Skin Cancer Awareness Month

Podcast transcript

INTRO
Welcome to Docs in a Pod presented by WellMed. Over the next half hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-host Dr. Rajay Seudath and Carmenn Miles will share information to improve your health and well-being. And now here are Carmenn Miles and Dr. Rajay Seudath.

CARMENN MILES
Hello everyone, and welcome to the award winning Docs in a Pod. I'm Carmenn Miles and I'm delighted to have you listening in today. Docs in a Pod comes to you every week with a look at a variety of health and wellness issues as they affect people of almost any age, but predominantly those who are 65 and older. Our resident co-host, Dr. Rajay Seudath is with us today to help guide the conversation. He is a board certified family medicine physician. He's a proud Tampa native and the lead physician at the University location for Optum. He brings a great passion to primary care, is a wealth of knowledge, and he makes health literacy so interesting and fun that you just want to keep learning more. Dr. Seudath, how are you today?

DR. RAJAY SEUDATH
I'm doing wonderful. It's good to be back.

CARMENN MILES
I know. It is good to be back. We have a great topic today, but before we go there, we have another important matter to discuss. We just want to say thank you, to all our incredible nurses on this week, Nurses Week. We want to thank our nurses for your compassion, your dedication and strength. Your care makes a difference every single day, and we truly appreciate everything you do for our patients, our families and communities. You want to add anything to that, Dr. Seudath?

DR. RAJAY SEUDATH
Oh, yes. We absolutely love our nurses. Health care really needs the nursing profession because they move so many things forward. So, it's great. I always think of Nightingale, the lady who pioneered nursing in general. So, it's just it's great to be thankful and to acknowledge all the wonderful work they do for us.

CARMENN MILES
Yeah, it would be hard for any of our clinics to operate successfully and for a provider to be as successful as they are without the assistance and the help of the nurses out. They have their own set of responsibilities that helps with all the ebbs and flows right in our clinic. So, we're thankful and grateful for all our nurses on Nurses Week. Well, here we are in May and it is Skin Cancer Prevention Month. It's a time that's set aside to raise awareness about how to reduce your risk, how to spot skin cancer early and why prevention matters for every skin tone at every age and every lifestyle. I personally, Dr. Seudath, before preparing for this show, did not realize that there are so many different types of skin cancers out there and that skin cancer is the most common of cancers worldwide. It affects more people than we realize. So, I think it's safe to start by, first of all, just sharing how skin cancer develops, and then maybe touch on some of the main types of skin cancers that you and your colleagues encounter with your patients.

DR. RAJAY SEUDATH
Yes. You're absolutely right. There are different types of skin cancer. Primarily, skin cancer occurs from sunlight damage. So, UVA and UVB. UVA being the one that causes premature aging, that causes the changes. ItÕs the DNA of the skin cells. Being exposed to sunlight is one of the things that causes damage to the skin, and that's what makes it turn into skin cancer. Other things can cause skin cancer occasionally. Burns that don't heal properly or chronic infections. Sometimes if you have a surgery and that area as it's healing, that itself, that inflammation of that area can cause a type of skin cancer to occur. But primarily when we're talking about skin cancers, especially here in Florida, we are talking about sun damage. That is what's causing these types of changes to occur, and one of the major ways that we can prevent skin cancer is by blocking the sun damage.

CARMENN MILES
Very true. So, when we say cancer and the development of cancer, I really want to try to understand. I mean, we hear cancer and we automatically seize up, but to really understand how cancer develops, is it more cells that keep growing and then divide? How does that work?

DR. RAJAY SEUDATH
Yes. That's a good understanding of it. Cancer is when normal cells or even early young cells for whatever reason get deranged and they start to grow uncontrolled. Typically, in our bodies there's an equilibrium for the cells that are all around each other. Your eye cells, they grow until they become eyes, your nose cells grows until it becomes a nose. Everything kind of gets to where it should be and then it stops. Cancer doesn't have those cues, and they continue to grow out of control. Some cancers grow very, very fast. Some cancers grow rather slow. So, that can tell us what we need to do based on that.

CARMENN MILES
I love it. Let's take a moment to welcome those who may have just joined us. YouÕre listening to the award winning Docs in a Pod presented by WellMed. IÕm Carmenn Miles, chatting with our co-host for today, none other than the Dr. Rajay Seudath out of Tampa, Florida. Docs in a Pod is available wherever you listen to your podcasts. You can also find us on the radio and several Texas and Florida markets. Today we're talking prevention, diagnosis, and typical treatment for skin cancers. Dr. Seudath being from Florida, and also with this month being Skin Cancer Prevention Month, understandably so. Just in time for summer. Skin cancer, as you mentioned being from Florida, isn't just a summer problem, is it? There are other ways, as you mentioned. I just want to go over other ways that cancer develops.

