Melanoma Monday

Last Updated by Samantha Dlugosh on
BEVERLYSKIN.COM

The sun is out, and so is the aloe vera. If your skin is feeling the effects of the May sunshine, it might be time to reconsider the notion of a "healthy glow."

Today is Melanoma Monday. We're talking tanning beds and cancer screenings.

Here's some statistics to get us started: Nearly 44% of high school junior girls and nearly 50% of high school senior girls currently use tanning beds in South Dakota (2013, YRBS)

David Benson is the South Dakota Government Relations Director for the American Cancer Society Cancer Action Network, Inc. in Sioux Falls. Dr. Jacob Kusmak is a Sanford dermatologist. This conversation has been edited for web use, to listen to it in its entirety click here

Lori Walsh:                           

Welcome back to In the Moment. I'm Lori Walsh. The sun is out and so is the aloe vera. If your skin is feeling the effects of the May sunshine it may be time to reconsider the notion of a healthy glow. Today is Melanoma Monday. We're talking tanning beds and cancer screenings. Here are some statistics to get us started. Nearly 44% of high school junior girls, nearly 50% of high school senior girls currently use tanning beds in South Dakota. David Benson is the South Dakota government relations director for the American Cancer Society Cancer Action Network in Sioux Falls. He joins me now in the studios at STPB Studios at the University of Sioux Falls. David Benson, thanks for being here. Thanks for stopping by.

David Benson:                    

Thanks for having me.

Lori Walsh:                           

Also on the phone we have Dr. Jacob Kusmak. He's a Sanford dermatologist. Dr. Kusmak, welcome.

Dr. Kusmak:                         

Appreciate it, Lori. Thanks again for inviting me.

Lori Walsh:                           

Let's start with you, doctor, because let's lay the ground work for what exactly melanoma is.

Dr. Kusmak:                         

Well, let's talk about melanoma. Melanoma is one of the most serious cancers there is that we can get. So it's important that we're aware of what this is and how serious it can be. In our nation, about every hour a patient dies of melanoma in our country, so that's pretty serious statistics. In terms of what we can do to prevent that, we'll talk about that later today, too, but I also wanted to discuss some ways that we can look for that early and some opportunities in our community to help people in our community to find it.

Lori Walsh:                           

So does everybody have the same risk factor for melanoma? Based on the way your skin looks does that make a difference? Or is it only based on behavior and lifestyle?

Dr. Kusmak:                         

Oh, great questions. As a dermatologist and as physicians and people in our health system, we divide our risk factors into two different categories. There's ones that are preventable and the ones that you can't prevent. So you can't change your genes. You can't change your parents. So those are things you can't control and some of those kind of things that we see in the skin would be somebody that has a lighter complexion, maybe a lot of moles or gets more exposure related to different places they live and things that you can't really control too much. But then we talk about the preventable risk factors and that's sun protection, avoiding the tanning booth, avoiding getting sun burns, and then really trying to protect your skin as much as possible.

Lori Walsh:                           

All ages? How soon do you have to start paying attention to sun protection?

Dr. Kusmak:                         

Well, we try to educate people as soon as we can, as early as we can, of course. We see patients of all ages in dermatology clinic, but in terms of ages that we start to educate people about, that's when you're swimming when you're kids. You're out in the pool, you wanna get outside and be in the pool it's important to protect your skin so you don't get early sun damage. And then all through middle school, high school, and then as adults, too. [inaudible 00:03:16] trying to continue those practices.

Lori Walsh:                           

When does it start showing up? If you went swimming a lot as a kid, you were outside as a teenager, or you used those tanning beds as a teenager, how soon can you start seeing the effects of that?

Dr. Kusmak:                         

Well, that's impossible to know for sure, to be honest with you, Lori. That's a great question, but certainly the more exposure you have, the more damage you get and the earlier some of the real serious stuff like a melanoma can show up.

Lori Walsh:                           

I wanna bring David Benson into the conversation. First, tell me a little bit about what the American Cancer Society Cancer Action Network is.

