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Skin Cancer

Councilwoman Susan Berland stands with the free sunscreen dispenser now at Crab Meadow Beach in Northport. File photo from A.J. Carter

By Victoria Espinoza

One Huntington Town official is determined to have residents covered when it comes to their skin.

Councilwoman Susan Berland (D) received support from her Huntington Town Board colleagues to expand her pilot program and provide sunscreen protection for Huntington residents at 14 new locations in addition to Crab Meadow Beach.

Last summer Berland launched a free sunscreen dispenser program at Crab Meadow Beach after working in conjunction with IMPACT Melanoma, formerly known as the Melanoma Foundation of New England, an organization that provides education, prevention and support for the most serious form of skin cancer.

“The [Crab Meadow Beach dispenser] was a success,” Berland said in a phone interview. “It got a lot of use last year and this year. So I wanted to expand it to 14 other locations.”

For about $1,600, the town will purchase from IMPACT Melanoma 14 additional BrightGuard sunscreen dispensers along with a supply of BrightGuard Eco Sport Sunscreen Lotion SPF 30 for each designated location.

The new dispensers will be installed at Asharoken Beach, Centerport Beach, Crescent Beach, Fleets Cove Beach, Gold Star Battalion Beach, Hobart Beach, Quentin Sammis/West Neck Beach, Greenlawn Memorial Park, Heckscher Park, Ostego Park, Veterans Park, Crab Meadow Golf Course, Dix Hills Golf Course and Dix Hills Pool. The sunscreen is environmentally safe, made in America and Para-AminoBenzoic Acid (PABA) free, according to Berland’s office. The councilwoman said she chose locations based on need and their supervision.

“For example the town pool is where all town camp programs are held,” she said. “I’m willing to bet there are some kids who are not using sunscreen or will forget it and this can help.”

Berland said the reaction to the first dispenser and a melanoma prevention and awareness event she hosted earlier this summer have indicated both been a success.

“I get swarmed at the dermatologists office about how great the first dispenser is,” she said. “People can forget to pack their sunscreen or some people have never even used sunscreen before. It’s just not on their radar. So people are now trying it, it’s a great preventative for the residents.”

According to the Journal of Clinical Oncology regular sunscreen use can reduce the incidence of melanoma by 50 to 73 percent.

According the 2014 report “Surgeon General’s Call to Action to Prevent Skin Cancer,” skin cancer is the most commonly diagnosed cancer in the United States, and most cases are preventable. Melanoma is responsible for the most deaths of all skin cancers, killing almost 9,000 people each year. It is also one of the most common types of cancer among U.S. adolescents and young adults.

Berland is a skin cancer survivor herself and said this issue is very personal to her.

“People need to take care of themselves early in life,” she said. “This has opened up people’s eyes to the entire issue.”

The resolution will be presented to the board at the next town board meeting. Supervisor Frank Petrone (D) said in a phone interview he believes the program’s relatively low cost is an added benefit to the positives it will do for residents.

“It’s a very minimal price,” he said. “It’s not something to put my thumb down on.”

For more information about this program, call Berland’s office at 631-351-3173.

Councilwoman uses personal experience with skin cancer as motivation to spread awareness

Councilwoman Susan Berland stands with the free sunscreen dispenser now at Crab Meadow Beach in Northport. File photo from A.J. Carter

For one Huntington Town councilwoman, warning residents about the dangers of the sun isn’t just a work obligation — it’s personal.

Councilwoman Susan Berland (D) has been dealing with the effects of spending summers under the sun’s rays for nearly a decade, and it has motivated her to host “Melanoma Prevention: Avoiding the Dangers of Tanning,” an event open to the public Tuesday, April 25, at 7 p.m. at Town Hall, 100 Main St.

“I think it’s important for any parent whose kid wants to tan to learn spending too much time out in the sun is dangerous,” Berland said in a phone interview. “Hopefully this sways people from making bad decisions.”

Berland said she had her first run-in with skin cancer seven or eight years ago, when she discovered she had an irregular mole on her lower back that was precancerous. These moles, also known as dysplastic nevi, increase the risk of a patient developing melanoma in a mole elsewhere on the body.

“When I was in high school, I was one of the girls wearing Hawaiian Tropic [sunscreen] zero [SPF] and using tinfoil at the beach getting fried,” Berland said. “I did a lot of damage. Nobody knew, you just always thought you looked so much better with a tan.”

When she had kids, she said she was focused on making sure her children were protected with sunscreen, and would often “run out of steam,” by the time it got to her skin.

