Hope Unscripted
Hope Unscripted is a podcast from Hope Cancer Resources that brings real conversations to the forefront of health, prevention, and community care. Through honest discussions, expert insights, and personal stories, we explore what it means to live well, before, during, and beyond cancer. Each episode dives into topics like cancer prevention and education, survivorship, wellness, and the realities people face every day. You’ll hear from survivors, caregivers, healthcare professionals, and community voices, all sharing perspectives that inform, empower, and inspire. Whether you’re looking to learn, support someone you love, or simply take better care of your health, Hope Unscripted creates space for meaningful conversations that meet people where they are — unscripted, supportive, and rooted in hope.
Hope Unscripted
Ep. 7 - Sun Safety Matters: Know the Skin Cancer Risks
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Neglecting your skin isn't just about wrinkles—it’s about managing your body’s largest organ and its primary defense against the world. Many people treat sun protection as an afterthought or rely on "base tans" that offer zero real protection, but the reality is that cumulative UV radiation is a silent profit leak for your long-term health. We sit down with Dr. Courtney Book from True Dermatology and wellness manager Hannah Qualls to dismantle the myths surrounding skin cancer and provide a tactical guide for prevention.
We get into the specific mechanics of UV damage and why certain populations, including childhood cancer survivors and outdoor workers, face significantly elevated stakes. The conversation covers the tactical use of "missing-middle" protection like UV sleeves and wide-brimmed hats, the chemical differences between mineral and synthetic sunscreens, and the clinical reality of Mohs micrographic surgery. Dr. Book shares her "secret sauce" for early detection: the Ugly Duckling sign, a simple mental framework for identifying high-risk lesions before they require extensive surgical repair.
The unglamorous truth is that skin cancer can be a quiet, slow-moving threat that many ignore until the surgical margins required for a cure become invasive and life-altering. You will walk away with a clear understanding of how to conduct a monthly "inventory" of your own skin and why a 10-minute daily habit is the most effective hedge against future complications. This isn't about fear; it's about shifting your mindset from reactive treatment to proactive maintenance.
Welcome And Skin Cancer Awareness
SPEAKER_02Welcome back to the Hope and Scripted Podcast. Today, my co-host is Hannah Quals, who is our wellness manager at Hope Cancer Resources, and we're very honored to have Dr. Courtney Book from True Dermatology with us today as we talk about skin cancer awareness. May is Skin Cancer Awareness Month, and so thinking about all the importance of education, early detection, and prevention is super important. Dr. Book, thank you so much for joining us today. Thank you so much for having me. I'm so excited. And Hannah, thank you for being on with us too. Yes, I'm happy to be back.
Dr. Book’s Journey Into Mohs
SPEAKER_02Yes. So, Dr. Book, to get us kind of started, let's just talk about you and how you got into dermatology, what kind of drove you to that work and things like that.
SPEAKER_00Yeah, so I did not go to med school to be a dermatologist. I went to med school to be a pediatrician. Okay. Big job. Yeah, yeah. So I thought I was gonna be a pediatrician. Um, really liked my pediatric citation, but also liked working with adults. And so then I was like, hmm, maybe I'll do medpeeds. And so then I was like medpeeds interest group president in med school and thought I was gonna do that. Um, but really liked surgery too, but kind of didn't like how I didn't get to talk to the patients. They were unconscious the whole time that I was working with them. Um, and then I did my dermatology rotation, and it was just such a good melding of all the things that I liked. I got to have that continuity of care with patients and see them over the course of their life. I got to see different people from the same family and kind of form those relationships. I also got to do surgery because I ended up specializing in skin cancer surgery. And my patients are awake for all the surgeries, and so I get to talk to them and get to know them. And so it was just a really great kind of combination of all of those things. And then I also really found, you know, skin cancer and skin health. You don't know if the person next to you has high blood pressure or if they have diabetes necessarily, but like you sometimes will know if they have a really debilitating skin condition. And I felt I found the the kind of nature of that and the gratification of helping improve that and fix that like really rewarding. Yeah. So that's awesome.
SPEAKER_01Yeah, that's great. So, how did you get into that specific practice and like how long have you been practicing in the skin cancer specialty?
