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Skin Cancer

Skin Cancer: Ask an Expert

May 9, 2011
12:00 p.m. – 1:00 p.m. (EST)

  • Darron DiGiulio, DO - Dermatologist

Between 40% and 50% of Americans who live to the age of 65 will have skin cancer at least once. With the inherent ultraviolet light exposure in Florida and resulting sun damage, the Department of Dermatology offers expertise in the screening, diagnosis, and treatment of skin cancers.

Cleveland_Clinic_Host: Today's Live Web Chat, "Skin Cancer" with Darron DiGiulio, DO will begin at 12 noon EST. Please submit your questions by typing them below and then clicking 'Ask'.

Cleveland_Clinic_Host: Welcome to our Online Health Chat "Skin Cancer: Ask an Expert!" with Darron DiGiulio, DO. We are thrilled to have him here today for this chat. Let’s begin with the questions.

SunFan: What is Basal Cell Carcinoma?

Darron_DiGiulio_DO: This is the most common type of skin cancer. There are several types, but most often it looks like a red rough spot that may or may not bleed, translucent bump, or a sore that won't heal. These are associated with sun exposure as are melanoma and squamous cell skin cancer.

Rkm1948: My grandson, 13, has FMD. He also has many freckles all over his body. He has very olive skin. We live in Florida. We use a lot of sunscreen at the beach and he's never had a bad sunburn. I am concerned about: .....2 freckles on the bottom of his feet ......1 freckle on his arm that is much darker than the others. I would appreciate your opinion. Thank you so much.

Darron_DiGiulio_DO: I commend you on his use of sunscreen! These spots should be examined by a dermatologist to know for certain whether they are benign or not.

SunFan: What is squamous cell carcinoma?

Darron_DiGiulio_DO: The second most type of skin cancer also associated with sun exposure. Organ transplant patients are also at greatly increased risk for this. This cancer often presents as a rough spot or changing nodule. This can be more aggressive than basal cell skin cancer, but it is easily treated and generally curable when detected early.

ADG27: Should I worry about sun spots becoming cancerous?

Darron_DiGiulio_DO: When you say sun spots I am going to assume you mean "liver spots" or "age spots" that are seen as flat brown spots on the arms and upper back. The medical term is solar lentigo. These are a sign of sun damage, which means there is an increased risk of skin cancer so you should be examined by a dermatologist at least once a year.

ADG27: Will using skin bleaching products make my skin worse or more susceptible to skin cancers in the future?

Darron_DiGiulio_DO: If you were applying these agents to the face, I would apply a broad spectrum sunscreen over the area. Sun makes brown spots darker so not only will you be protecting your skin, the bleaching product will also be more effective!

Cleveland_Clinic_Host: For those now joining us, we are currently chatting with Dr. Darron DiGiulio who is taking your questions about skin cancer. To ask a question, type in the box below and then click 'Ask'.

CopperToned: Not everyone burns / tans the same way. Are different skin types more at risk for skin cancer... a more olive skinned person vs. a fair skinned person?

Darron_DiGiulio_DO: I hope you are naturally "coppertoned" and not so from sitting in the sun. There is no such thing as a healthy tan. Suntan means sun damage. The people most susceptible to skin cancer are the blue-eyed, red heads that always burn and never tan. Patients of Latin and African origin are less susceptible, but no one is immune.

Tim24: How do you get skin cancer?

Darron_DiGiulio_DO: There are multiple risk factors including genetics but the biggest one that can easily be avoided is sun exposure. Seek the shade, use a hat, and use your sunscreen.

ADG27: If I wear lotions with SPF 50 and then put make up over it, am I still being protected from the sun?

Darron_DiGiulio_DO: Yes! Sunscreens should be reapplied every 2-3 hours or immediately after swimming. Applying makeup over the sun block is fine.

Tim24: What is the best protection for your skin? Sun-block? What does the SPF rating mean?

Darron_DiGiulio_DO: The best protection is really to avoid the sun. Part of living in Florida is to enjoy outdoor activities- it's why we live here so enjoy yourself, but use sunscreen when you go out. SPF refers to Sun Protection Factor. Simply put, it's a factor of time that it would take to burn while using the product. For example, if you normally burn in about 30 minutes without sunscreen, if you apply a product with SPF of 15, you would theoretically burn in 30 minutes x 15 or 7.5 hours. I recommend using a SPF of 30 or higher. Make sure you use enough - about a shot glass full for the body. If you don't use enough, your protection is compromised.

TMan: If I stay in the shade, should I still wear sunscreen?

Darron_DiGiulio_DO: An umbrella at the beach helps, but remember sun comes not only from above but also reflects off surfaces. You are not protected from the UV light reflecting off the sand. To answer your question, shade helps but still use your sunscreen.

Cleveland_Clinic_Host: We have approximately 8 minutes left in the chat. We received a large amount of questions and we will continue to answer as many as possible. We apologize if we did not get to your question. If you have additional questions after the chat, please use our contact link clevelandclinic.org/webcontact to submit your questions.

Songcanary: I am fair skinned and had many blistering sunburns before the age of 25. I am currently 55 years old and so far no problems. But what types of skin changes would I look for in a suspected skin cancer?

Darron_DiGiulio_DO: Blistering sunburns are a risk factor for skin cancer including melanoma. Examine yourself monthly and see a dermatologist yearly at minimum. Look for new or changing lesions as a general guide.

Nystrom: I had all of my moles checked and was told that some of the ones I thought looked questionable were not moles but keratosis. What really is the difference and can keratosis be pre-cancerous? When should I consider having them removed?

Darron_DiGiulio_DO: You probably had what are called Seborrheic Keratoses. These are benign, friendly growths that are often confused with melanoma. They typically are brown, well-demarcated and scaly or crusty. They have no cancer potential.

Cleveland_Clinic_Host: We are getting ready to close for today, but will answer 2 more questions. A large number of questions were received and we apologize if we did not get to your question. If you have additional questions, please go to clevelandclinic.org/health/livepersonchat to chat online with a health educator. .

Athena: I have numerous basal cell cancers, and have had squamous cell cancer once. I am light skinned and freckled, and in my youth and several blistering sunburns. Does my past skin cancer experience put me at an increased risk for malignant melanoma? I am 53, and live in FL. Thank you!

Darron_DiGiulio_DO: It does as you clearly have had sun damage with several skin cancers, blistering sunburns, and are of fair complexion all of which are risks for melanoma. A family history of melanoma would also be an additional risk factor. This does not mean you will develop a melanoma, which occurs in about 1 of 55 people, but you should be monitored as you are at risk.

Athena: Is there any reason to use a sunscreen with an SPF higher than 55? I currently use 85 (because of my past skin cancers & fair skin), but I have read that the higher number only protects you for a longer period of time. I use uva/uvb with "helioplex."

Darron_DiGiulio_DO: I tell patients not to get too caught up in SPF numbers above 30. A SPF of 30 will block about 97% of UVB which is responsible for sunburn. More importantly use it properly! Apply about 30 minutes before going outdoors, reapply every 2-3 hours and immediately after swimming, and apply enough! You will be protected.

Cleveland_Clinic_Host: I am sorry to say that our time Darron DiGiulio, DO is now over. Thank you again Dr. DiGiulio for taking the time to answer our questions today about skin cancer. If you are interested in scheduling an appointment with Dr. DiGiulio, or any one else from our Dermatology Department in Florida, please call toll free 877.463.2010

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