DR. RAJAY SEUDATH
Yes. We were talking about that earlier. The skin cancer is happening anytime there's changes in the cells. So, primarily this is happening through ultraviolet light from the sun. It's damaging the DNA of the cells and that's causing them to multiply without any guidance. They're kind of multiplying however they want. If they get to a blood supply, they'll steal that blood supply. If they get to a bone, they'll invade the bone. If they get to a lymph node, they're going to invade that lymph node. Oftentimes when people think about skin cancer, they think about something growing upwards and becoming this eruption, this mountain of tissue. But the ones that we're really afraid of are the ones that are growing downwards. The ones that are burrowing deep into your skin. So, that brings us to the three types of skin cancers. Again, the skin being the largest organ in the body. It makes sense like you said. It's the most commonly diagnosed cancer because it's the largest organ of the body. So, there's three types of skin cancer. Basal cells skin cancer, squamous cell skin cancer and melanoma skin cancer. The basal cell is the most commonly diagnosed. So, when we're thinking of basal cell we're thinking of the epidermis underneath the dead skin layer. So, that's basal cell. What do those usually look like? Those are usually a fleshy tone. Sometimes they can be a bump. Sometimes that bump can have an open sore or an ulcer, but it's typically a little bit crusty, but more of a kind of fleshy or an open sore type of look. That's how we see those. Again, those can grow upwards until the blood supply doesn't meet the middle, and then it starts to make like a sore. Those can also grow downwards and kind of go to your bloodstream and spread.

CARMENN MILES
By the time that it that it creates a sore, does that mean that it's been there for quite some time or does that even come into play?

DR. RAJAY SEUDATH
It depends on how fast it is growing. If it's growing so fast, it's outpacing its blood supply, its nutrient supply, it's going to make that wound or ulcer because it's growing, but it can't get enough food, so that part starts to die away in the middle. If it's growing downwards, we may not know how long it's been there until we start to do testing for it.

CARMENN MILES
I see.

DR. RAJAY SEUDATH
Now, the next one is squamous cell cancer. Squamous cell cancer are usually folks who are very upwards in their journey of life. They're in their 70s and 80s. They've spent many, many afternoons at the beach or working outside. Typically, there were the generation that did not use any skin protection at all. So, oftentimes they'll see they have crusties on their arms or on their face. TheyÕll say, Doc, I pick this thing away and it comes right back in a few days, and I can never get it to go away. So, those are pre-cancerous changes. We see those very, very often. And that's a squamous cell. Squamous cell skin cancer, they're kind of crusty. You can scratch them and peel them off and they come right back. Those, too, can turn into cancers that spread. So, those are the ones that you want to treat early. Oftentimes we see them as they're pre-cancerous, meaning they're abnormal, but they're not quite cancer yet. So, we often see those as pre-cancerous forms. Those can be frozen off by the dermatologist. You can have a topical medicine to get rid of them, to destroy them on the surface. You can also have those removed, which then leads us to our last, which is the scariest one, which is melanoma. Melanoma is the one where we are always worried because melanoma tends to grow downwards, not necessarily upwards. So, that's the one that we're always trying to catch early. Those are the ones that if we see something that doesn't look right, we're trying to get you to the dermatologist. So, the melanomas, they can be raised or they can be completely flat where you're not seeing anything above the surface. Melanomas come in many, many different forms. Melanoma, meaning melanocytes. Those are the skin cells that give us pigment that make your skin brown. So, melanocytes are in freckles, moles, people who have darker skin tones. So, those are the kinds of pigments that give you that color. It's when those skin cells are having a problem. When those skin cells are having the issues and they're growing out of control, that's when we have a problem.

CARMENN MILES
Very good. Well, we're going to take a break. When we come back, we'll talk a little more about when we should or should not have a biopsy. I think we can touch on some of the surgical approaches to skin cancer, some of what you've mentioned, and of course, prevention. We'll be back in just a moment. YouÕre listening to Docs in a Pod presented by WellMed.

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CARMENN MILES
We're back on the award winning Docs in a Pod presented by WellMed. Thanks for sticking with us through the break. It's Skin Cancer Prevention Month and we're talking prevention, diagnosis and treatment for skin cancers. Just before the break, Dr. Rajay Seudath of Tampa, Florida was discussing one of the most dangerous forms of skin cancer, melanoma.