Berland, like many other people, learned of a “base tan,” a once-popular idea to get before vacations, where the thought was getting a starter level for a tan on your skin would help protect it from getting burnt when on tropical vacations. Many science and health organizations, including medical research group Mayo Clinic, have come out against base tans in recent years, saying they do not protect skin anymore than sunscreen and can actually cause more damage long term.

“I didn’t get fried anymore, and I really thought I was doing the right thing and getting a healthy tan,” Berland said. “Turns out there’s really no such thing as that.”

The councilwoman said she’s had six procedures so far — the most recent in March — to remove dangerous parts of her skin, and she goes for full-body checks every three months.

“I always hope to leave the doctor’s office as I came in but that hasn’t been the case yet,” she said. “The pain is just not worth it — it’s just not.”

In some cases she said skin abnormalities had to be removed with liquid nitrogen. “On a scale from one to 10, that’s about a seven, but in some cases I had to have the procedure on my lip and that is like a 50,” she said of the pain associated with the treatment. “And that is why I am doing this. People are not paying close enough attention. I am a total convert now, I lay under an umbrella at the beach and wear SPF 50.”

Berland said she hopes people will realize how serious skin protection is during the event, where Meghan Rothschild, a cancer survivor and spokesperson for the Melanoma Foundation of New England will be speaking about her fight against cancer and how to prevent melanoma, the deadliest form of skin cancer and the second most-common cancer in children, teens and young adults aged 15-29. New York State Attorney General Eric Schneiderman (D) will also be attending the event, and echoed the dangers of tanning.

“To many people, indoor tanning seems like a harmless activity — it’s not,” Schneiderman said. “Each session increases your risk of skin cancer and contributes to premature aging, eye damage, allergic reactions and more. There are many myths and misconceptions concerning the safety of tanning, many of them perpetrated by the indoor tanning salon industry. If you engage in indoor tanning or are thinking about it, it’s important to make sure you know the significant associated health risks.”

Berland said she would tell young children considering going to a tanning booth to get their tan out of a bottle.

“Spray tans or makeup, if you don’t like it you can wash it off and start again,” she said. “But in a booth there is nothing you can do to reverse the damage. It’s just not worth it. The pain you go through, the anxiety of wondering when the next spot will be found on your body. You’re playing Russian roulette with your body.”

Diet choices and vitamin B3 have surprising effects

By David Dunaief

Dr. David Dunaief

Warmer weather is finally upon us, we now have long, sunny days and, soon, the beach. However, longer sun exposure does increase the risk of skin cancer. Melanoma is the most serious skin cancer, but fortunately it is not the most common. Basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (SCC) are more prevalent, in that order. Here, we will focus on these two types.

The incidences of these skin cancers are very difficult to pin down because they are not readily reported. However, most of us either know someone who has had these types of skin cancer or have had them ourselves. There were roughly 3.5 million nonmelanoma skin cancer treatments in the U.S. in 2006, with the number of treatments increasing 77 percent from 1992 to 2006 (1). SCC and BCC outcomes diverge, with the former having a higher risk of metastases compared to the latter, which tends to grow much slower (2).

These skin cancers may present in different ways. BCC may have a bump that is pearly, waxy, light-colored or pink or flesh-colored or brown. It may bleed, ooze and crust, but may not heal, and can be sunken in the middle (3). SCC has the appearance of a growing nodule. It may also be scaly or crusty and may have flat reddish patches. It may be a sore that also may not heal. It is found on sun-exposed areas, more commonly the forehead, hands, lower lip and nose (3). Interestingly, SCC develops over years of gradual UV sun exposure, while BCC develops more like melanoma through intense multiple sporadic burns (4).

The more well-known risks for these types of skin cancer include sun exposure (UV radiation), light skin, age, ethnicity and tanning beds (2). But there are other risk factors, such as manicures. There are also ways to reduce risk with sunscreen reapplied every two hours, depending on what you are doing, but also NSAIDs (nonsteroidal anti-inflammatory drugs) and even vitamin B3. Let’s look at the research.

Beyond skin cancer

Though nonmelanoma skin cancers (NMSCs) have far less potential to be deadly, compared to melanoma, there are other risks associated with them. In the CLUE II cohort study of over 19,000 participants, results show something very disturbing: A personal history of NMSC can lead to other types of cancer throughout the body (5). The increased risk of another type of cancer beyond NMSC is 103 percent in those with BCC and 97 percent in those with SCC, both compared to those who did not have a personal history of NMSC.

Tanning beds — No surprise

We know that tanning beds may be a cause for concern. Now the FDA has changed the classification of tanning beds from low to moderate risk and requires a warning that they should not be used by those under the age of 18 (6). The catch is that this does not have teeth; if tanning salons ignore the new rules, there is no punishment.

