Dr. Mark answers questions on how to best protect your skin

Friday, March 30, 2018

In light of news that Lacey Adams, wife of U.S. Surgeon General Jerome Adams and former Indiana’s State Health Commissioner, has metastatic melanoma (skin cancer that has spread), we re-visit a conversation we previously had with Lawrence A. Mark, M.D., Ph.D., an assistant professor of dermatology at Indiana University School of Medicine and a physician-researcher at the Indiana University Melvin and Bren Simon Cancer Center. He answered questions about skin cancer and how to best protect yourself.

Q: I know I’m supposed to wear a hat and long-sleeves, but when it gets terribly hot and humid that doesn’t seem very practical. What can or should I do?

Dr. Mark: First off, staying in the shade during the peak sun hours of the day is helpful. There are also multiple clothiers that make highly breathable fabrics that allow you to stay cool despite long-sleeves and also contain ultraviolet protective additives (UPF) that block UV rays.

Q: What if I wear clothes that are made with UPF? Do I still need to slather on sunscreen?

Dr. Mark: I would still cover up with sunscreen on areas that don’t get covered by the protective clothing.

Q: What are the best ways that I can protect my skin?

Dr. Mark: Wear appropriate clothing that particularly helps cover cosmetically sensitive areas such as the face, ears, and nose -- also known as a hat. Also cover up skin that only gets strong exposures of UV once in a while, such as your back, belly, and legs. Wear sunscreen on areas that you cannot cover such as the backs of the hands and back of the neck. Also, avoid the peak hours of UV exposure when the sun is at its strongest, between 10 a.m. and 2 p.m.

Q: I’m confused by all of the SPFs (Sun Protection Factors) I see listed on products. How can I decide which SPF offers the best protection? 

Dr. Mark: A daily moisturizer with SPF 15 or better would be reasonable. If you know you will be getting more prolonged exposures, an SPF of 30 or higher is better. Whatever sunscreen you use should state on the bottle that it is “broad-spectrum,” which means that it covers both the UVA and UVB portions of sunlight.

Q: Who needs to apply SPF?

Dr. Mark: I would suggest all skin types use sunscreens as they can also defy the aging effects of chronic UV exposure. That being said, even darker skin types can develop melanoma such that it maybe helpful for anyone.

Q: What are some signs of skin cancer?

Dr. Mark: Watch out for what I call the “ugly duckling sign.” If you have a spot that just doesn’t look like any other, it is best to have a doctor examine it, just to be on the safe side. Also, be familiar with A,B,C,D,E:

ABCDE of skin cancer

Q: When I think of skin cancer, I naturally think of my face and arms – those areas that are exposed to the sun. Can I get skin cancer anywhere else?

Dr. Mark: Yes. Be mindful that skin cancer can develop in places you may not consider: between the toes, on the soles of your feet, on the palms of your hands, under your finger and toe nails, and on oral or genital mucous membranes. 

Q: What are researchers such as yourself learning about skin cancer?

Dr. Mark: We are making advances in therapy for aggressive and unresectable (unable to be removed with surgery) melanoma, squamous cell carcinoma, and basal cell carcinoma, but it has been a long and hard struggle to treat them because there are so many diverse changes that can happen to their genetics and cellular functions when they go awry. So your best chance of doing well is to first prevent them from occurring by using the guidelines above or having them found early when they are still surgically removable.

What is skin cancer?

Skin has several layers. Skin cancer begins in the epidermis (outer layer), which is made up of squamous cells, basal cells, and melanocytes. There are several different types of skin cancer. Squamous cell and basal cell skin cancers are sometimes called nonmelanoma skin cancers. Nonmelanoma skin cancer usually responds to treatment and rarely spreads to other parts of the body. Melanoma is more aggressive than most other types of skin cancer. If it isn’t diagnosed early, it is likely to invade nearby tissues and spread to other parts of the body. The number of cases of melanoma is increasing each year. Only 2 percent of all skin cancers are melanoma, but it causes most deaths from skin cancer.

You can learn more about skin cancer, including melanoma, from the National Cancer Institute.