DR. RAJAY SEUDATH
Yes. We were talking about melanomas. Again, they are the ones that we really worry about spreading, causing metastasis where the skin cancer is going downwards and spreading to other areas. So, that's one of the things that we're always worried about. In Florida, about 600 people per year can die from melanoma. That's a pretty big statistic. Actually, Texas is one of the states that has the least amount of skin cancer, which I was very surprised, considering how sunny it is there. I thought that was pretty interesting, but Florida, lots and lots of skin cancer. Maybe it's because we have such a high elderly population and they've been exposed. When it comes to melanoma, when it comes to basal cell skin cancers, squamous cell cancers, there is what's called the ABCDEs. So, if you have a spot, what's the spot? Is that a good spot? Is that a bad spot? The ABCs. A, is it asymmetric? If you were to take a line and draw it through the center, does the left side look like the right side? If it's asymmetric, that's not good. B, borders. Are the borders nice and smooth or is that border jagged? Is it up and down? Does it look like a kid scribbled with a pencil to make the border of that spot? C, the color. Is the color of the spot different from the rest of it? Is it a dark purple and your skin is a peachy tan? Okay, that's a little different, right? D for diameter. Is it bigger than a centimeter? Is it greater than 10 millimeters? Any of those ABCDs being positive, that's an indication your dermatologist should look at this. Then E is for evolution. Well, it wasn't brown before it was a nice, normal flesh tone, but now it's a dark brown. Or, it used to be a half centimeter, now it's a whole centimeter. Or, it used to just be a spongy spot, and now there's a hole in it that's bleeding. So, any of those evolutionary changes, that's going to make me a little more worried and we're going to want to do something about that. So, that brings us up doing something about it. What do we do? Doc, I got this thing. It doesn't look right. It's been there 20 years, but now it looks different. So, what should we do?

CARMENN MILES
What are our next steps?

DR. RAJAY SEUDATH
What are the next steps? Oftentimes, I'm going to send my patient over to a dermatologist. I want them to have an expert to look at that spot. Now, when you go to the dermatologist, they're going to give you a wonderful, uncomfortable paper gown and say, do you have any spots that you'd like the doctor to look at? You'll say, yeah, I got this spot here. And theyÕll said, would you like to wear this uncomfortable gown and have them look at you naked? And you'll say, no, no, just this one spot. I'll be fine. I want you to put on the uncomfortable paper gown and have them do a full body skin exam.

CARMENN MILES
You may as well. You're there already.

DR. RAJAY SEUDATH
Absolutely. Just because you have one spot in a sun exposed area, there may be other spots that are showing up in unexposed areas. So, that's one of the things with melanoma, for basal cell, for squamous cell that usually occurs in sun exposed areas. For melanoma skin cancer, those can show up in unexposed skin areas. So, it could be on the toes. It could be in the underarms. It could be almost anywhere in your body, and that's why a full body skin exam by a trained expert can be one of the major ways to prevent a skin cancer from becoming something that is dangerous. Most people know I have Caribbean culture in my background, and one of my heroes, one of the people I really enjoy his music, Bob Marley, Bob Marley's life was shortened because of melanoma. It was a melanoma under the nail of his toe, and that's ultimately what was the reason that that claimed his life. Even though that's not a place we typically think of with sun exposure, that's one of the places where it can occur. So, that's one of the things that we want to make sure that if you're going for a full body skin exam, let them look everywhere. If they identify a spot and say, this spot is suspicious. What are they going to do? Typically, they're going to do a biopsy. There are different types of biopsies. Punch biopsy, you can take a scalpel and remove it. Oftentimes that's all you need to do. They remove it and they send it to pathology. Pathology meaning another doctor is going to look at it under a microscope and say, hey, there's no skin cancer at the edge of the spot we took. However, if they remove that spot and they look at it under a microscope and the edges do have cancer at the edges, you may have to have a more invasive type of surgery. That's called Mo's surgery.

CARMENN MILES
Let me let me jump in right quick. Is that the difference doctor can have between benign and malignant or am I jumping ahead?

