Well Wisconsin Radio

Skin Cancer Prevention and Treatment

Host: The information in this podcast does not provide medical advice, diagnosis, or treatment. It should not be used as a substitute for healthcare from a licensed healthcare professional. Consult with your healthcare provider for individualized treatment or before beginning any new program.

Hello, and welcome to Well, Wisconsin Radio, a podcast discussing health and well-being topics with experts from all around the state of Wisconsin. I’m your host, Renee Fox, and today my guest is Niham Ahmad, professor and vice chair for research in the Department of Dermatology in the School of Medicine and Public Health at the University of Wisconsin, Madison. Dr. Ahmad, thank you so much for joining us today to talk about skin cancer prevention and treatment.

Guest: Thank you very much for giving me this opportunity. I am very excited today.

Host: Oh, so glad you’re here. Can you start our conversation today by telling us about the different types of skin cancers and the most common causes?

Guest: So, there are three main types of skin cancer. One is melanoma, which is less common, but more aggressive skin cancer. It originates in the pigment producing cells, which are known as melanocytes within the skin. And it can develop on any part of the body, including the areas that are not actually exposed to the sun.

Then we have a basal cell carcinoma and squamous cell carcinoma, which are often grouped together as non-melanoma skin cancers. These usually develop on sun exposed areas like the face, scalp, neck, and hand. And the ultraviolet radiation, solar ultraviolet radiation, is the major factor for all of these skin cancers.

Host: So what factors put us at higher risk for developing these different types of skin cancers that you just described?

Guest: So, Renee, there are a number of factors that can contribute to our risk of developing skin cancer. So, as I said, sun exposure, prolonged and unprotected exposure to solar ultraviolet radiation is the major cause. But other factors. are fair skinned. People with fair skinned light hair, such as blonde or red hair, and light-colored eyes, blue or green eyes, have less melanin, which provides natural protection against UV radiation. So these individuals are at a higher risk. History of sunburn, experiencing multiple instances, instances of blistering sunburn, particularly during childhood and adolescence age, increases the risk of a skin cancer later in life. Family history of a skin cancer. So, having close family members such as parents or sibling who has had this skin cancer, that also is a factor. Previous diagnosis of, any type of skin cancer puts one at a higher risk for of developing another skin cancer.

Having a large number of moles when I say large number, meaning more than 50 moles or atypical moles that increase can also increase the risk for melanoma. In addition to that, weak immune systems. So for example, due to medications such as medications for HIV and AIDS or medications for other immunosuppressant medication can heighten the risk for skin cancer.

If one has had a previous radiation exposure for conditions like acne or some, some other type of cancer can increase the chances of developing skin cancer. Also certain occupations that involve prolonged sun exposure, such as outdoor construction workers or are farming. Those folks have higher risk for developing skin cancer. And ultimately the, the risk for developing skin cancer increases with age.

Host: Hmm. Interesting. So what are some things that we could do to lower our risk, particularly if we are in those occupations where we’re outside, or maybe we’re just trying to, you know, spend time outdoors with our family? So how can we keep ourselves and our family safe as we are spending time outside?

Guest: Sure. So most important thing is applying sunscreen. So, use a broad spectrum sunscreen with a sun, SPF protection factor, which is known as SPF 30 or greater. Limit sun exposure and seek shade wherever possible, whenever possible. Stay in the shade, especially during peak sunlight hours, which is somewhere between 11:00 AM to 4:00 PM time range.

Always wear protective clothing and sunglasses, dressing in loose fitting long sleeve shirts—although I have on short sleeves today—long pants and hats, and avoid tanning beds. And stay hydrated as much as you can because it helps maintaining the overall health and elasticity of the skin.

Host: Yeah, great recommendations. And I’ve heard some people just express some hesitation around using sunscreens and just putting that on their skin based on the number of ingredients included. What information can you share with us about the ingredients that are in sunscreen? Is there anything also that we should just look out for?

Guest: Yeah. So sunscreen ingredients can indeed be a topic of concern for some individuals. And it is very important to be informed about the ingredients in sunscreen products and understand their efficacy and safety. I can give you some information about sunscreen ingredients and what to look out for.

So, there are two types of ingredients. Non-organic, or physical sunscreen ingredients. Examples are zinc oxides and titanium oxides, which form kind of a protective barrier on the skin surface. They are considered safe and are less likely to cause skin irritation or allergic reaction. They provide broad spectrum protection and are effective against both ultraviolet A and ultraviolet B radiation. Both of these radiation ranges are responsible for skin cancer.

