Skin Cancer & UV Exposure: Protection Involves More Than Sunscreen

Skin cancer is the most common cancer in the human body. The American Academy of Dermatology reports that one in five Americans will develop skin cancer in their lifetime. The good news?  Advances in prevention, diagnostic technologies, immunotherapy drugs and other treatment modalities make it one of most treatable forms of cancer.  

“There are more skin cancers diagnosed in the United States than all other cancers combined,” says dermatologist Jill Waibel, M.D., the medical director of the Multidisciplinary Skin Cancer Clinic at Miami Cancer Institute. “The number one cause is sun exposure. And what happens is that ultraviolet (UV) radiation changes our DNA and creates defects that will then turn into cancer.”

For years, health experts have advised us to wear sunscreen and cover up when we go outside, but there’s more to it than that. All sunscreens are not created equal. The sun can harm your skin through a window or a car’s windshield. Even the shirt you’re wearing may not offer enough protection.

According to Dr. Waibel: “A regular white T-shirt only has a sun protective factor of two — which, you might as well be walking around without a shirt. So, you’ve got to make sure if you’re in the sun, going to a game, going on a boat, you want to really have a preparation plan in mind. But we want you to enjoy life. We want people to be out exercising and having a great time. It’s just that common sense goes a long way.”

Dr. Waibel shared her expertise during the latest episode of the Baptist HealthTalk podcast, hosted by Jonathan Fialkow, M.D., deputy medical director, chief of cardiology and a certified lipid specialist at Miami Cardiac & Vascular Institute.

Their extensive conversation ranged from the different types of skin cancer, to groups at higher risk, to the use of artificial intelligence to fight the disease. Check out some highlights below. You can access this and other Baptist HealthTalk podcast episodes on your computer or smartphone, or via Apple Podcasts and Google Podcasts.

Dr. Fialkow:
“What should people think about when they are going to have sun exposure?”

Dr. Waibel:
“So, the first thing we tell everyone is sun protection. We want, and you as a cardiologist, want people out there running for an hour. What dermatologists don’t want, we don’t want you to go to the beach from eight ‘til five, laying out in the sun, that is very unhealthy. So, some protective clothing, sun protection, sunscreens, physical blocks, — we’ll get into that — zinc and titanium. You want to reapply every two hours. There’s no such thing as water resistant. So if you go swimming or in the pool, you need to come out and protect. Wear hats, wear sunglasses. There’s great UPF protective clothing these days.”

Dr. Fialkow:
“What should people look for in sunscreens?”

Dr. Waibel:
“There’s a lot going on in sunscreens in 2020. Last fall the FDA issued a pretty strong warning (about) chemical sunscreens and things with oxybenzone, azobenzene, these names you don’t necessarily have to remember. They had several studies where they took healthy volunteers and put them in a house for two weeks. And they had them apply sunscreen with chemicals three times a day. And then they did a series of blood draws. And, scarily, what they found was that there were toxic levels of these chemicals in the blood…So the FDA is doing more studies, but at this point most dermatologists are recommending physical sunscreen. So those ingredients are either zinc or titanium dioxide. It needs to say ‘physical block’. Those do not penetrate through your skin. They actually stay on top of your skin and reflect the sunlight.  And so, this is a very big emerging story to keep people healthier and safer.”

Dr. Fialkow:
“What kind of things would you recommend to a parent to develop good habits for their children and good protective steps early in life?”

Dr. Waibel:
“Good topic. So, the first thing I tell people is, six months or younger, no sun. Infants have very, very thin skin, so they can get sunburned very quickly, and it actually can cause a lot of damage. Early sunburns in childhood are a marker for melanoma. So, if you have a baby, keep them out of the sun. You know, now once they get a little older, one, two, and you’re going to go put them in a baby pool or swimming, get them on protective clothing. Get the hats on them, again, their skin has not seen sun and they are at higher risk for sunburn.”

