And so if I put sunscreen on in the morning and I'm in my office inside of rooms without windows all day, that's the only time I'm going to put on sunscreen. If I'm lucky enough to pop out and meet someone for lunch or go for a walk, then I'll reapply it. But if I'm inside where there is no sun, then then, you know, I don't really think we have to be reapplying it, you know, as per the label, which is every 2 hours. But that changes if you're doing an outdoor activity. And so if you're outside and getting more sun exposure, if you're sweating, if you're swimming, then you do want to apply it every 2 hours or immediately after you get out of a pool or a lake.

BRIAN GOLDMAN: And people naturally think about putting sunscreen on as the weather gets warmer. What about the rest of the year? You were saying off the top that you apply sunscreen every day, even in the wintertime?

JULIA CARROLL: I do, because ultraviolet B, there's so there's 2 million types of ultraviolet light that come from the sun. Ultraviolet, A ultraviolet. B, when we're talking about the skin in particular ultraviolet B, changes in the. With the seasons, it goes up and down, and that's the one that burns. So, you know, we noticed that that, you know, we don't get a lot of sun burns in the winter, perhaps if we're skiing. But where you are in the world, say I'm in Toronto, the ultraviolet. A-levels don't fluctuate based on the season. They're always there. It's the B levels that go up and down and ultraviolet levels are the ones that go deep in and can damage the DNA, which causes skin cancer.

BRIAN GOLDMAN: Oh I didnt know that. That's a that's a lot of practical information.

JULIA CARROLL: Good!

BRIAN GOLDMAN: Yeah. No. And you've given me a lot to think about and I think it'll be wearing sunscreen a lot more often. So I want to thank you, Julia Carroll, for coming on to The Dose to to tell us all about how to prevent melanoma and about early detection.

JULIA CARROLL: All right. Well, you'll be thinking about UVA and our melanoma message to our morning when you put on your sunscreen, your new habit.

BRIAN GOLDMAN: And thank you for giving me that new habit. And thanks for coming on The Dose.

JULIA CARROLL: My pleasure.

BRIAN GOLDMAN: Dr. Julia Carroll is a Toronto dermatologist. She sits on the board of Melanoma Canada. Here's your dose of smart advice. Melanoma is the deadliest form of skin cancer. It can originate inside moles which are benign to start off with but can turn into melanomas. The most important risk factor for melanoma skin cancer is ultraviolet radiation from the sun and indoor tanning. Increased sun exposure is an important reason why cases of melanoma have gone up over the past 30 years. Both men and women can get melanoma. Although men are at greater risk. You're also at greater risk if you have more than 50 moles on your skin or if you have a history of two or more. Blistering sunburns before the age of 20, melanomas are deadly because they metastasize. But early detection provides the best chance for a cure before they spread. Check your skin regularly for new moles and for changes in the ones you already have. Look at your entire body, including the tops and the soles of your feet, as well as between your toes. Ask your hairstylist to check the tops of your ears and your hairline. Use the ABCDEF rules to check for melanomas A for asymmetry, which means the left side of the mole doesn't look like the right side. B is for border, which means the mole has an irregular or jagged edge. C is for suspicious colors of the mole, including brown, black, blue, gray or red D means diameter. The risk of melanoma is greater when the mole is larger than the size of a pencil eraser. E means the mole is evolving or changing its color, size, shape or feel. And F refers to a family or a grouping of moles, one of which no longer looks like the others in the group. The most effective way to prevent melanomas is by limiting sun exposure. That means staying indoors between 11 a.m. and 3 p.m., wearing hats and other sun protective clothing. And by putting on sunscreen, SPF 50 or higher wear sunscreen year round and not just during the summer because UVA rays, which penetrate deeply into the skin, are present in all four seasons. If you have topics you'd like discussed or questions answered, our email address is the dose at CBC dossier. If you like this episode, please give us a rating and review wherever you listen. This edition of the Dose was produced by Isabelle Gallant. Our senior producer is Colleen Ross. The dose wants you to be better informed about your health. If you're looking for medical advice, see your health care provider. I'm Dr. Brian Goldman. Until your next dose.

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How can I prevent and detect melanoma?- Transcript

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