(bright music) - Summer is here, and while we are all eager to get outside and enjoy the sunshine, it doesn't come without risks.

Skin cancer rates are on the rise, and our summers are hotter than ever.

Today on "Health Matters, simple and effective ways to protect your family from skin cancer and the dangers of extreme heat.

(gentle music) One in five Americans will develop skin cancer by the age of 70, that's according to the Skin Cancer Foundation, making it the most common cancer in the world.

Now, extreme heat events are becoming one of the deadliest weather disasters we face.

Spokane County alone saw 19 deaths during the heat dome event of 2021.

The good news: both skin cancer and heat-related illnesses are largely preventable when you know what to do and what to look for.

Good evening.

I'm Aaron Luna.

Joining us today: Dr. David Larrymore, a medical dermatologist with MultiCare Rockwood Clinic; Dr. Daniel Baird, a dermatologist with Northwest Dermatology; Rebecca MacMullan, emergency preparedness and response specialist with the Spokane Regional Health District.

Let's start with the basics.

Dr. Larrymore, how much sun exposure is actually safe?

We often hear we should be getting at least 20 minutes a day.

Should we be protecting ourselves every time we go in the sun, or is there a threshold?

- There is always going to be sun damage as soon as you get out into the sun.

However, it's very minimal over the first few minutes.

You know, 10 to 15 minutes, you don't really have too much to worry about if, you know, you're going from your car to the supermarket.

You know, I don't think that's something that most of us really need to worry about.

However, if you have the likelihood of getting stuck out, you know, the neighbor, you know, grabs you and starts to want to talk to you, or you're going to a sporting event, let's say for your children, something along those lines, you know you're gonna be outside for a while, and, at that point, it is going to be important to go ahead and think about that and protect yourself from excessive sun exposure because it's gonna be more than 10 or 15 minutes at that point.

- Associated with that question, a lot of people say, "Hey, you need that for your vitamin D intake for the day."

Do we need that exposure for vitamin D, or is there other ways to get it, maybe better ways?

- That is one way to get vitamin D. I think what's not as well understood is, for many people, how little sunlight you need to get as much vitamin D as you could possibly have for the day anyway.

And that's very depending on where you're at in the world, what season it is, what skin type you have.

And so it's very difficult to kind of convey that to everybody and be precise about it.

So very often it's actually just simpler to get your vitamin D through your diet rather than relying on, you know, just enough sun but not enough, and you don't really know because it changes from day to day.

And so, you know, the total amount for someone under the age of 70 is reported to be about 600 international units of vitamin D a day, and you can easily get that with just a piece of salmon, vitamin D in your milk.

I mean, it really doesn't take that much, and you're getting what you need for the day and not having to really worry so much about, you know, is this not enough sun, too much sun, because it really is gonna change literally every day.

- Mm-hmm, mm-hmm.

Let's talk about sun exposure and the heat that comes with it.

For many of us, every midsummer feels like the hottest summer ever.

Rebecca, what's the reality when it comes to the amount of heat events we're experiencing, especially here in Spokane?

- Well, I asked our great partners at the National Weather Service, Spokane office, you know, "Are the summers actually getting hotter in Spokane?"

'cause when they talk about seasonal normals, they're looking at a 30-year average.

And then they shared with me that, "Yes, from, we go from the '70s to 2000 hot temperatures, the average in July and August were about 82 degrees.

If you slide that 30-year window up another decade, then it's at 83 degrees.

And then the most recent 30-year interval, we're at 84 degrees as our average high temperatures for July and August.

So yes, it is overall getting higher and hotter, but that doesn't mean we couldn't have a cool July or we couldn't have an extreme event of heat in June like we did in 2021.

That kind of day-to-day, week-to-week weather can still vary a great deal.

- And how do we know when heat is dangerous?

What are the determining factors that play into extreme heat?

Is it a cut and dried temperature that we hit?

- Well, again, the National Weather Service has developed a heat risk forecast.

So they're looking at, when we talk about the heat risk overall, how unusual is the temperature for that time of year?

So 90 degrees in May is gonna be a lot harder for us to tolerate than 90 degrees in July when we're like, "Oh, it's just another July day."

Overnight lows play a role in determining heat risk, especially here.