Dr. Fialkow:
“What would be the direct recommendation you would have to someone who’s working outside as part of their occupation?”

Dr. Waibel:
“We have a lot of people that work for FP&L, our migrant workers, our lifeguards. That’s a little bit of a different strategy. Those patients we want to get into Miami Cancer Institute. We want to be doing more preventative exams. We want to start them on Retin-A. There are treatments such as photodynamic therapy, which actually prevents 80% of future skin cancer. And there are antioxidants, both healthy eating as well as some things you can apply to your skin to help prevent that breakdown of the DNA and causing cancer. So, lots of great things we can do to prevent skin cancer.”

Dr. Fialkow:
“Can you talk to us about when and how to get screened?”

Dr. Waibel:
“We tend to recommend starting at the age of 40. If you don’t have a significant family history of melanoma, or you haven’t had skin cancer, we recommend people at the age of 40 start to come to Miami Cancer Institute or your board-certified dermatologist to do a skin cancer screening, where we literally look from head to toe.”

Dr. Fialkow:
“So, the key is early detection, early assessment and early treatment. Is that what you’d say?”

Dr. Waibel:
“That is 100% true. The earlier detected, the higher survival. And much less morbidities, smaller surgeries, easier cures. The deadliest skin cancer is malignant melanoma. Malignant melanoma happens when a mole turns into cancer. 50% of melanomas come from a mole people have had on their body their whole life. So, I have a lot of patients that come in, they’ll be like, ‘I’ve had this my whole life.’ And I’ll be like, ‘Well, that’s melanoma.’”

Dr. Fialkow:
“You’re saying that’s 50%?”

Dr. Waibel:
“Yes, and the other 50% show up de novo, like you wake up one day and boom: a new mole. That’s a bad sign. You get moles from the time you were born until you’re 40. So, if you’re over the — again, that magic age of 40 in dermatology and you get a new brown spot, that’s a little more concerning than if you get a new mole when you’re 20. Now there’s other fun things you get that I call wisdom spots. But, if you’re 55 and wake up with a really black mole, that could be a melanoma.”

Dr. Fialkow:
“Okay. So now let’s turn to the great stuff that’s being done at the Miami Cancer Institute’s Multidisciplinary Skin Cancer Clinic.”

Dr. Waibel:
“It’s an honor to be part of MCI’s Skin Cancer Multidisciplinary Clinic. We have eight physicians that span from surgical oncologist, the radiation oncologist, the medical oncologist, the dermatologist, and we all work together. We literally spend about four hours per patient, from prep to seeing the patient together, to discussing the patient and making a plan.”

Dr. Fialkow:
“Can you tell us a little bit about some of the advanced technologies that are available there?”

Dr. Waibel: “Miami Cancer Institute is the only place that I know of in the world that has three cutting edge imaging technologies to detect skin cancer. The first one is called the Vectra 360. This is an imaging device where you step into a 92-camera device and it takes photos of every part of your body. And it can detect cancers and melanomas that we can’t see with the human eye… I found an eyelid cancer on a patient, a basal cell on an eyelid that I couldn’t see visibly, but the Vectra picked it up. So, the Vectra, there’s about four in the United States right now, there’s about 18 in the world.

“We have an Optical Coherence Tomography, OCT. You might have had it done at your ophthalmologist, if they ever take a picture and you can see the different levels of your retina. The OCT is one of my areas of expertise and one of my favorite tools. It’s like an ultrasound, but no gel. You just apply a probe to the skin and you can see right then and there: basal cell, squamous cell, some melanomas, without a biopsy.

“And then the third technology is called reflectance confocal microscopy. And with that you can literally diagnose a melanoma and map out the margins of a basal or squamous. So, the surgeons come into the room and we mark out the cancer and then they go and use those margins for surgery and we’re increasing our accuracy. So, we have all of these. It’s an artificial intelligence world out there and we’re using these imaging (systems) for patient care and we’re really pushing treatments forward.”