DR. RAJAY SEUDATH
Yes, there is a little bit of a difference. So, a benign growth is typically not cancer. A benign issue is not going to turn into cancer. We removed it just to be sure, but that's not going to turn into cancer. You're not at any risk. However, a malignant one, we want to make sure that's gone from your body. So, if there's a malignant looking cancer at the edge of where we took, if that's not healthy tissue at the edge, that means it's still there. So, most surgery is they go layer by layer. So, they're going to take off some of that area and they're going to look at a microscope and say, nope, there's still some at the edge. Take off a little more. Nope. There's still some of the edge. Take off a little more. Okay, we got it all. There's none left. Everything looks good. So, that is when we do most surgery. However, if they do a Mo surgery, they're going down, they're trying to get this surgery and they can't get all of it, then we may have to refer a person to radiation therapy or even oncology for systemic cancer therapy. Oftentimes, we want to prevent that. We want to get to cancer before it becomes that sort of thing. So, prevention, prevention, prevention. I'm a family medicine doctor, a primary care doctor. In our world, an ounce of prevention is worth a ton of response. So, I live by those words day and night. We absolutely want to prevent this kind of stuff.

CARMENN MILES
So many of us tend to seize up at the at the big C word, but the truth of the matter is just based on what you've shared here today is that many cases of skin cancer are easily treated and preventable. Again, easily treated by your dermatologist and even in some cases, your primary care doctor. So, how do you encourage people to not delay. The earlier the better, right? It's the best prevention.

DR. RAJAY SEUDATH
Yes. That brings me to one of the things called the Fitzpatrick Scale. So, these are skin types. It goes from one, which is the fairest, the lightest translucent of skins. They have almost zero melanocytes, which is the pigment, all the way to number six, which is dark brown. Very dark midnight skin. Now, any one of those can develop skin cancer. Folks who have very fair skin tones, though, are at a higher risk of skin cancer because they don't have the melanocytes. The melanocytes protect your skin. There's a saying here in Florida, fair skin, fair eyes, Florida dermatologist once a year.

CARMENN MILES
Oh, wow. You're going to go on to some great stuff, but I just so happen to be a woman of color and I have a bit more melanin than some, but I want to just say and address the myth that only fair skinned individuals are at risk. ThatÕs not the case, right?

DR. RAJAY SEUDATH
Absolutely. A case in point. I had a gentleman who went to the beach, and he got a sunburn, and he's like, I'm black, Doc. I'm black. I don't get sunburns. The fact of the matter is, absolutely, you can get a sunburn. It may take a little bit longer than a person who has fair skin, but no, every human, when you're exposed to sunlight, can get a sunburn. That is what sunblock is doing. Sunblock is almost mimicking melanocytes. There's actually a really fun thing that you can look up. Any of our viewers, you can type in UV camera sunblock. Wat you'll see is when people are putting on the sunblock with a UV camera, just under the UV camera, sunblock looks completely black. So, it's almost like people are putting on stage makeup to make their skin look dark, but that is what the sunblock is doing. Now, even though that's what it's doing, it's not 100%. So, you need to put on sunblock, even if you have dark skin and you're going to be outside for a long period of time. That brings us to sunblock. SPF, sun protection factor. Everyone should be using SPF greater than 30, even if you're indoors, you should have it on any sun exposed areas. If you're going to be out at the beach, you're going to be doing something active, SPF 50 and above. For people who have very, very fair skin, Fitzpatrick two, Fitzpatrick one, you may even do a SPF 100 or an SPF 120, but for the most part, SPF 50 applied every two hours. So, that means it gets smudged, it gets moved around, you have to reapply it. I want people to try it before you use it. If you buy some sunblock, put it on, make sure it isn't gummy. Make sure you don't have a reaction because when you need it for the beach, if it's not feeling good, you're not going to use it.

CARMENN MILES
Absolutely. My gosh, the time has passed so quickly. Are there any final comments before we close out today?

DR. RAJAY SEUDATH
I would just say get your skin looked at by your doctors. If you see something that doesn't look right, even if it's been there for years and years and years, have your doctor look at it right.

CARMENN MILES
And remember, no one is exempt. No matter your age or lifestyle or skin tone, you are susceptible to skin cancer, but all of it is treatable. Just see your doctor if something looks strange or a little bit different than it did a few months before. Make sure to go see your dermatologist or your primary care doctor. That's all for today's episode of Docs in a Pod presented by WellMed. Thank you all for joining us as we explored ways to live healthier lives. Don't be a stranger. Subscribe to this podcast so you never miss an episode. Sharing is caring. Share with their friends and family if you think they will benefit from these conversations as well. You can listen to Docs in a Pod wherever you get your podcasts, and you can also catch us on the radio in several Texas and Florida markets. Until next time, stay well.

OUTRO
Executive producer for Docs in a Pod is Dan Calderon. The producer is Cherese Pendleton. Thank you for listening to Docs in a Pod presented by WellMed. Be sure and listen next week to Docs in a Pod presented by WellMed.

DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.

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