Here comes the sun… and we are on top of it. Besides checking the weather forecast every morning to see if we are any closer to stable warmth, we checked in with Dr. Kosari from DERMATOLOGY LASER & VEIN SPECIALISTS OF THE CAROLINAS to get the latest answers to our sun care and sun damage questions.

Our logic was, if we need to update our phone software systems at least once every few months to keep up with technology, surely we should do more of the same when it comes to such an acutely observed and intensely-studied area as The Big C.

WHAT IS NEW? We have come a long way from skin cancer 101 back in the day, when all we knew was that getting burnt can give you cancer. Dr. Kosari gave us the latest scoop on tanning beds, Vitamin D deficiency, what age to get your full body exam, and much more.

Why are tanning beds dangerous in terms of skin cancer?

Tanning beds use lamps that emit ultraviolet radiation and induce the same changes to cells that the sun’s rays do. The use of tanning beds increases the risk of all forms of skin cancers including the deadliest form, melanoma.   In fact, Tanning beds have recently come under the watch of the American Academy of Dermatology for their ability to cause UV-induced damage to skin and increase the likelihood of development of skin cancers. As a result, tanning beds are slowly becoming inaccessible to underage seekers and are not recommended for adults. 

What about all this we are hearing about vitamin D deficiencies, and needing to get out in the sun to build up Vitamin D?

For those that are known to be vitamin D deficient, the current recommendation is to obtain vitamin D through diet and supplementation, not by exposing yourself to ultraviolet radiation.

We know there are 3 types of skin cancers.  What are the differences between them [and why should we care – as long as it’s not melanoma?]

First of all, Dr. Kosari explained we need to know and care because the three cancers are distinguished “by their source of origin in the skin and their aggressiveness”.
He told us the three types are Basal Cell Carcinoma (BCC), Squamous Cell Carcinoma (SCC), and Melanoma. Even though the first two types are classified as non-melanoma, and are much less likely to metastasize, they can still be highly dangerous:

Basal cell carcinoma (BCC) is one of the most common forms of cancer and arise in the first layer of the skin.
It is most common in Caucasians. Although there is very low metastatic potential, these cancers can be locally invasive and aggressive.
Cutaneous squamous cell carcinoma (SCC) arises from keratinocytes, the cells that give rise to the first layer of the skin. Unlike BCC that rarely metastasizes, cutaneous SCC has a 2-5% metastatic potential and typically metastasizes to the regional lymph node.
Melanoma arises from melanocytes. Melanocytes also reside in the first layer of our skin and are responsible for the tone of our skin and for producing melanin when tanning occurs.
Melanoma is the most deadly form of skin cancer and incidence rates have been increasing for the last 30 years.
Caucasians with red or blonde hair, or blue or green eyes are at highest risk. Importantly, five-year survival rate for people whose melanoma is detected and treated before it spreads to the lymph nodes is 98%.
Anybody at risk is recommended to have full body exams.

Ok so on that topic of exams, our immediate question was:

For each of the different skin cancers, are you supposed to look for different things in self-exams?

Basal cell carcinoma appears as a pearly or translucent red bump. It is typically not associated with pain but bleeds easily.
Squamous cell carcinoma appears like a red, rough, scaly bump. Unlike BCC, SCC can be associated with pain.

Basically, non-melanoma skin cancers can come up on any sun-exposed area of the body. The most common area of the body for these cancers is on the face, scalp, ears, neck, and upper extremities.

Melanoma commonly arises independent of any pre-existing moles but can also appear as an extension of a prior mole. It appears as an asymmetric, multicolored, sometimes raised mole. If arising within a prior mole, the mole will be described as having changed in color (darker) or shape. It is common on the upper back, torso, lower legs, head, and neck.

So then we asked ~ How often should you get a full body derm exam? We asked Dr. K if there is a crucial age to do this, like with mammograms and bone density tests.

There are no formal guidelines as to when one should perform self-exams or when to begin full body exams with a dermatologist.
It is plausible that everyone should have a baseline full body exam by age 40; sooner if there is a lesion of concern, if you have more than 50 moles, or strong personal or family history of skin cancer.

Stay tuned next week for Dr. Kosari’s tips for finding the best sunscreen, and why sun damage goes way beyond the occasional burn.

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Dr. Payman Kosari is a board-certified dermatologist.  He received his Bachelor of Science degree in Biology from the University of California, Los Angeles before earning his Medical Degree from the Chicago Medical School. He completed his internship at Cedars-Sinai Medical Center and relocated to North Carolina for his Dermatology residency at Wake Forest Baptist Health. Dr. Kosari specializes in the treatment of pediatric and adult disorders of the skin, mucosal membranes, hair, and nails and has had extensive training in the diagnosis and treatment of skin cancers including malignant melanoma. He has a particular focus in venous disorders & associated treatments such as endovenous laser ablation and sclerotherapy.

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