People have homes where they open their windows at night, but if we're not able to cool down overnight and let that heat dissipate from the roads and the sidewalks and the built environment, then that heat accumulates, and also the duration of the heat plays into heat risk.

So I'd encourage people to look at that heat risk forecast rather than a specific temperature because it can vary so much how each person is affected by just the temperature itself.

- And it doesn't have to always be in the middle of the summer or at those times where you normally think of peak heat.

- That's right.

- And Dr. Baird, there's been some controversy about sunscreen safety.

A lot of information on social media platforms claim that sunscreen is toxic, and that it's better for you to not wear it at all.

Where are these concerns coming from, and is there any validity to them?

- That's a good question.

I've seen a lot of stuff on social media as well.

It seems like a lot of the debate around sunscreen is kind of between the chemical sunscreens and then the, you know, physical blockers.

So, zinc and titanium dioxide, I don't see a whole lot of controversy around those two.

So, you know, if you have concerns about sunscreen, and you're worried about some of the ingredients in them, I always just direct patients to zinc or titanium dioxide sunscreen.

The concern around the chemical sunscreen has to do with some studies that were conducted a while ago.

There was one study in vitro, which basically means in a lab, on mice that showed some of those chemical sunscreens in extremely high quantities did kind of mess with the rat's endocrine system.

But, again, that was a lot of the sunscreen.

The same, you know, results haven't been seen in humans, but there have been recent studies that show some of the chemicals do make it into the human body.

What, you know, significance that has kind of remains to be determined.

It doesn't seem to really affect humans that much, but if you're worried about that, you know, that's reasonable, and so I would just say use zinc sunscreen, you know.

Zinc sunscreen arguably works the best, and it doesn't carry any of those risks.

So that's what I like to use.

You know, I'll use the chemical sunscreens too, but, you know, just use zinc sunscreen if you're worried about it.

- Yeah, and that kind of goes along with my next questions because we're looking at things like, is the spray better for you or the way you apply it, like mineral-based ones that you were talking about, even saw one ad that was talking about sunscreens that looked like whipped cream.

So there's a lot of different styles you can use.

What should we be looking for in a sunscreen, or does it matter as long as we're wearing something?

- There are certain things you should look for.

The most important thing is to look for one that has broad spectrum in the name.

When you look at a sunscreen label, it usually will say like SPF 15,30, or 50, and that's really actually only referring to the UVB protection.

But there's UVA in sunlight as well, which is also problematic, and the SPF doesn't necessarily mean that it covers that.

So you want to look for broad spectrum on the label 'cause that means it'll cover UVA as well.

As far as, you know, using the spray versus the cream, I prefer not the spray for a few reasons.

Probably the biggest, I think it's hard to get the whole area with the spray.

It's harder to see where you missed, and if you're gonna use it, you gotta spray it on and then rub it on after to make sure you really get even application.

I like using the creams just because it's easy to make sure you got everything.

I would, you know, suggest that people put more on than they probably think.

The studies that showed like SPF 15, you really had a lot of that on to get the SPF 15 effect.

People probably aren't really getting the full SPF 15 with that one 'cause, you know, you're putting on, people don't put on as much as they should.

You know, you look white, you look greasy, so you kind of try to be a minimalist with it, but it doesn't work as well unless you really lay it on thick.

- So you're saying I have to read the ingredients, and I have to read what I'm buying and not give into gimmicks.

(Dr. Larrymore laughing) - I think that would be a good idea.

(Aaron laughing) - Okay.

Now, Rebecca, a lot of things we use to protect ourselves from the sun can be used to avoid heat.

You know, we're talking hats, you know, wraps, scarves, things of that nature.

- Right.

Light colored clothing.

It's gonna reflect the sun's heat away from your body and loose clothing so that the air can come to your skin, and you can dissipate your heat and sweat with the looser clothing is better than tight clothing.

- I've seen some clothing that advertises, you know, the SPF 50.

Will all clothing have the same sort of sun-protective factors to it?

- I'll take that, I guess.

So it's not the same.

It's calculated completely differently.

But a simplified way of thinking of it is, yes, the higher the number, the better the blocking.

Doesn't really matter so much exactly how they test these things in the end if you, you know, just realize that that's the case.

And the fact is, is that just regular clothes that we wear that cover our skin actually do have, you know, a UPF value.

It goes anywhere from something like a, you know, a white T-shirt, a soft white new T-shirt that's not wet and is loose fitting and so on.

