Warm weather comes and goes—but the risk of skin cancer is always in season, says three-time Olympic medalist Julia Mancuso. Photo courtesy American Academy of Dermatology.

Slathering on sunscreen to sidestep skin cancer is often associated with being outdoors in the hot, summer sun. But don’t drop sun-smart habits to prevent and detect skin cancer just because the air temperatures fall. People remain at risk during cold weather months, especially if they are around snow (which reflects damaging UV rays) or at are at higher altitudes (where rays are more powerful).

Top alpine skier Julia Mancuso is passionate about raising awareness of skin cancer. And it’s a family affair: Her grandfather and aunt are dermatologists.

“Ever since I was a little girl, my mom instilled in me the importance of protecting my skin from the sun. I follow that advice to this day—on the mountain or off,” says America’s most decorated Olympic female alpine skier. Join in the fight against skin cancer with Julia’s tips and video for protecting your skin while on the slopes: 

More than 3.5 million cases of skin cancer are diagnosed annually. Here's what you need to know about the disease. Infographic by Four Points Dermatology.

Click image to enlarge.

• Always pack sunscreen in your ski gear bag.
• Cover your nose: I use zinc oxide to prevent sunburn. 
• Apply sunscreen every couple of hours because it wears off. I reapply every time I go into the lodge.
• Start your day with a daily moisturizer that contains sunscreen.
• Wear goggles or sunglasses with UVA/UVB protection for your eyes.
• Pull on a mask or wrap a bandana over your face to filter out the sun—and help prevent a wicked goggle line!  
• Grab a hat. When I’m not wearing my helmet on the slopes, I love trucker hats to help protect my face from the sun.

Currently, skin cancer strikes one in four Americans and early detection is key to successful treatment. Now, a new video “Skin Self-Exam: How to Do” from the American Academy of Dermatology shows how to inspect your skin and what to look for.

“Check your skin regularly and see a board-certified dermatologist if you spot anything suspicious. Examining your skin only takes a few minutes, but it could save your life,” said Thomas E. Rohrer, MD, FAAD, a board-certified dermatologist in private practice in Chestnut Hill, Mass. To track suspicious spots, use the American Academy of Dermatology’s Body Mole Map.

Skin-Saving Tips from Alpine Superstar Julia Mancuso The Saturday Evening Post

To prevent skin cancer, sunburn, and early skin aging, dermatologists recommend a water resistant, broad spectrum (blocks UVA and UVB rays) SPF between 30 and 50. Why do we see products with much higher numbers? Marketing, basically. Higher numbers make us think we’re getting better protection, but proof is lacking according to the FDA, which has proposed capping SPFs at 50 to limit unrealistic claims.

So skip the overblown numbers and save your skin with five simple tips from the American Academy of  Dermatology:

• Apply sunscreen 15 minutes before going out in the sun. Exception: Products with titanium dioxide or zinc oxide are effective immediately.

• Spread lotion in thin layer on dry skin (or use enough spray for a glossy sheen as it goes on).

• Reapply product every two hours.

• Seek shade whenever you are taller than your shadow.

• Wear protective clothing, hats, and sunglasses.

Burning Questions The Saturday Evening Post

Previous studies suggest that taking nonsteroidal anti-inflammatory drugs, or NSAIDs, which include aspirin, ibuprofen, and naproxen, as well as a variety of other nonprescription and prescription drugs, can decrease an individual’s risk of developing some types of cancer.

Sigrún Alba Jóhannesdóttir, B.Sc., of Aarhus University Hospital in Denmark, and her colleagues analyzed medical records from northern Denmark from 1991 through 2009 and identified 1,974 diagnoses of squamous cell carcinoma, 13,316 diagnoses of basal cell carcinoma, and 3,242 diagnoses of malignant melanoma. They compared information, including prescription data, from these patients with information from 178,655 individuals without skin cancer.

Individuals who filled more than two prescriptions for NSAIDs had a 15 percent decreased risk for developing squamous cell carcinoma and a 13 percent decreased risk for developing malignant melanoma than those who filled two or fewer prescriptions for the medications, especially when the drugs were taken for seven or more years or taken at high intensity.

Individuals who took NSAIDs did not seem to benefit from a reduced risk of developing basal cell carcinoma in general, although they did have a 15 percent and 21 percent reduced risk of developing this type of cancer on less-exposed sites (body areas other than the head and neck) when they took them long term or at high intensity, respectively.