SPEAKER_00Yeah, so I did um four years of undergrad at Mizzo, then I did four years of medical school at Mizzou, then I did a four years of residency at Wake Forest in North Carolina. That's where I did my dermatology residency. And then I did an additional surgical fellowship out in Script uh at Scripps in La Jolla, California, where I kind of specialized in skin cancer surgery, um, specifically MOS micrographic surgery, which is a kind of specialized surgery for skin cancers in high priority areas. Um, over the country to do all this. I did for the it was great to get like a breadth of training with that too, because there are regional differences and in both patient populations and what you see. And so I liked that a lot. But also, I um started practice about a decade ago. Um, started in Kansas City, was there for a few years, and then we moved down here and have been here for a while now. So you weren't originally from northwest Arkansas. No, I'm from central Missouri. Okay, that's interesting. Not too far, not too far.
SPEAKER_02So you're still in the you know all the weather that happens.
SPEAKER_00Very very similar folks, you know, and I think that especially northwest Arkansas is becoming more of like a melting pot, which is which is fun since I've had patients kind of from all different areas. I love that I get to kind of continue to see patients from all different areas.
SPEAKER_02Yeah, okay. That's great.
Skin Health And Cancer Risk
SPEAKER_02So let's talk about um what about skin health? Do you feel is often overlooked and misunderstood?
SPEAKER_00I think just maybe there's a general lack of awareness of how much skin health feeds into your overall health. Um, you know, it is one of our largest organs, it's the barrier to the outside world, and so it's a huge protection against infection, also plays a really big role in kind of maintaining our our fluid balances, um, as well as vitamin D production, which is really important for bone health. Um, it also can be a really good signaler for internal disease. And so there are certain conditions that are not necessarily skin conditions, that some of the first findings can be skin findings that can kind of be harbingers for that. And then, of course, there are uh primary skin conditions that can have a really big impact on people's quality of life and mental health, um, overall wellness and even mortality. Yeah, for sure.
SPEAKER_01So, as you said, Brittany, May is skin cancer awareness month. Can you just give us a sense of how common skin cancer is?
SPEAKER_00Yeah, so skin cancer is incredibly common. Skin cancer is actually there are more people in the US diagnosed with skin cancer than all other cancers combined. Um, and so I think that's why it is hugely important. Uh, we know that one in five Americans by the time they reach age 70 are gonna be diagnosed with a skin cancer. Um, so there's a good chance that either you or someone you know will be impacted by it.
SPEAKER_02I'll be honest, a friend of ours just had some taken off of his face last week. And I didn't realize he had, and I went and saw him. He works with my husband closely, and they're cowboys, they're out in the sun all the time. They don't think about it. That sun hat does not protect everything. And when I saw him, I said, What cow kicked you in the face? Like that was he just looked like he took one to the eye, and he said, No, I've got skin cancer cut off again. And I was like, You don't wear your sunscreen, yeah.
SPEAKER_00And I mean, also, if that's happening at a younger age, then unfortunately, and you can make behavior modifications, lifestyle changes, those kinds of things that has a huge impact. Yeah, um, but if it's happening at a younger age, like that's a good sign that's gonna continue to be happening because a lot of that is watered under the bridge.
SPEAKER_02I mean, he just turned 50 not that long ago, but still I'm like, when was the other one? Did I miss all of this? And he was like, Yeah, you just don't pay attention. Yeah. So um, what are some of the biggest risk factors for people that they may not realize that they have?
SPEAKER_00Yeah, so obviously the biggest risk factor is UV radiation. Um, some studies have shown that up to 90% of non-melanoma skin cancers are caused by UV radiation. And so that's certainly one of the biggest skin uh risk factors, but also family history. So if you have a family history, that can relay both in terms of like your skin type, so more fair skin types, light colored eyes, light hair, that's gonna be a higher risk because you have less melanin. Melanin can be protective. Um, but also there are genetic conditions or genetic um like genes that can be mutated that can place you at an increased skin cancer risk, um, lifestyle. So the cowboy um or the outdoor worker that's just getting chronic sun exposure, or the hobbyist, um, you know, the golfer, the tennis player, um, that's out there and getting a significant amount of sun exposure, that's also gonna place them at risk. I think for hope cancer resources is important to note that cancer patients. So if you're immunosuppressed, um, you have an increased risk of skin cancer. Um, if you are a survivor of childhood cancer, you have you're twice as likely to develop melanoma. Um if you don't know that. Yeah, yeah, yeah. If you have had radiation, you're significantly increased risk for skin cancer in that radiated area in the next 20 to 40 years after that. And so there's a lot of different things that play into it. Um and there's there's a lot of other small risk factors, but I think those are some of the biggest.