Somewhere roughly around a UPF of 7 or so.

And then if you start to talk about like double layering and, you know, doing those sorts of things, it can actually get pretty high up there.

If you're gonna be doing something, I think, fairly extreme, biking, skiing, you know, extreme in that you're gonna be out in the sun for a long time, then I think that's a point at which, because you're not gonna want to wear bulky clothes at that point, you're going to want to wear something that's a little thinner, and the clothing that's marketed as UP protective or ultraviolet protective, those things have a much denser weave, and it actually does block the UV light better even though it's thin whereas normal thin clothes don't do as good of a job blocking the UV radiation through them.

- So the fishing gear that you see that says, you know, that has the hood that comes up and the long sleeves and the UPF of 50 is actually, it's pretty a tested product.

- It's really good, yeah.

A UPF 50 basically means like 1/50 of the amount of sunlight gets through it is a way of thinking about it, which is very little sunlight.

So if you're going for a UPF of 50, I think you really don't have too much to worry about with that type of clothing.

- Okay, excellent.

Good to know.

We probably all know someone who's had a skin cancer scare or diagnosis.

It's scary and shocking no matter who you are.

One Idaho mom found out even a small warning sign can be an indicator of a much larger problem.

(air whooshing) For some people, it's just part of the summer cycle.

- I have fair skin, and I got sunburned repeatedly in my youth.

- [Aaron] Burn, peel, tan, repeat.

- As a teenager, everybody wants to have that golden, lovely bronze tan.

- [Aaron] Mel Gunnell was one of those people, but the damage that cycle caused wouldn't show itself for years.

- I definitely was a golden child for skin cancer.

I mean, if someone's gonna get it, it was me.

- [Aaron] About eight years ago, the recipe blogger and content creator noticed a tiny scab on the side of her nose.

- You know, at first I thought, "Well maybe it's like a pimple."

It wasn't that.

It was a scab.

And over the course of three months it would scab up, and then look like it was gonna heal but never fully healed.

And it was tiny.

It was like a pin prick.

- [Aaron] Several months went by without the spot healing.

Reluctantly she went to the doctor.

- I'm a little bit hesitant to go into the doctor because I feel like so often you go in and it's nothing.

You just don't want to be that person.

- [Aaron] The dermatologist knew instantly it was basal cell carcinoma.

- It was like this whirlwind of like this is abnormal, and this is something that you need to get taken care of.

So it kind of caught me by surprise to be honest.

- [Aaron] So much so that she drove herself to surgery thinking it would be quick, simple, and mostly painless.

It was not.

- I was in shock at how big of a deal it was.

- [Aaron] She walked out of surgery with 20 stitches stretching from the base of her nose to between her eyes.

- When I finally got out of the appointment and was driving home, I think my body went into a little bit of shock.

Like as I was looking at myself, I mean, it was bandaged up at that point, but recognizing I had this enormous bandage, and it was starting to hurt.

It felt like I had been cleaved through the face with a hatchet - [Aaron] Recovery took months, and in the year since, she's had additional skin cancers removed.

Now she's diligent about sun protection, known for always applying sunscreen, carrying an umbrella, and using protective clothing.

- What that looks like for me is, at the pool, I am the one wearing the, you know, long-sleeve rash guard, or I have swim leggings.

- [Aaron] Even with all that, Mel gets her skin checked every six months trying to make sure things don't go untreated for too long.

- But the dermatologists have said if another basal cell spot comes up in that same area, that would require pretty much a whole reconstruction because of the scar tissue and everything that's there.

(gentle music) - [Aaron] She's also committed to using her social media platform to share her experience and help make sure others are not only protecting themselves from the sun but looking for the signs and not waiting to get checked out like she did.

- I was blown away by the number of comments and messages people sent me that said they never would have gone in to get something checked or their skin checked had they not read that because, again, they were probably like me, which is like, "I'm sure it's nothing."

I am not kidding you.

Hundreds of people went in, and it ended up being squamous cell or basal cell, and in some cases it ended up being nothing, right?

A shocking number of people were able to go in and get some type of skin cancer caught early.

And for that reason, I feel like it is important for me to share.

- [Aaron] Mel wants everyone to wear their sunscreen, grab their umbrellas and their sun hats because even small things can reduce your risk of skin cancer.