Then the second type of ingredients are organic or chemical sunscreen ingredients. And some examples are oxybenzone, oxynol, oxynosate. What are the other ones I’m forgetting. I think homosalate. They absorb UV radiation and convert it into heat, which is then released from the skin. So the safety of some chemicals on the sunscreen ingredients has been debated and concerns have been raised about their potential effect on hormone disruption and skin irritation. However, Extensive research and, especially by regulatory agencies, and laboratories such as FDA included in that, have deemed these ingredients safe for use in sunscreen. So, FDA approved sunscreen are the best ones to choose from. So one should choose sunscreens that are approved by FDA because they undergo rigorous testing.

Host: Really helpful information. So are there other lifestyle behaviors that we should be embracing or avoiding to help further minimize our risk of developing skin cancer in addition to wearing that sunscreen?

Guest: Sure, there are several lifestyle behaviors that can minimize your risk for developing skin cancer. So, avoid indoor tanning, as I mentioned before also, be mindful of medications. So some medications such as certain antibiotics, anti-fungal drugs and non-steroidal, anti-inflammatory drugs, which are known as NSAIDs, can increase your skin sensitivity to sunlight.  So if you take those medicine, don’t go, uh, out in sun, uh, stay hydrated is, is the mantra, you know, for the overall skin health, follow a healthy diet, a balanced diet, which is, rich in fruits, vegetables, whole grains, lean proteins provide the essential nutrients and antioxidants that promote overall skin health and antioxidant help protect you, the skin from free radicals, which can damage the skin cells.

Quitting smoking—smoking damages the skin and accelerates the aging process, the skin aging process. Regular exercise, engaging in regular physical activity promotes overall well-being, including healthy skin, and also exercise improves circulation, which nourishes the skin as a natural defense mechanism. Also perform regular self-examinations and routine dermatologist visits to promote sun safe behavior, basically educate yourself and your family, friends and community and encourage them to practice sun safe behavior.

Host: Oh, wonderful. Thank you. Love all of those great reasons for following the healthy lifestyle too. It’s really amazing to think about how it does impact your skin as well as many other health benefits. So say if we’ve had a long history of sunburns in the past, maybe in our childhood, we spent a lot of time outdoors and we’re trying to be more mindful and protect our skin as we age, what steps can we take to minimize any potential damage and just further prevent our risk of cancer?

Guest: Again, as I said earlier, using broad spectrum sunscreen with a SPF of 30, more than 30 on all exposed skin, even on cloudy days, because UV rays are there on even on cloudy days, and reapplying that sunscreen every two to three hours or more frequently if you are sweating or if you are swimming. Wearing protective clothing between 10 to 4 pm time peak sunlight hours is very important. Regular skin checks, you need to perform self-examination of your skin to monitor any changes. New moles, any suspicious spots, if you notice anything unusual consult your doctor or dermatologist promptly. Schedule routine dermatologist visits and maintain overall skin health.

Host: Excellent. So how often should we be getting professional skin cancer screenings and should everyone go or are there certain populations that should go more frequently?

Guest: Yeah, so professional screenings for the high-risk individual is very important. So people with, with the high-risk conditions, which I already talked to you about, should consider frequent, regular professional skin cancer screening. So talk to your dermatologist right away, and maybe on a yearly basis at least. And for general population, for individuals without specific risk factors, it is recommended to be aware of any skin changes and perform self-examination regularly.

If you notice any concerning sign or changes, uh, then consult your PCP or your dermatologist. And at your yearly visit with your doctor, your PCP, your skin should be. Checked for any possible changes.

Host: So, if we are diagnosed with a non-melanoma type of skin cancer that you described earlier What does treatment typically involve?

Guest: Yeah, so there are a number of treatment options for non-melanoma skin cancer and the easiest one and the most common one is the surgical excision. So, the dermatologist will look at your skin, anything there, they will remove it surgically, and send it out for pathology to check what kind of skin cancer it is.

Then we also have Mohs surgery. Mohs micrographic surgery is kind of a specialized technique that is used to treat skin cancer, particularly for the cancers on the face or other areas where tissue preservation is critical. So, it involves removing thin layers of skin one at a time and examining them under a microscope until no cancer cells are detected. That ensures the minimal damage to healthy tissues, such as on your face or on your nose. So, that is, in fact, one technique, Mohs surgery, that was invented here at the University of Wisconsin in the dermatology department by Dr. Frederick Mohs, a long time ago.

The other treatment options are, electro dissection, curettage, where the tumor is scraped with a curette, which is a spoon shaped instrument, and then using an electrode needle to destroy any remaining cancer cells and control bleeding. This is common for smaller, basal cell carcinoma and squamous cell carcinomas. We also have radiation therapy, sometimes topical, medications are used for some superficial form of non-melanoma skin cancers. Cryotherapy is used, that involves basically freezing the cancer cell with liquid nitrogen, and that causes them to die and kind of shed off. This is commonly used for small BCCs and SCCs and also pre-cancerous lesions such as actinic keratosis.

Then there is a technique, not very often used but sometimes it’s used, known as photodynamic therapy or PDT. So PDT involves applying a photosensitizing agent to skin and then exposing that skin to a specific wavelength of light.