“We hope that the potential cancer-protective effect of NSAIDs will inspire more research on skin cancer prevention,” said Ms. Jóhannesdóttir. “Also, this potential cancer-protective effect should be taken into account when discussing benefits and harms of NSAID use.”

Click here for sun protection tips from the World Health Organization.

Source Article: “Nonsteroidal anti-inflammatory drugs and the risk of skin cancer: A population-based case-control study.” Sigrún Alba Jóhannesdóttir, Ellen T. Chang, Frank Mehnert, Morten Schmidt, Anne Braae Olesen, Henrik Toft Sørensen. CANCER; Published Online: May 29, 2012 (DOI: 10.1002/cncr.27406).

Summer Skin Care The Saturday Evening Post

Researchers zeroed in on women with a history of non-melanoma skin cancer (such as basal or squamous cell cancers) enrolled in the Women’s Health Initiative, a large clinical trial involving 36,282 postmenopausal women who received either placebo or 400 international units of vitamin D and 1,000 milligrams of calcium carbonate per day.

“In preventive medicine, we want to target people most at risk for the disease,” said dermatologist Jean Tang, MD, PhD, lead author of the study in a university report. “If you previously had a non-melanoma skin cancer, calcium plus vitamin D might reduce your risk of the more deadly melanoma.”

But the supplements didn’t help everyone. Study data show melanomas were detected in about as many women without a history of non-melanoma skin cancer who took the supplements as in their placebo-group counterparts.

The study was published online on June 27 in the Journal of Clinical Oncology.

Can Vitamin D and Calcium Help Prevent Skin Cancer? The Saturday Evening Post

Here are some digital freebies to stop smoking, protect your skin, and live well with diabetes:

Clear the Air: Are you ready to quit smoking and willing to share the good, the bad, and the ugly about your experience? If so, the National Cancer Institute invites you to Smokefree Women, an interactive community for women who want to get (and stay) smokefree.

Skin Savers: Look up your UV Index online, download My UV Check to your Mac or PC, or get the Sun Alert Lite iTunes app.

Diabetes On the Go: Track and send glucose readings, medication records, and food intake to your health care provider with Diabetes Log for iPhones and OnTrack Diabetes for Droid. The American Diabetes Association and websites like dlife offer videos, message boards, news, and tips on food and fitness.

Tell us your favorite apps and website to keep you looking—and feeling—good!

Free Tech Tools for Health The Saturday Evening Post

“AKs are a direct result of UV damage to cells in the top layer of the skin called keratinocytes, and have up to a 20 percent chance of degenerating into squamous cell skin cancer,” points out cosmetic surgeon and skin cancer specialist Dr. William Beeson, a clinical professor at Indiana University School of Medicine. “That’s why most doctors prefer to treat AKs early.”

Topical treatments such as freezing (cryotherapy with liquid nitrogen spray) or applying prescription drugs (5-fluorouracil [5-FU] or imiquimod) can take care of small areas on the head or hands.

But when larger parts on the body require treatment, many dermatologists are using a newer treatment called photodynamic therapy (PDT) to protect healthy skin cells.

“During PDT, doctors apply a special liquid (5-aminolevulinic acid, ALA) that readily penetrates upper skin layers and is absorbed by precancerous cells,” explains Beeson. “Then, a special type of light is used to activate the ALA, killing abnormal cells without harming normal ones for quicker healing and faster recovery.”

Most people resume their usual activities within 3 days after PDT treatment. In contrast, typical laser therapy vaporizes the entire top layer of skin, leaving the treated area very red for about 9 weeks.

“Studies show that photodynamic therapy treatments actually stimulate new collagen in the skin, and many physicians use this same treatment to rejuvenate skin for an improved cosmetic effect,” adds Dr. Beeson. “It may also be used to treat some teenagers with severe cases of acne.”

Of course, always use sun precautions and sunscreens to prevent skin cancer recurrence.

A Better Skin Cancer Treatment The Saturday Evening Post

Nearly one in three women ages 18 to 24 are tanning indoors and almost quarter of them are oblivious to its dangers, according to research published in the Archives of Dermatology.

So, don’t delay. Tell the women in your life that staying away from indoor tanning salons can save their skin—and maybe even their lives.

Need proof? Read on for 5 facts about indoor tanning from the Skin Cancer Foundation:

1. Tanning beds emit UV radiation, which causes skin cancer.

2.  People who tan indoors are three times more likely to develop melanoma (the deadliest skin cancer), 2.5 times more likely to develop squamous cell cancer, and 1.5 times more likely to develop basal cell cancer than those who don’t.