David Benson:                    

ACSCAN, we're the non-profit, non-partisan advocacy arm of the American Cancer Society. We support evidence based policy at the federal, state, and local levels. Our goal is to empower advocates, volunteers, every day people to engage with legislators and elected officials to pass policies in the fight against cancer. So it might seem a little strange for the government relations guy to be on a conversation as it relates to Melanoma Monday, but in the last few years we've been bringing a bill that would prohibit those under the age of 18 from accessing indoor tanning devices. And the evidence, the science, shows us that if we can limit that exposure it's gonna reduce risk for not only the kids actively using, but later on in life.

Lori Walsh:                           

What's the evidence? Tell me what you know about the potential damage and just how keeping it from a 16 year old, a 15 year old, a 12 year old would make a difference.

David Benson:                    

As you mentioned, we already know that teenagers are actively using to have nearly half of our high school senior girls actively using indoor tanning devices and we know why. The societal factors with prom and other events leads to that activity. But we know that tanning before the age of 35 increases the risk of melanoma by 59%, so the risk is there and we know that, again, if we can limit that access at a young age, we can probably curb that usage long-term.

Lori Walsh:                           

What do you know about ... You mentioned prom. Are those tanning devices being used for an event-based thing and then not done anymore? Is that okay? Is there any amount of safe exposure is what I'm trying to get at.

David Benson:                    

There's no safe exposure. There's a lot of misconceptions about a base tan or a healthy glow. Those are marketing tactics. To have a sense that you need to go get a base tan before vacation to limit your risk, it's false. And when you are getting a tan, it's an indication that your DNA's changing. Your skin is telling you stop, you're affecting the DNA in a negative way. When you drive around town or across the states and you're seeing advertising, it is marketing in a way during the times of prom or other activities or to gear up before summer and we know we have seasons here in South Dakota, although sometimes it doesn't feel like it this year. But to advertise in a way to prepare yourself for summer is in a way targeted towards kids.

Lori Walsh:                           

Dr. Kusmak, you see that. I'm not a tanning bed user. I have incredibly fair skin. It's shorts season and I'm gonna get teased. I'm gonna get made fun of when I put on a skirt or shorts about how white my legs are. You get that from your patients, right? What are your thoughts about the sort of cultural notion of what our skin should look like?

Dr. Kusmak:                         

Well, and that's one thing that we talk about in the dermatology clinic is just being who you are and trying to be smart about being healthy. David was alluding to some of these other statistics. I have some more that I'll contribute with, but I encourage people to really just cherish who they are and not trying to be somebody different and damage their body. Any tan is damage to your skin and has a risk factor. My statistics, that I tell patients and that we talk about in dermatology, one single session, one time at the tanning booth. One time, five minutes or whatever that is, increases your risk for melanoma about 25%. Multiple times throughout your entire life, five or more in your entire life, increases your risk more than 80%. So anybody that's going tanning in the school systems obviously is going at least five times. So that's something that we worked with and David and I worked with and he talked a little bit about that trying to encourage South Dakotans to make some restrictions so we don't have that opportunity for our kids to go tanning. So many states, about, I think 34, 35 states in our country now ban tanning for anybody less than 18. In South Dakota, there really are no rules.

Lori Walsh:                           

David, let's talk a little bit about policy though because as we learn more about cancer there are many things that people can do, many lifestyle choices they can make to reduce their risk of cancer. How do you know as an organization when there's the evidence and the traction to bring policy forward that might make a difference?

David Benson:                    

Certainly, as a national organization we do an annual report looking at where each of the states are at with a variety of priorities and we certainly talk to folks on the ground and law makers to see what they’re interests are in and we've had some incredible legislative champions as relates to this bill. We can look to states like Minnesota who have passed similar legislation that we're proposing here and what they've seen just in a short period of time since passing their bill is that for those under 18 the number of 11th grade white females using indoor tanning devices decreased over 70%. So as more and more states are starting to get on board, we can look to our neighbors or across the country to determine what did they do that's demonstrating a record of not only legislative success, but impacting lives. So when we look at this, we know in South Dakota we have a tradition of looking at ways to protect our kids and we feel that when you have the science and you have other states starting to get on board with this. And it's not just this issue specifically. We also along with the state medical association and the American Heart Association brought legislation this last session dealing with increasing the age for tobacco product purchasing, raising that up to the age of 21. There's a number of issues that we're talking to legislators about, talking to members of Congress to look at how we're protecting our kids, how are we reducing the risk of cancer and reducing the death rate associated with cancer.

