VB Gives Back

#VBGIVESBACK: Elizabeth K. Hale, M.D.

May 1, 2018

More people are diagnosed with skin cancer each year in the United States than all other cancers combined, with one in five Americans developing skin cancer by the age of 70. This statistic is made even more startling given the fact that skin cancer is often preventable. The causes are known and there are steps that can be taken to minimize risks. Since 2003, Elizabeth K. Hale, M.D., has been working with the Skin Cancer Foundation to increase awareness around skin cancer and provide education about sun protection. We are especially honored to support this organization during skin cancer awareness month this May.

What are the types of skin cancers and how are they different?

Skin cancer is the most common cancer diagnosed in the United States. The three main types of skin cancer are Basal Cell Carcinoma (BCC), Squamous Cell Carcinoma (SCC) and Malignant Melanoma (MM). BCC comprises about 80% of new skin cancer cases, SCC about 15%, and MM less than 5%. However, while melanoma accounts for less than 5% of new skin cancer cases, it is responsible for the overwhelming majority of deaths from skin cancer.

Most skin cancers are completely curable if they are caught early; this is why early detection is so important. Melanoma, if caught early, has a 99% cure rate. However, if it is not detected early, once it invades the skin and develops potential to spread throughout the body to the organ systems, the cure rate drops dramatically. This is why advanced melanoma has such a high mortality rate.

When it comes to skin cancer, what are the common misconceptions?

It seems that every day in my practice, patients tell me, “The damage is already done,” or “It’s too late for me to wear sunscreen now.” There is a common misconception that it is too late to improve our sun habits and effect a meaningful change. This is not true! Only 25% of our lifetime damage occurs by adulthood. Furthermore, studies show that making sunscreen part of our daily routine, even as adults, will decrease our risks of skin cancer and signs of premature aging.

Another misconception I hear is that indoor tanning can provide a “healthy base tan” before a sunny vacation. This is not true! There is no such thing as a healthy tan, especially when it comes to indoor tanning. Indoor tanning beds emit UV radiation that is 12X more powerful and damaging than outdoor UV rays. Exposure to indoor tanning beds can increase our risk of melanoma by 75%.A sunless tan is a better option before a vacation, but the sunless tan does not protect you from sunburns and sun damage, you still need SPF!

Why is melanoma more prevalent in young women? What is causing this cancer to develop?

BCC and SCC, also known as non-melanoma skin cancers, are more common with chronic sun exposure, so we often see these skin cancers on areas that are exposed year-round, like the head and neck, the ears and lips, and the back of the hands. Because they are linked to chronic sun exposure, we also see more of these types of skin cancers as people age.

Melanoma, on the other hand, is particularly common in young women. We see a peak in melanoma incidence in women aged 21-35. This is a direct reflection of sun habits in this age group. Interestingly, the type of sun exposure young women get is not necessarily the same chronic exposure that outdoor workers or older people in retirement communities get. Rather, it is common for young women to get intense “bursts” of UV exposure. For example, living in a moderate climate like New York City and staying covered up for most of the year and then flying to the Caribbean for a week vacation provides an intense “burst” of sun exposure to skin that has otherwise been covered up and protected. The type of skin-damaging mutations induced by this “sun-bursting” is more likely to contribute to melanoma formation.

Indoor tanning beds also are responsible for these “sun-bursting” mutations. Interestingly, young women often get melanomas on areas that are normally covered throughout the year and then get exposed to these intense bursts of damaging UV radiation. For this reason, for example, melanomas in women often occur on the legs. And in women who have indoor tanned, I have diagnosed many melanomas on the breasts and buttocks, areas that have not been otherwise exposed, except to the intense bursts emitted by indoor tanning beds.

Dr. Hale and Dr. Robins, founder of the Skin Cancer Foundation.

How did you first get involved with the Skin Cancer Foundation?

I have been involved with the Skin Cancer Foundation (SCF) since 2003, when I was training in Mohs micrographic skin cancer surgery with my mentor Perry Robins, MD. Dr. Robins founded the Skin Cancer Foundation to increase awareness about skin cancer diagnosis and treatment. To this day, he is a giant in our field, and he has been a true role model and advocate for dermatologists and our patients. Over the past 15 years, I have worked closely with him and the rest of the SCF staff and members to further our mission. I am now a Senior Vice President and serve on the Foundation's Champions for Change Gala committee.

Is there a story from your time working with skin cancer that continues to make an impact?

One of my most memorable professional experiences resulted from a skin cancer screening I did for the foundation. I often volunteer my time to perform skin cancer screenings through the Foundation's Destination: Healthy Skin program as well as visiting corporate offices to screen their employees in order to raise awareness. Several years ago, I was volunteering at a major corporation, and the CEO of the company came to get his skin checked. I was literally checking his skin in the bathroom at their headquarters. I ended up diagnosing him with an early melanoma and potentially saved his life.

This showed me how we need to work to increase awareness, so people know that having their skin checked can potentially save their life. A 10 minute examination is often all you need, and the Skin Cancer Foundation makes this possible for people who might not have otherwise been checked.

Norah O'Donnell and Dr. Hale

What steps can be taken to prevent skin cancer?

Melanoma is the most common cancer, but it is also often the most preventable! We know exactly what causes it, and we can be educated on how to minimize our risks. It is thought that in 2018, more skin cancer is linked to sun exposure than lung cancer is to smoking. We should still enjoy our time outdoors, but we want to do it safely. I recommend a broad-spectrum SPF 30 or higher every single day of the year. This is the best way to decrease our chances of developing skin cancer and signs of premature skin aging. And when you are outside in warm weather, I recommend reapplying sunscreen every 2 hours.

I also recommend staying in the shade whenever possible; sunscreen is not a “free pass” to lie out and seek a tan. I also personally use and recommend hats, sunglasses, and sun-protective clothing. Educating our children is also very important; we should teach them early to practice sun safe behaviors and to use regular sunscreen, much like we teach them to brush their teeth or wear helmets for bike-riding and skiing. Teaching our children safe habits while they are young can ensure a healthier life for them as they grow up.

What type of sunscreen should you be wearing?

As far as choosing a sunscreen, the best sunscreen is one you will actually use. For some patients, this is a lotion or a cream. For others, it may be a spray, a powder, or one of the newer whipped formulations. Zinc Oxide is a great ingredient for daily use on the face, as it is a broad-spectrum physical blocker which helps mitigate Ultraviolet A (UVA) damage, which is a main culprit of skin aging and skin cancer development. However, sunscreens that are purely physical are not good as providing water resistance as the chemical sunscreens. The chemicals used in US sunscreens have been proven to be safe and effective. I personally think a combination of physical and chemical sunscreen ingredients may be the best option.

May is Skin Cancer Awareness month and Dr. Hale will be appearing on CBS This Morning alongside Norah O'Donnell on Melanoma Monday, May 7.


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