3. The International Agency for Research on Cancer includes ultraviolet (UV) tanning devices in its Group 1 list of the most dangerous cancer-causing substances, along plutonium, cigarettes, and solar UV radiation.

4. Frequent tanners using new high-pressure sunlamps may receive as much as 12 times the annual UVA dose compared to the dose they receive from sun exposure.

5. Ten minutes in a tanning bed matches the cancer-causing effects of 10 minutes in the Mediterranean summer sun.

New York state wants to ban minors from indoor tanning salons, and we agree it’s a smart move. What’s your opinion?

Indoor Tanning and Skin Cancer The Saturday Evening Post

Post editors interviewed dermatology specialist Babar K. Rao, M.D., of The Skin & Cancer Center of New York, The American Skin & Cancer Center, NJ, and West Coast Skin & Cancer Medical Center, California, to find out more about VivaScope laser technology to diagnose basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma, the most deadly of all skin cancers.

The advanced device system, in use in a growing number of clinical dermatology practices across the country, provides more accurate examination of deep skin layers than previously possible without removing tissue. Post editors asked Dr. Rao about the type of worrisome skin lesions that might still require pathologist-read biopsies:

Dr. Rao: Current limitations of the current VivaScope device are related to lesion position and thickness. Many lesions that concern dermatologists or patients are located in easy-to-reach places on the skin. Sometimes, however, skin cancer occurs on the ears and sides of the nostrils—locations that are hard to access with any instrument, including the VivaScope. Future modifications of the device are expected to make it easier to manage these areas. In addition, some lesions may be too thick to visualize with the VivaScope. But most early skin lesions seen by dermatologists are thin.

Post: Is the new technology covered by insurance providers?

Dr. Rao: Medical insurance reimbursement is a complicated system. There are two facets to this technology: imaging and reading. To date, no insurers make payments for the imaging, so patients pay for this from their own pockets. But some insurers are paying for reading the images as the process is very similar to today’s standard; both involve looking directly at cells. The device maker is actively working to help experts understand the imaging and reading components to ensure that patients have access to this technology in the short term.

Post: Is it difficult for physicians to learn how to utilize VivaScope technology?

Dr. Rao: A physician or his assistant can learn within a few days to acquire what we call “confocal” images. In contrast, reading these images and using them to make a diagnosis is not for all physicians. In general, a skin pathologist would have the expertise to interpret these cases. The training curve involves becoming familiar enough with the equipment to feel confident in making the diagnosis, so it’s important that the image reader gain as much experience as possible.

We will be hosting a CME-accredited training course in confocal image interpretation at the UDMNJ Robert Wood Johnson School of Medicine in May of 2011 that will assist skin pathologists and dermatologists to further their education and experience. A variety of other education options exist today, including online training, in-person training courses and lectures and discussions at the American Academy of Dermatology society meetings.

Post: What do patients think of the new technology?

Dr. Rao: Patients are very excited and curious and they want to know more about it. Given the option, most people prefer to avoid being cut. Many patients with a history of skin cancer have had numerous biopsies and I’m happy that my practice can offer an alternative to some of them.

Post: Are there any misconceptions about the device that you can address?

Dr. Rao: There is a general feeling among dermatologists that the VivaScope tool is too expensive for use in the private-practice. This simply isn’t true. I have two VivaScopes, one in my Manhattan practice and one in my Fresno practice. The Company has made it quite easy for me to access, use, and grow my practice with this device.

Another misconception is that this noninvasive imaging tool is still in development, but the VivaScope has been FDA-cleared since 2008, and its manufacturer has since been further refining the device system to fit within the current workflow of the practice.

Post: What advantages does the new technology offer to you as a dermatologist?

Dr. Rao: Personally, for the first time in my dermatology experience, I can see cellular details of disease versus normal tissue without cutting. I know when I must excise a lesion and when I can be confident in leaving one alone. Early detection is the key to management of skin cancer and this device is changing the way that we detect, follow, and manage the disease.

Only your physician can determine whether VivaScope technology from Lucid, Inc., is best for you. For more, interested readers can find a doctor in their area who utilizes the advanced imaging system or request an information packet for their doctor.