Lori Walsh:                           

When you talk to law makers, the opposition must come from an industry, obviously, and then also from people who are just hesitant to have more regulation, when do you draw the line. How do you communicate with them? What's the talking point there to say this legislation has value?

David Benson:                    

It's education. Everything we work on we have citations, we have evidence, we have studies that we can point to strengthen the rationale for why we're bringing the bill. So there's education, but it's a constant conversation and we've been able to get the bill out of committee. There continues to be challenges that we know from the opposition. There's been some proposals at the national level that have kind of put a wrinkle in it and those dynamics changed. And certainly with the turn over. We're gonna be dealing with a new body of legislators, a new administration. So, again, it's more of that education, those conversations to talk about here's the reality, here's what we're facing here in South Dakota, here's what we can do here in South Dakota and work towards the passage of the bill. Again, the more that we can look at other states that have done it and demonstrate the success and curbing the usage strengthens the work we do here in South Dakota.

Lori Walsh:                           

In South Dakota, David, is it concentrated in the urban areas, the indoor tanning industry? Or is it spread out to smaller communities throughout the entire state?

David Benson:                    

As Dr. Kusmak had mentioned, this is an industry that's not really regulated. There's no registry that I've come across that demonstrates how many tanning devices that are out there. So it's a guessing game to some degree and I think the key thing, and we appreciate being on the program today, is certainly there's the legislative work that happens, but also the public education and we know that individuals have tanning devices in their homes. But I have to think that if the parents had the education, the knowledge, and I think that comes with us bringing this bill and talking to law makers and having forums like this, they start to realize that maybe having a tanning bed in their basement's not a great idea. That this idea of a base tan or a healthy glow is just false.

Lori Walsh:                           

Dr. Kusmak, let's talk a little bit about Melanoma Monday and some of the screenings or events that might be happening today.

Dr. Kusmak:                         

Yeah, great. Let's talk about what we do as a nation. As a dermatology group throughout our nation we pick one day a year called Melanoma Monday and this happens once a year, first Monday in May. And many communities around our country have events and we partner with Lewis Drug here in our community and they do a great job. We've been doing it for a number of years so thank you, Lewis, for doing that. And here in Sioux Falls, from 4:30 to 7:30 at Lewis Drug on 26th and Sycamore they will have screenings. No charge. Patients can come in. I think they do want you to call ahead and see the arrangements and might have some more information about that. But that's where you can get a free skin check and that would look for any concerning moles. And then individually from patients, people that are listening, I encourage to look at all their moles. We always just say once a month look at all their moles and look for anything that looks funny. One of the rules is the ugly duckling rule. So any mole that looks different to anything else. So that's kind of unique.

Lori Walsh:                           

Freckles, too? How do you define mole? Are you looking at freckled skin and skin with moles or what am I looking for?

Dr. Kusmak:                         

So, there's many different spots on you body. Everybody has spots on their body. So when we look at moles we mostly, specifically for melanoma, there are pigmented spots on your skin in most cases and so we look for perhaps a mole that's flat, it even could be raised, but it just looks different than anything else on your body and that's something that should be alarming. We look for different features of a specific mole. We want to make sure that it's even. Asymmetric is something that's abnormal, so we want it to be symmetric, both sides are even if you cut it in half or draw an imaginary line. The borders are usually pretty even. Nice and smooth of a mole. The colors, we usually like to have maybe one or two different colors within a mole and that's normal in most cases. And then the most common thing people think about is a pencil eraser. You don't want a mole bigger than your pencil eraser. But that being said, those are four things that we talk about. But when you go to the dermatology office or your regular doctor's office, they'll look at different features of a mole and help educate patients about what to look for specifically.

Lori Walsh:                           

Do I go to my regular family practice doctor and do a skin check as part of a regular check up? Or when do I know I need a specialist, I need to make sure I have a dermatologist that's checking me every year?

Dr. Kusmak:                         

Great question and we get that question a lot. In dermatology, in most cases we have a primary doctor refer patients to see us. That being said, we have all patients. We don't just look at moles and skin cancers. We look at any part of the skin and any different problem of the skin. Hair, nails, all that kind of stuff. But most often it's a referral from your primary care provider. But if you have a high risk in your family. Say, your family history of a melanoma or family history of other skin cancers, that puts you at higher risk. You can't control that. Somebody like that probably should be seen in dermatology maybe every now and then or at least established to make sure there's no loose spots that they're concerned about.