However, in a prospective (forward-looking) study, results show that people’s responses to warnings depended on how the warnings were framed (7). Compared to the text-only FDA warning requirement, graphic warnings that emphasized the risks of skin cancer were more likely to help people stop using tanning beds, whereas graphic warnings that demonstrated the positive benefits of not using these devices had no effects. So you may have to scare the daylights out of those in their teens and early twenties.

A recent study showed that drying lamps used after a manicure could lead to skin cancer.

Manicure risk, really?

I am told women and some men love manicures. Manicures cannot possibly be dangerous, right? Not so fast. It is not the actual manicure itself, but rather the drying process that poses a risk. In a prospective study, results show that drying lamps used after a manicure may increase the risk of DNA damage to the skin, which could lead to skin cancer, though the risk is small per visit (8).

There were a lot of variables. The shortest number of visits to increase the risk of skin cancer was eight, but the intensity of the UVA irradiance varied considerably in 17 different salons. The median number of months it took to have carcinogenic potential with exposure was around 35, or roughly three years. The authors recommend either gloves or suntan lotion when using these devices, although both seem to be somewhat impractical with wet nails. It’s best to let your nails dry naturally.

Vitamin B3 to the rescue

Many vitamins tend to disappoint when it comes to prevention. Well, hold on to your hat. This may not be the case for vitamin B3. In the Australian ONTRAC study, the results showed that vitamin B3 reduced the risk of developing NMSC by 23 percent, compared to those who took a placebo (9). Even better was the fact that SCC was reduced by 30 percent.

The most interesting part about this study is that these results were in high-risk individuals who had a personal history of NMSC. The participants were given B3 (nicotinamide 500 mg) twice daily for one year.

After the patients discontinued taking B3, the benefits dissipated within six months. The study was on the small side, including 386 patients with two or more skin cancer lesions in the last five years, with a mean of eight lesions. The side effects were minimal and did not include the flushing (usually neck and facial redness) or headaches seen with higher levels of niacin, another derivative. The caveat is that this study was done in Australia, which has more intense sunlight. We need to repeat the study in the U.S. Nicotinamide is not expensive, and it has few side effects.

NSAIDs as beneficial?

Results have been mixed previously in terms of NSAIDs and skin cancer prevention. However, a more recent meta-analysis (nine studies of varying quality, with six studies considered higher quality) showed that especially nonaspirin NSAIDs reduced the risk of SCC by 15 percent compared to those who did not use them (10).

Diet — The good and the bad

In terms of diet studies, there have been mixed positive and neutral results, especially when it comes to low-fat diets. These are notoriously difficult to run because the low-fat group rarely remains low fat. However, in a prospective dietary study, results showed that effects on skin cancer varied depending on the foods. For those who were in the highest tertile of meat and fat consumption, compared to those in the lowest tertile, there was a threefold increased risk of a squamous cell cancer in those who had a personal history of SCC (11). But what is even more interesting is that those who were in the highest tertile of vegetable consumption, especially green leafy vegetables, experienced a 54 percent reduction in skin cancer, compared to those in the lowest consumption tertile.

Thus, know that there are modifiable risk factors that reduce the risk of nonmelanoma skin cancer and don’t negatively impact your enjoyment of summer. There may be easy solutions to help prevent recurrent skin cancer, as well, that involve both medication and lifestyle modifications.

References: (1) Arch Dermatol. 2010;146(3):283. (2) uptodate.com. (3) nih.gov. (4) Br J Cancer. 2006;94(5):743. (5) J Natl Cancer Inst. 2008;100(17):1215-1222. (6) federalregister.gov. (7) Am J Public Health. Online June 11, 2015. (8) JAMA Dermatol. 2014;150(7):775-776. (9) ASCO 2015 Annual Meeting: Abstract 9000. (10) J Invest Dermatol. 2015;135(4):975-983. (11) Am J Clin Nutr. 2007;85(5):1401.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.

People should go through several bottles of sunscreen in one season. Using an ounce of sunscreen is ideal, as companies measure the SPF of a sunscreen by applying that amount of sunscreen to the body. Photo by Giselle Barkley

A little dab here and a little dab there. That’s usually how people apply sunscreen to their skin, according to Dr. Michael Dannenberg of Dermatology Associates of Huntington, chief of dermatology at Huntington Hospital. But with around one in five people developing skin cancer on their scalp, a dab of sunscreen isn’t enough.