Detect Skin Cancer—in Minutes The Saturday Evening Post

“No one wants to think about developing a disfiguring, even deadly, disease like skin cancer, so many Americans live in a state of denial,” says Joshua Fox, M.D., a leading dermatologist and medical director of Advanced Dermatology of New York and New Jersey. “Most people know they are supposed to be checking their skin monthly for changes that might be cancer, but they aren’t exactly diligent about it. It’s something that gets put off for later, often indefinitely.”

Checking your skin regularly, and making an appointment to have your dermatologist do the same, is the best and only way to catch skin cancer before it spreads.

“For the past twenty-five years, we’ve told people to pay attention to the ABCDs of pigmented skin irregularities,” Dr. Fox continues. “Checking for asymmetry, border irregularity, color variation, and diameter more than 6 mm (about 1/4 inch) is still the key to identifying a problematic growth among a bunch of innocuous-looking freckles and moles.”

Here are Dr. Fox’s five rules to save your skin:

1. Make it a habit to check your skin at home.

Inspect yourself, head to toe, once a month. “Many cases of melanoma and other cancers develop on the scalp,” Dr. Fox says. “These cancers can be deadly, but unfortunately, most people don’t check the tops of their heads very often.”

Helpful Hint: Look over every inch of your birthday suit, even in areas where you’ll need a hand mirror to get a good look.Check the palms of your hands, your nails, and the soles of your feet, too.

2. Know what is normal.

In most cases, a normal mole is a uniform shade of brown, tan, or black, and can be flat or raised, round or oval. Some moles are present at birth and others develop later in life, especially in areas that get lots of sun.  Once moles appear, they most often remain the same size, shape, and color. Others eventually fade and disappear. “Almost everybody has moles, and almost all moles are harmless,” Dr. Fox says. But people with lots of moles, more than 50, are at a higher risk for skin cancer.

Helpful Hint: Be on the lookout for flesh-colored, pearl-like bumps or pinkish or reddish patches of skin that flake, scale, or even bleed. They can be basal or squamous cell carcinomas.

3. Pay attention to changes in your skin.

Be on the lookout for new marks and check for changes in old ones. Also note whether skin around a freckle or mole becomes crusty, for example, or spots start to feel itchy or sore.

Helpful Hint: “Spots on the skin come in all shapes and sizes, and not every mark you see will be cancer,” Dr. Fox says. “But if you see something that really stands out, what dermatologists call an ‘ugly duckling’, be sure to tell your dermatologist in a timely manner.”

4. Schedule an annual skin check with your dermatologist.

Most people should see the dermatologist once a year. At this exam, the doctor will check your skin and discuss any changes that the two of you have found.

Helpful Hint: Anyone who’s had skin cancer already or who has other significant risk factors should make an appointment at least every six months.

5. Find a dermatologist who uses dermatoscopy technology.

Also known as epiluminescence microscopy (ELM), or surface microscopy, this is a relatively new method of screening that’s extremely effective at identifying cancers, helping the doctor distinguish malignant lesions from benign ones, says Dr. Farkas, who uses a dermatoscope in her practice at Advanced Dermatology. “The dermatoscope uses polarized light and a magnifying lens to let us ‘see’ the skin more clearly,” she explains. “It significantly increases the accuracy of the exam, meaning we can detect problems much more reliably than with the naked eye.”

Helpful Hint: Next week, Medical Update offers bonus coverage from dermatology specialist Dr. Babar Rao about VivaScopes with advanced laser technology that provides optical images of cells at and below the surface of living skin to detect and diagnose skin cancer—without a biopsy.

5 Tips to Spot Skin Cancer The Saturday Evening Post

Unlike other cancers, malignant melanoma develops on the body’s surface. And spotting its distinctive visual clues remains critical to saving lives, according to new research reported online on CA First Look http://caonline.amcancersoc.org/papbyrecent.dtl from the New York University School of Medicine Melanoma Cooperative Group, which recommended in 1985 that attention to asymmetry (A), border irregularity (B), color variegation (C), and diameter more than 6 mm (D) of colored skin lesions could promote earlier recognition of the dangerous disease.

Approaches to detecting melanoma have evolved dramatically in the past 25 years. In the 1990s, dermoscopy revealed new subsurface features to help differentiate between melanoma and ordinary moles. Today, advanced computer-based technologies are helping doctors better identify the lesions that require further inspection.

Examining tumor cells under a microscope remains the gold standard for diagnosing melanoma. But a “good eye” remains key.

“From the development of the ABCDs through current attempts that use complex computer algorithms and genetic markers, a clinician’s ability to detect melanoma in its earliest form has been augmented,” write the authors. “However, a ‘good clinical eye’ is still fundamental to selecting the lesions for evaluation among the sea of those that are prevalent.”

