Tag Archives: skin cancer


I commented on the myth of base tans for Scientific American. See the article here:

Salon / Scientific American.

Over the years I have been impressed by how many college students insist on “getting a tan before they get a tan” at spring break. This American rite of passage invariably results in an untold number of sunburns–red, painful noses, shoulders, feet–virtually anywhere the sun can get reflected by sand and water. The MYTH has been that a base tan will help protect your skin for the “REAL THING”. Unfortunately, this is not the case. Any sun exposure intended to tan will harm your skin damaging the DNA inside the skin cells. Tanning is a natural mechanism to prevent damage to the DNA but it is not a strategy to protect against intentional injury. A so-called base tan provides a sun protection factor so low it is practically equivalent to having no meaningful protection at all. See my comments in this article from the

In a regrettable demonstration of confused priorities state senator Michael McLachlan squelched a law that would have protected thousands of teenagers, mainly girls from the dangers of artificial tanning. Such tanning has been scientifically proven to cause skin cancer and melanoma. The bizarre amendment that McLachlan used to scuttle the tanning law would have required the same parental consent for abortions by minors. To be fair there are legitimate positions on either side of the abortion argument but it should not have been conflated with attempts at protecting children from potentially deadly activity. Tanning parlors must be regulated at least in the same fashion as we control cigarette access to minors. It seems McLachlan probably is not familiar with the evidence linking ultraviolet radiation to cancer. I routinely see young women now with skin cancer, most of whom have used artificial tanning parlors in their teenage years.The health of our children, born or unborn, is not a zero sum game. Protecting children from one harm does not mean we believe in harming them in another fashion. But if you think this way, as McLachlan apprently does, we will lose many easy opportunities to protect the health of the next generation.

Thanks to Nancy Alderman’s activism, the tanning bill made it right up to the end. Her relentless efforts at passing intelligent tanning parlor regulations will prevail.Read the editorial in the Danbury News Times. Nancy has worked very hard to educate newspaper editors and opinion leaders about the need for tanning parlor regulation, and in this case the harmful, needlessly provocative actions of McLachlan.

My Quick Take on the New Regs

As I mentioned yesterday, the FDA guidelines for sunscreen labeling have been published. The final guidelines clearly reflect the input that has been received through the public comment period. Here are the key points in the new rules in the FDA’s own words with my comments in italics:

  • Broad Spectrum designation.Sunscreens that pass FDA’s broad spectrum test procedure, which measures a product’s UVA protection relative to its UVB protection, may be labeled as “Broad Spectrum SPF [value]” on the front label. For Broad Spectrum sunscreens, SPF values also indicate the amount or magnitude of overall protection. Broad Spectrum SPF products with SPF values higher than 15 provide greater protection and may claim additional uses, as described in the next bullet. This is a reasonable guideline that seeks to provide the consumer with some clarity around the issue of “broad spectrum” coverage. I typically recommend sunscreen with SPF minimum of 15 to 30 so this guideline is reinforcing.
  • Use claims. Only Broad Spectrum sunscreens with an SPF value of 15 or higher can claim to reduce the risk of skin cancer and early skin aging if used as directed with other sun protection measures. Non-Broad Spectrum sunscreens and Broad Spectrum sunscreens with an SPF value between 2 and 14 can only claim to help prevent sunburn. Sunscreen less than SPF 15 is unhelpful in terms of skin cancer protection so I am glad this has been defined for the public. Also, critical to note that “other sun protection measures” must be followed to optimize skin cancer risk reduction.
  • “Waterproof, “sweatproof” or “sunblock” claims.Manufacturers cannot label sunscreens as “waterproof” or “sweatproof,” or identify their products as “sunblocks,” because these claims overstate their effectiveness. Sunscreens also cannot claim to provide sun protection for more than 2 hours without reapplication or to provide protection immediately after application (for example– “instant protection”) without submitting data to support these claims and obtaining FDA approval. This rule is consistent with what I have been telling patients all along: regardless of what the label says, reapply every couple of hours while outdoors. Its a hassle, but very doable when you consider the alternative.
  • Water resistance claims. Water resistance claims on the front label must indicate whether the sunscreen remains effective for 40 minutes or 80 minutes while swimming or sweating, based on standard testing. Sunscreens that are not water resistant must include a direction instructing consumers to use a water resistant sunscreen if swimming or sweating. Reasonable.
  • Drug Facts. All sunscreens must include standard “Drug Facts” information on the back and/or side of the container. Probably the most helpful addition: we all read those boxes with detailed information. While sunscreens are over-the-counter products, they are obviously regulated. They have significant beneficial effects and this new requirement will help consumers better understand what ingredients do. The more useful information, the better!

Sun Hygiene Activities

Consistent sun hygiene includes regular use of sunscreen or sunblock.

In a recent interview with Marketwatch.com I coined the term “sun hygiene” to specifically refer to those activities that are proven to help maintain your skin in healthy condition while outdoors. Dermatologists talk frequently about the ways to protect your skin from the damaging effects of ultraviolet radiation, and dentists talk frequently about the importance of good dental hygiene to maintain your teeth and gums in a healthy state. In essence, care of your skin needs to follow the same daily routine that you pursue for dental health. The care, when it comes to your skin, goes beyond just the use of sunscreen, which is critical, but involves a whole range of simple steps that will help your skin stay healthy and attractive throughout your life.

Here are five key steps to effective sun hygiene: Continue Reading »

Melanoma Alphabet

The majority of cases of melanoma are treatable when diagnosed early. The seriousness of a particular melanoma relates to its thickness, so if the melanoma can be diagnosed when it is thin and less risky, simple surgical removal often yields an extremely high cure rate.