- You don't have to alter your entire lifestyle, and you can still really enjoy being outside, but I have learned so acutely that this can happen to anybody.

(gentle music) (air whooshing) - And as you just heard from Mel, her skin cancer started out as a really small spot.

She said it looked like a pimple or maybe as if she scratched herself.

And Dr. Larrymore, let's discuss the types of skin cancer and how to spot them.

What should we be looking for in a basal cell carcinoma like what Mel had?

- So basal cell carcinoma, it's funny that she said that because nearly all of my patients that have basal cell on the face, they almost all say the same thing, where it looked like a pimple that wouldn't heal.

And of course we all know pimples heal, right?

So that's one of the first clues is a growth that just doesn't go away and perhaps slowly over time gets larger.

Basal cell carcinoma is usually slow growing.

It's often sort of kind of pink in color.

Once it gets large enough, it will often start to bleed without very much provocation.

It takes very little, just wiping your skin with a towel or something along those lines.

And then eventually it will actually ulcerate in the center of it very often.

But just in general, basal cell carcinoma is not gonna look normal over time on your face.

It's not gonna be like a pimple or a sunspot or something like that.

So if something doesn't look like anything you've ever had growing on your face, generally speaking, it's a good idea to have someone look at it.

- And squamous cell carcinoma.

Did I say that correctly?

- We pronounce it squamous though.

- Squamous.

- So squamous cell is generally rougher textured.

It's often more eruptive, quicker growing, often tender, and is more, I would say, concerning for people because of how rapid, and, for lack of a better word, bad it looks.

There are times where these skin cancers can be very difficult to discern from each other and from normal growths, and so I often tell people, "Hey, look for the thing "that doesn't look like anything else you've ever grown."

You know, we call that the ugly duckling sign, the thing that doesn't match the other things.

And that's a good screening tool for yourself to think about because very often it's not normal to grow something that you've never seen before, and maybe you could avoid what this lady, the ordeal that she went through in having such a large surgery.

- Mm-hmm.

And how about melanoma?

It's not the most common.

- No, it's not nearly as common as squamous cell carcinoma and basal cell carcinoma as we mentioned.

But unfortunately it is far more deadly, and that's the reason that we're very worried about melanoma when it does happen.

There's a roughly, by some accounts, a 1 in 50 lifetime risk for development of melanoma.

That changes depending on how fair you are and some of your genetics.

Some are gonna be more prone and some less prone, but melanoma, generally speaking, is gonna be very dark where you had either nothing there before, and all of a sudden there's a very dark spot that is growing and getting larger, or it can also occur from a mole that maybe you've had for a long time, but all of a sudden that mole really starts to change and change fairly rapidly and start to look different than all your other moles.

Again, that ugly duckling sign is invaluable for people to realize.

The idea of looking for the ABCDEs of melanoma, which is sort of an older concept: asymmetry, border irregularity, color variegation, diameter greater than a pencil eraser.

I think E is probably the most important, and that's evolution over time where the thing is changing, and it's changing before your eyes over weeks to months even.

These aren't usually changing over decades.

They are faster than that.

- And Mel had mentioned that she had it once and talked about now she gets regular screenings.

Once you have a cancer spot, are you at a higher risk for more spots?

Is that common?

- You are very much at higher risk.

It's probably the main thing that puts you in a higher-risk category actually is a history of skin cancer yourself.

It's because you have proven that not only do you have the DNA damage from your whole life, but also that your immune system has not been able to key in on these cancers and take 'em out before they ever become anything problematic.

And so you have the predisposition, and you have an immune system that won't do what it needs to do to take 'em out on its own.

- And Dr. Baird, when should people start getting skin cancer screenings?

Most cancers have a certain age, they should get regular screenings, most people.

Is that true for skin cancer as well?

Are there genetics or maybe family history factors that play an impact, and when should people get screened due to those?

- Yeah, it's a little different than other cancers.

You know, colon cancer, there's a specific age to start getting colonoscopies.

Skin checks, it's a little more individualized.

It's gonna depend on you and your history, your family history.

Like Dr. Larrymore was saying, if you've had skin cancer before, then at that point you'll be set on a certain protocol that's pretty well defined by the American Academy of Dermatology of how often you should get your skin checked.

And, you know, that even depends on what type of skin cancer you have.