Melanoma grows slowly and may occur anywhere on the skin. Regular and thorough skin checks can discover early signs of trouble. Always report suspicious signs to a dermatologist right away.

Click here http://www.saturdayeveningpost.com/2009/05/30/wellness/medical-update/skin-cancer-melanoma-skin-exams.html for more on how to screen yourself (and your friends and family) for skin cancer and to download the Body Mole Map from the American Academy of Dermatology.

Click here http://www.cancer.gov/aboutnci/servingpeople/snapshots/melanoma.pdf for melanoma research from the National Cancer Institute.

Melanoma Update The Saturday Evening Post

Healthy and more youthful skin begins with judicious—and year-round—use of sunscreen that allows skin to heal and the immune system to repair some existing damage. Experts say that other products and therapies are beneficial, too.

Follow these tips from New York City dermatologist and spokesperson for The Skin Cancer Foundation Dr. Deborah Sarnoff to help prevent and even reverse skin damage:

1. Exfoliate: Use a loofah, alpha hydroxy acid (AHA) cleanser, or a home microdermabrasion unit to remove dead skin cells and remnants of self-tanning sprays or lotions that can make skin appear blotchy and uneven.

2. Bleach the brown: To lighten stubborn brown spots and other accumulations of unwanted pigment, try an over-the-counter product that contains kojic acid, Hydroquinone, Retin-A, and a mild steroid cream.

3. Hydrate: Hand, body, and foot creams restore moisture and correct damage. Applying moisturizer with AHAs or a facial serum with hyaluronic acid around the eyes helps skin appear less dry and wrinkled. Continued use may promote collagen formation.

4. Visit a dermatologist: Ask your doctor about laser and resurfacing treatments. Photodynamic therapy—laser or intense pulsed light (IPL) in combination with the topical substance Levulan—helps remove scaly patches of actinic keratoses (precancerous lesions) from the skin. A dermatologist can check for and remove these precancerous patches.

5. Shop smart: Wearing hats and opting for special lip balms, clothing, and window film also protect skin (and eye) health. Sunglasses that block 99 to 100 percent of UV-A and UV-B radiation help prevent skin cancer on the eyelids, a surprisingly common diagnosis accounting for up to 10 percent of all skin cancers.

“Eyelid skin cancer is not something most people think about,” said Dr. C. William Hanke, senior vice president of The Skin Cancer Foundation and Post dermatology consultant. “With their thin, delicate structures, the eyes and surrounding areas are particularly prone to cancers. And, it’s an area people often forget to protect from the sun.”

Most eyelid cancers occur on the lower lid. Check labels, tags, or packaging carefully when shopping for sunglasses and other sun-protective products.

Click here for a list of specific items that meet The Skin Cancer Foundation’s criteria for effective UV sun protection.

5 Steps to Healthier Skin The Saturday Evening Post

“People who check their skin regularly for any changes in existing moles or new moles are taking an important first step in detecting the early warning signs of skin cancer,” dermatologist and president of the Academy David M. Pariser, MD, FAAD tells the Post. “Asking a partner to help monitor your skin for any changes or to assist in examining hard-to-reach areas can be very beneficial in spotting skin cancer.”

Regular and thorough skin exams improve early detection and save lives. Melanoma grows slowly, and, given time, can spread through the body. It may occur anywhere on the skin and is most common on areas that are hard to see, such as the backs of men and legs of women.

When looking at a spot on the skin, use the ABCDE guide from the American Academy of Dermatology and report suspicious signs to a dermatologist right away.

	Asymmetry: One half unlike the other half.
	Border: Irregular, scalloped, or poorly defined border.
	Color: Varied from one area to another; shades of tan and brown or black, sometimes white, red or blue.
	Diameter: While melanomas are usually greater than 6 mm (the size of a pencil eraser) when diagnosed, they can be smaller.
	Evolving: A mole or skin lesion that looks different from the rest or is changing in size, shape, or color.

On the Horizon
Researchers are developing new ways to detect skin cancers earlier—and without cutting into the skin. One promising technology, called dermascopy, utilizes a hand-held light device to help doctors distinguish between melanoma and ordinary moles. Laser microscopy scans skin cells beneath the surface to help detect cancerous tissue.

Click here to download the Body Mole Map (PDF).

Spot On: Skin Exams Save Lives The Saturday Evening Post