Ritu Saini, MD (New York, NY), National Skin Cancer Foundation, “Mohs Surgery, Skin Cancer and Melanoma”
Sharon’s first guest was Dr. Ritu Saini, a Dermatologist, representing the National Skin Cancer Foundation. Sharon noted that malignant melanoma is a skin cancer on the increase (most other cancers are decreasing), which she attributes to dry air and increasing solar exposure. With education and early detection, the disease is 95% preventable and 99%curable. Sharon’s Save a Child’s Life Foundation raises money to combat melanoma in children.
Dr. Saini is a specialist in Mohs Micrographic Surgery, a procedure to remove skin cancers. It was invented in the 1960’s as a way to remove the cancer lesion and get an almost instantaneous pathogenic analysis to help surgeons know if they removed the entire growth so they won’t have to go in a second time. Tumors are also biopsied prior to surgery.
Sharon noted that it is important to teach patients to educate themselves and check their skin periodically for changes. She observed that not all skin cancers are large and pigmented and they do not all occur in sun-exposed areas.
According to Dr. Saini, there are three kinds of skin cancers:
1. Basal cell carcinoma presents as a pale lump that does not spread (metastasize).
2. Squamous cell carcinoma presents as an oozing or crusty patch that also does not metastasize.
3. Malignant melanoma presents as a large, dark growth that very much does metastasize and which can be fatal.
4. (Note: Some types of malignant sarcoma may appear as skin growths but are considered cancers of the connective tissue, not the skin. They do very much metastasize. See http://www.wikipedia.com.)
Dr. Saini explained that skin cancers start in the skin’s dermis, or lower layer and are usually not visible for some time, until they invades the epidermis, or outer layer.
Sharon wondered if there was a demonstrated correlation between dry skin, insufficient water intake and skin cancer. Dr. Saini said that such a link was suspected but not proven.
It was noted that fair skinned people have a higher incidence of skin cancer and that there is definitely a genetic predisposition. It is theorized that Oregon has an unusually high skin cancer rate because it has a lot of fair skinned people.
There was a lengthy discussion of sun protection. It is important for everyone always but far more important if you are fair skinned and/or spending a day at the beach (or have a family history of skin cancer). Sharon noted that many indoor conditions can dry and weaken the skin and make you more vulnerable and that you should apply sunscreen after every bath or shower (and drink lots of water).
Dr. Saini recommended sunscreen that offers both UVA and UVB protection, and sunscreens based on titanium or zinc dioxide rather than chemical formulations because they are less likely to cause an allergic reaction. She stressed that the use of sunscreen should not give you license to spend hours in the sun and that tanning is never good for you. Babies especially should be shielded from the sun.
The best protection: Drink plenty of water, cover up and wear sunglasses and hats.
The National Skin Cancer Foundation is in its 30th year and, among other things, sponsors a nationwide program of skin cancer screening in a motor home, underwritten by Rite-Aid. They have so far screened 3,000 people. They may be reached at www.skincancer.org.
Sharon asked about ocular melanoma, which can cause blindness or death. She believes that chronic dry eye and/or chronic eye irritation can contribute to ocular melanoma (which is caused by chronic inflammation, usually associated with dry eye). Ocular melanoma is on the rise and can cause blindness or death. Annual full body examinations of the skin should always include the eyes (other eye problems besides melanoma can arise from chronic dry eye).
Final words: Each year, on your birthday, give yourself a full skin examination head to toe.