Atypical appearing mole

More than two decades ago, a general guideline was developed to help people recognize skin lesions that could be melanoma. The so-called “ABCD” guideline was a simple way of identifying key factors of moles or other lesions that required prompt attention to make sure that melanoma was not developing or already present. Ultimately, melanoma can only be diagnosed by skin biopsy, but whether through self skin exam, an annual skin exam by your physician, or if you have a lesion that is concerning, it is important to know whether the growth truly requires additional attention.

Hopefully, the ABCD paradigm, which some expand to include the E for “evolving”, and I expand to include the letter S, for suspicious, is well known. Here is a brief reminder but it should be remembered that this just represents an aid to recognition and should not replace any specific concerns that you have about particular skin lesions.

A–asymmetry. If you look at the lesion and fold it in half in your mind’s eye the two sides do not match. Normal moles typically grow in a somewhat circular and therefore symmetric fashion. Abnormal moles and melanoma, because of factors related to their biology of growth, may develop an asymmetric appearance. Continue Reading »

Dermatologists recommend an annual total body skin examination as a means to identify skin cancer and melanoma at its earliest most treatble stage. While melanoma and skin cancer can be dangerous, the good news is that careful monitoring of your skin allows you to become better aware of the moles and skin growths so that abnormal lesions can be identified and changes in moles will be more apparent. While the majority of skin cancers are probably identified by the patient or partner (female spouses and partners are best at this in my opinion), there are often lesions that are not of concern to the patient but identified by the doctor as suspicious and therefore in need of biopsy or close monitoring.

The Total Body Skin Exam

When we say “TOTAL” we mean “TOTAL”. The proper exam is performed in a well lighted room with the aid of a magnifier if necessary. The doctor or other specially trained care provider should be systematic and study the skin from the scalp to the feet, including often ignored areas like the palms, soles and in between the toes. One patient told me his dermatologist did not want to examine his scalp because “he had too much hair”. Most balding men would view that as a good problem to have but its not an excuse to perform an inadequate exam. Scalp should be examined carefully ( in many people the scalp has received much sun over the years). Hair should be parted with fingers, a comb or even a hair dryer set on cool. Many people are surprised by how fast some doctors perform a full skin exam. In fact, skin examination is all about pattern recognition and at a first pass very concerning lesions do jump out. Closer exam of these lesions is then necessary. The length of the exam is less important than its completeness and your sense that it has been thorough. If you are wearing naill polish, you must return to have the doctor examine your nail area or make sure you do so yourself when the polish is removed. There has been a spate of new products and machines  that claim to systematically scan for moles and skin cancer. Most of these are just sophisticated digital imaging methods that serve as an aid to identify lesions of concern but are not in themselves diagnostic tools. For now the best computer for melanoma identification resides between the two ears of the dermatologist.

In addition to the annual full skin exam, people at high risk for skin cancer:

1. people with fair hair, fair skin or blue, grey or green eyes

2. people with a family history of skin cancer or melanoma

3. people who have had blistering sunburns in childhood

should all be seen a second time each year for examination of the high risk sun exposed areas. After that follow the recommendation of yoru dermatologist for a follow-up plan unique to your situation

Moles of concern include those that are greater than 6-7 mm (the size of a pencil erase); asymmetric (when folded over in your mind’s eye the halves don’t match); change in color including presence of black, red or white colors; irregular rather than smooth rounded borders; moles that itch or bleed and, perhaps most important, moles that you are concerned about. Very often patients will point out lesions that bother them thouh they can’t say why. I teach my residents that those must be biopsied. Patients have  a sixth sense about their body and this must be respected by the doctor.

May Is Melanoma Awareness Month

The month of May has been designated MELANOMA AWARENESS MONTH. While the yearly calendar is packed full with days, weeks and months dedicated to many important medical and social causes, Melanoma Awareness Month is especially important and directly relates to activities we all participate in when the sun rises higher in the sky and the power of damaging ultraviolet radiation is more intense. More intense UV rays means more risk of skin damage from the cancer-causing mutations in the skin. Interestingly, ultraviolet radiation causes “fingerprint” mutations in certain cancer genes. The mutations are unique to the sun and so it is possible to identify in damaged skin, what mutations were accumulated while lying, working or playing in the sun unprotected. While not all melanomas are caused by the sun ( it is estimated that 40% of melanomas may not  be sun-related) the role of the sun in melanoma is well-established and that critical fact creates an opportunity for strategic protection. There are so many diseases and ailments for which the cause is not known. In the case of melanoma and skin cancer, we not only know the cause ( UV radiation) but we know how to minimize it, thus providing one true approach to preventative health. A great public service advertisement was recently posted on youtube.com:


CA Gov. Jerry Brown has Mohs Surgery

Today the Los Angeles Times reports that Governor Jerry Brown, underwent surgery for a skin cancer of the nose.   Basal cell cancer, the lesion that was removed from his nose using a technique called Mohs surgery, is the most common form of skin cancer in humans. Continue Reading »

Protecting Against Skin Cancer

A Yale Cancer Center podcast hosted by Dr. Ed Chu, Deputy Director and Chief of Medical Oncology, and Dr. Francine Foss,  Professor of Medical Oncology and Dermatology. Continue Reading »

Sunscreen Myths

One of the myths about sunscreen is that sunscreens won’t prevent skin cancer – and may even cause it.  Dr. Leffell is quoted in an article published in the Seattle Post Intelligencer as saying “Sunscreens can prevent skin cancer, but they need to be part of an overall protection program.  You also need to stay out of the sun from 10 a.m. to 4 p.m., wear protective clothing, and seek shade whenever possible.” Continue Reading »