The agent is selectively absorbed by the cancer cells. And when it is activated by light, it destroys the cancer cells.

Host: Wow. Thank you for describing this. Now let’s shift gears and talk about melanoma. So when someone has a diagnosis of this type of cancer, what treatments are typically available for those patients?

Guest: Yeah, so treatment for melanoma can vary depending on a stage of disease and individual factors. Uh, and again, a number of options are available currently. Surgery is a primary treatment for localized melanoma. An extent of surgery depends on the stage, you know, stage one versus stage two, how deep the surge surgery has to be done.

Then we also have, immunotherapy. Immunotherapy is kind of a newer treatment and that helps to stimulate the body’s immune system to recognize and attack cancer cells. Several type of immunotherapies may be used to treat melanoma, which includes interleukins. Interleukin or IL 2 is a type of immunotherapy stimulates the immune system to attack cancer cells.

It is typically used for advanced cases of melanoma. We also have checkpoint inhibitors. These drugs target specific molecules that act as a checkpoint on immune cells, allowing the immune cell system to recognize and attack cancer cells more effectively. And this is a pretty new treatment strategy.

Then, recently in the last couple of decades, we have had targeted therapy. These drugs work to block the activity of a specific molecule, which is involved in cancer growth and spread. Targeted therapy is used for melanomas with specific gene mutations. An example is BRAF mutation. So FDA approved BRAF inhibitors for BRAF mutant melanomas not too long ago.

We also have radiation therapy and chemotherapy that can be used for, uh, you know, for, uh, melanoma treatment. Can you talk about the research and clinical trials that the doctors and scientists are leading at UW Health? And do those include any of the examples you just talked about? And then, and how is this work, um, just, you know, collectively helping advance melanoma care?

So, a number of research areas and research endeavors in the field of melanoma often focus on various areas. Some of them are genetic and molecular studies where researchers are investigating the genetic and molecular mechanisms underlying melanoma development, progression, and response to treatment.

This knowledge helps in identifying potential targets for therapy and developing personalized treatment approaches. We are also doing lots of research in immunotherapy and targeted therapies areas. Studies are being conducted to develop and also to refine immunotherapy approaches, such as I mentioned before checkpoint inhibitors and the targeted therapies that specifically target genetic mutations found in melanoma or other proteins or genes which are dysregulated in melanoma. These treatments have in fact revolutionized melanoma care in recent years. Early detection and screening is another area where researchers aim to improve the early detection of melanoma through development of screening methods, new screening methods, novel diagnostic tools and biomarkers that can identify individuals at high risk for melanoma or detect the disease at its earliest stage. Some research is also ongoing on survivorship and quality of life where researchers investigate ways to improve the quality of life for melanoma survivors through studies focused on survivorship care, psychological support, management of treatment side effects and long term monitoring of patients. So those are the areas which, UW and other researchers are also working on.

Host: Oh, wonderful. Can you talk a little bit more about like any stories about a patient that, you know, has participated in your clinical trials and how that has helped save that patient’s life or improve their quality of life, as you mentioned.

Guest: Faculty are involved in multiple single and multi-center phase one through phase three clinical trials right now. And we are also participating in translational research, evaluating blood-based biomarkers to predict immunotherapy response or resistance for advanced stage melanoma. If I remember correctly, recently there was, in media and in news, there was a story about UW being a part of conducting a canine melanoma study with some initial success. So, that was being done at UW veterinary school in collaboration with the SMPH, where the investigators were, are in fact currently trying to find new immunotherapy for canine melanoma with some initial success. So that I remember that story, how the family of the patient, canine patient was very happy with the initial results of a late stage melanoma.

Host: Wow, interesting. You know, I’m not as familiar with hearing about canine cancers in terms of skin cancers. How, how do those signs and symptoms appear? Like, what would a pet owner look for in that situation?

Guest: Uh, it’s again, you know, melanoma is very typical and other skin cancer, but melanoma is basically, are there any changes in the skin. But in this case, I think dogs have also have, and I’m not an expert on that, so I don’t know for sure, but dogs have the melanomas in their mouth. Yeah. So again, I’m not an expert. Maybe, you need to find an expert in that area someday.

Host: Yeah. That’s very interesting though. Any other just final recommendations that you have for our listeners or any resources that you’d like to point our audience to, and we can include those in the show notes.

Guest: Yeah, American Skin Association, on their website they have lots of good information. And always, always when you talk about cancer, National Cancer Institute or NIH, has a very good website and they have resources linked to other resources where you can find a lot of information about any type of cancer, including skin cancers.

Host: Thank you so much. Really appreciate those resources. Appreciate your time today and just exploring this topic.

Guest: Indeed. It’s a pleasure to be here today. Thank you.

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• FDA Facts about Sunscreen 
• American Skin Association
• National Cancer Institute