Lori Walsh:                           

Sun block, is that something that is safe and that we consider using every day? Are there different kinds of sun blocks that we're looking for?

Dr. Kusmak:                         

I encourage that a lot for patients and that's one of things, one of the preventable things you can do. Sun screen, there's really three rules that we talk about with that. We like a sun screen that's broad spectrum, means covers UVA and UVB light. We like a sun screen that's SPF 30 or higher. And the third rule is to reapply it about every two hours if you're outside. So keep it with you. Don't go to the park without some sun screen. Keep it inside the door inside of your car. Great places to keep your sun screen. I do get a question a lot from patients like what sun screen's gonna work better? Is it a cream? Is it a spray or a lotion or a gel? My simple answer to that is the one you're gonna use is gonna work better than the one you don't use. If you're gonna use the spray more, get that one rather than the cream.

Lori Walsh:                           

Is it better just to ... I'm thinking about hats and stuff. It's hard with hair to have a scalp. You have to worry about that as well. You can't really put sun block on your scalp can you?

Dr. Kusmak:                         

No, you can't. And certainly the other part of protecting your skin is sun protection. So not just the sun screen, but sun protection. So we like hats that cover your ears, different types of clothing that maybe is covering your skin, but maybe not be too warm in the summertime. So they make some better sun protective clothing, too, with some ultraviolet light protective factor in there, too. It's at most stores now. Additionally, just seeking shade. We try to avoid the peak hours of the sun during the day, so we usually say between noon and usually four, but I say two to four really for most people. Try to stay inside around those times.

Lori Walsh:                           

How treatable is this? Is it just a surgical removal always? Are we looking at people who get chemotherapy as treatment for this? What if it's already taking hold?

Dr. Kusmak:                         

This is what's so critical about finding this type of skin cancer as well as other type of skin cancers, but all cancers in reality is that the earlier you can find it, the better. So screenings such as the Melanoma Monday screening can perhaps find something that is very early melanoma that is simply just removed with a surgery and that's it. On the other end of the spectrum, there are some melanomas that are very serous, very deadly. And chemotherapy, there's better and better medications these days, but unfortunately melanoma is one of the most deadly cancers there is in our country.

Lori Walsh:                           

Dr. Kusmak, I was just reading an article the other day about people delaying their health care because they have a high deductible plans or they're worried about the expense. Since we're doing a public service here, what's your message to people who are like, "Oh, I can't quite go to the doctor because it might be expensive. It might be something I'm gonna have a hard time paying for."

Dr. Kusmak:                         

Well, that's a reality that we have to live in our society is that unfortunately we have great health care in our community, great health care across our country, but it can be expensive at times. So my discussion is that it's always best to find things early and most cases we don't have to remove things. We don't have to take off moles or rule out skin cancer, but really just making sure that it's nothing bad, that you're not on the other end of the spectrum where it's costing way too much money because you waited too long. Earlier the better. Prevention is better than anything really. But early identification is great. And something like the Melanoma Mondays screening does help us to identify some of these things at no cost to a patient.

Lori Walsh:                           

David Benson, any final thoughts on other work that your organization is doing or what else you wanna say about Melanoma Monday?

David Benson:                    

Yeah, if I could I'd just like to plug a great resource that we put together in support of our campaign. It's a website tanfreeteens.org. There you can hear stories, learn more information. We've got a page dealing with myth busters. Various questions that folks may have, some answers, and also a way to get involved. Certainly, I spend a lot of time in Pierre talking to legislators, but the more we can have individuals coming to Pierre to talk about their own experience of indoor tanning or sun exposure the better. To raise their voices, to talk about the concerns and ways to protect our kids.

Lori Walsh:                     

David Benson is the South Dakota government relations director for the American Cancer Society Cancer Action Network. Dr. Jacob Kusmak is with Sanford Dermatologist. Dr. Kusmak, thank you so much for being here today. We appreciate your time.

Dr. Kusmak:                         

Thanks, Lori. I appreciate it. And thanks again, David. I've worked with him in the past and he's done great things for our state.

Lori Walsh:                           

Thank you, David.

David Benson:                    

Thank you.

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