So if you have a basal cell versus squamous cell versus, you know, melanomas, sometimes the frequency of your skin check is gonna be different.

If you've never had a skin cancer, and you have no family history of them, you know, one easy place to start is just doing those self skin checks.

You know, if you notice something that's evolving or changing or looks different or bleeding, you know, that's probably a good time to go get your skin checked.

You know, if you've had a skin cancer before, obviously you should do it right away.

If your parents have, you know, you should probably get checked more frequently than other people, and, you know, some people have genetic conditions where they're predisposed to growing melanomas or other skin cancers, and they should get checked really young, but really it needs to be kind of individualized, and your dermatologist can help you kind of figure out how often you should get your skin checked.

- Are there differences in who gets skin cancer?

I know we talked about fair skin seems to be at higher risk.

- Yeah, you know, if you have red hair, blue eyes, you know, you're definitely gonna be at higher risk.

If you've had five sunburns, you know, you're twice as likely to get melanoma.

If you've had one blistering sunburn, you're a lot more likely to get skin cancer.

So, you know, there are differences.

It just kind of depends on your history.

Super fair skin, lots of sunburns, yeah, you're at higher risk than somebody who has dark skin.

That being said, if you have dark skin you can still get skin cancers.

And oftentimes people who have dark skin, their outcomes from skin cancer are actually worse.

And I think that's partially because they think that, you know, "I'm not gonna get skin cancer," you know.

"I have this natural protection," which is true.

They do have more natural protection than somebody who's Caucasian, but they can still get it.

But often that leads to delays in diagnosis, you know, healthcare disparities, other things, you know.

So I wouldn't say just because you don't have really light skin, that you can't get skin cancer.

You absolutely can, and we see it in people who have darker skin.

And also, additionally, some skin cancers aren't even related to the sun.

You know, if you get a melanoma on the bottom of your foot or on your palms, on your mucosal area, you know, that's not related to the sun.

That's just, you know, bad luck of the draw.

So it's still worthwhile to keep an eye on those things.

- Are there any treatments out there that are exciting to you right now?

- There are some, you know, especially for the skin cancers that are more advanced, I'd say that's where the biggest leaps have been made in medicine over the last, you know, decade or so.

Immunotherapy, you know, 50 years ago you get melanoma, and it's metastatic, it's just, you know, tough luck.

- [Aaron] Yeah.

- Nowadays we have medications.

They don't work in everybody, and they're not 100% effective, but for some people they really are magical.

They get rid of the melanoma, and, you know, survival rate really has improved.

So, I think, you know, those targeted immunotherapies, those are the most exciting area, not just for skin cancer, really for all cancer, but I'd say that's where the, you know, development is, you know, pretty impressive.

- Mm-hmm, and, Rebecca, we're still kind of early in the season, we're all kind of getting used to, especially the heat today.

What should people do to prepare for extreme heat, both for the immediate upcoming summer months and as we're looking at a generally warmer climate?

- Well, there are things we can do as individuals, as families, and then there's also what we can do as a community.

So, I'd say, you know, since we had that heat dome in 2021, there has been, you know, improvements and a community interest in working on those infrastructure components: increasing our urban tree canopy, providing more shelter at bus stops and playgrounds, expanding hours at the libraries and the community centers when we know it's gonna be an extremely hot day or week.

But, as individuals, we want to know how we're gonna get information, so know how to find the forecast and know what that heat risk is gonna be a few days out so you can adjust your plans if you need to to stay safe because heat-related illnesses can have serious health consequences.

Also, just having a plan for where you could go if it was too warm in your house, you know.

A good survey that was done a few years ago found about 15-16% of people in this area don't have any air conditioning, and if that's the case for you, then having a plan about how you can find a place where you can cool off, if that's a friend's house or the library or, you know, to beat the heat.

(laughs) - Mm-hmm.

Mm-hmm.

So read the labels, plan ahead.

If it doesn't look right, get it checked out.

I want to thank you all for the actionable steps we can all be taking to have a safe summer in the sun.

I know I'll be definitely wearing my sun shirt and my straw hat and my sunscreen as well.

You can share this episode.

(gentle music) It's gonna be available online at ksps.org.

For "Health Matters," I'm Aaron Luna.

Have a good night.

(bright music) - [Narrator] "Health Matters" is proudly supported by MultiCare.

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