Skin cancer is one of the most prevalent cancers in America, and cases for scalp cancer have increased in the past several years. While those who don’t have hair may be more prone to getting scalp cancer in comparison to those with hair, anyone can develop any form of skin cancer on this area of their body.

Squamous cell and basal cell carcinoma are common for those who are frequently exposed to the sun and those who are losing hair. Melanoma can also develop on the scalp. In 1935, one in 1,500 people developed melanoma, but the rate has since increased. Now, one in 50 people have a lifetime risk of developing melanoma.

According to Dr. Tara Huston, a surgeon in the Melanoma Management Team for Stony Brook Medicine, there will be 74,000 new cases this year of melanoma in the United States alone. Huston also said that this form of skin cancer usually requires a surgeon’s attention, as it calls for “a larger excision margin than either basal or squamous cell skin cancer.”

Huston and her team help patients with various forms of skin cancer. While dermatologists treat skin cancers like melanoma if caught early, people with more advanced stages of skin cancer may need surgery and additional treatment to recover. A patient’s lymph nodes are also examined. Lymph nodes are responsible for the drainage of certain parts of the skin. Doctors can further repair issues found from examining the nodes associated with the cancer in that area.

Sunburns, above, and increased sun exposure increase an individual’s risk of getting skin cancer like Melanoma, which accounts for four percent of cases, but 75 percent of skin cancer-related deaths according to Dr. Huston. Photo from Alexandra Zendrian
Sunburns, above, and increased sun exposure increase an individual’s risk of getting skin cancer like Melanoma, which accounts for four percent of cases, but 75 percent of skin cancer-related deaths according to Dr. Huston. Photo from Alexandra Zendrian

Although skin cancer of the scalp is not difficult to detect, Dr. Dannenberg says it can be missed because it is on the head. Lesions can vary based on the form of skin cancer on the scalp. Yet, it is easy to detect, especially when people receive frequent haircuts. According to Dannenberg, his office receives countless referrals from barbers and hairstylists who may find a cancerous lesion on their client’s heads.

Huston agreed with Dannenberg regarding the role of barbers and hairstylists, as a number of skin cancer lesions are identified by these professionals.

Squamous cell carcinoma appears in dull, red, rough and scaly lesions, while basal cell carcinoma appears as raised, pink and wax-like bumps that can bleed. Melanoma on the scalp appears as it would on any other part of the body — irregularly shaped, dark-colored lesions.

While sunscreen is more often associated with skin protection, dermatologists like Dannenberg also recommend protective clothing and hats. Cloth hats allow the wearer’s head to breathe while protecting the scalp. Hats with a three and a half inch or more rim offer the best protection, as they cover the head while protecting the ears and other parts of the face or neck. While people can also use straw hats, the hats should be densely woven and not allow sun to penetrate. Hats as well as sunscreen and protective clothing should be used together to provide people with the best form of sun protection.

“Nobody is completely compulsive about putting on that hat every moment they walk out the door,” Dannenberg said. “Likewise, even for people [who] are using sunscreens, people tend not to use enough of it and they don’t reapply it as often as necessary.”

One ounce of sunscreen might be hard to hold without dripping down the side of someone’s hand, but it is the amount of sunscreen people should use on their entire body. Dannenberg also says that sunscreens usually last for about three hours before people need to reapply.

Since few people follow the directions when applying sunscreen, Dannenberg as well as the American Academy of Dermatology recommend people use sunscreens with at least SPF 30. Using sunscreens with higher SPF counts means that people can under apply and still get some degree of sun and ultraviolet radiation protection.

Huston said individuals who don’t want to wear sunscreen or those with a history of tanning should seek a dermatologist and schedule appointments at least once a year to conduct a full body skin examination.

According to Huston, operating on areas of the head like the ears, nose, eyelids, lips and scalp is difficult because of the surrounding tissue.

“Reconstruction of a 2 cm defect on the nose may require multiple stages/surgeries in order to optimize the aesthetic result,” Huston said in an e-mail interview.

While some patients need skin grafts upon the removal of a cancerous lesion, Huston said, “incisions on the scalp can lead to alopecia, or hair loss along the incision line, if it stretches, and can be very upsetting to patients.”

Both Huston and Dannenberg emphasized the importance of protecting the skin and skin cancer education. Dannenberg hopes that the rates of skin cancer will decrease if people are more consistent about protecting their skin with protective attire, sunscreen and hats.

“We’ve been talking to people for years about wearing hats…telling them that as fashion always seems to follow need, that these hats are going to be coming in style,” Dannenberg said. “We’re hoping that over the next 10 or 15 years, we’ll be able to get a drop in the incidences of skin cancer.”

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