SPEAKER_01Okay. That's really interesting because you know, I see patients all the time and that have gone through radiation, chemotherapy, and they're wanting to try to do everything that they can to prevent any more types of cancer or their cancer coming back. So I think that's important that they know that you know they're at a higher risk.
SPEAKER_02Yeah, because I definitely didn't think of that either, especially with the radiation part of it and where that's we just did a podcast about radiation and talking about that.
SPEAKER_00And some of it is so localized in that area, you don't think about that's like so breast cancer patients who have had radiation, like that radiated field has a higher risk of skin cancer in it, but also breast cancer patients alone, they've done studies and shown that they have, I think it's around a 25% increased risk of skin cancer, of developing skin cancer, not just in the radiative field, all over. Another one would be um if you have a lot of moles. Yeah. So about 20 to 30 percent of melanomas arise in existing moles.
SPEAKER_02And so in existing ones. See, that surprises me too, because I've always been under the assumption if it's a new one that that's what you need to worry about.
SPEAKER_00Yeah, no, so it's I mean, certainly, yes, if you've got a new mole, not just if it's a new mole, and we'll kind of talk about that a little bit later, but kind of what to look for. But if you have existing moles, it's important to like take inventory of what you have so that if you've had a mole for 20 years and all of a sudden it like shoots off a Florida peninsula or something like that. Yeah, and that's something that you need to take note of. And if you're not taking a regular inventory, then you're less likely to notice that.
SPEAKER_01Okay, yeah, it's important to yeah, do those self-checks and keep an eye on your body. Yeah, for
Myths About Tans And Skin Color
SPEAKER_01sure. Um just when you're patient front seeing patients, um, what are a few misconceptions that you hear from your patients that they're like, oh well, I thought this, but yeah.
SPEAKER_00So this time of year, we actually did I'm I I work with our social media and so we actually just did something on this, but like um the base tan. Like I I'm guilty on this. I know I'm so guilty. I know. This is such a so base tanly like give you like a three to four percent, or I'm sorry, you like a SPF or UPF of like three, three to four. Yeah. Um, so it's not enough to like really protect you from a burn, but more importantly, I think something that people um I would I would want them to learn is that it's not just about the burn, it's about cumulative radiation. Burns are bad. Burns do increase your skin cancer risk in a different way, but that cumulative UV radiation, and the reality is that if you're getting that base tan, you're increasing your cumulative UV radiation, you're increasing the chances for that DNA to get damaged, and you're giving yourself very little risk reduction by doing it. So base tans, I would say, is one thing. Um, I think a lot of times people think, oh, skin cancer just happens in older people. Um, and that's definitely not true.
SPEAKER_02Yeah.
SPEAKER_00Yeah, yeah. So it's what um, you know, melanoma amongst like people under 50, it's top three for both women and men. Um and so it's not, and the incidence of melanoma in young people is increasing. Um, and so that's definitely something that I would like people to know. Certainly, it is more common in elderly people because again, it's that cumulative UV radiation. And so the longer that you're accumulating, the the more likely you are to form it. But um the incidence is increasing in young people as well. Um, also, I think people maybe with skin of color think, oh, I don't burn. And because I don't burn, I don't have to worry about this. And it kind of goes back to that same philosophy with the base tan. Um, having it melanin in your skin like is a protective method that does decrease how much of that UV radiation gets down and can damage the cells, but it doesn't block it, it just decreases it. And so you can still get those mutations. Um, and actually, people that have skin like more pigmented skin a lot of times have worse outcomes with skin cancer because they it's found at a later stage. Um, or like for instance, um in skin of color, like the melanoma, the most common site is like the foot instead of here or here or here. There's not as much in there. It's a different type. It's it's called acry lentigenous melanoma. It's actually what Bob Marley died from. Um, but it's just there are different yeah, yeah. He he had a melanoma on his foot and he tried to treat it with like different methods and um more holistic, which uh that's great for a lot of things, but for that particular thing, what did what did not work for him, and um yeah, but in in um skin of color, there are different risks and different skin, like what's common is different, but you can still get it.
SPEAKER_02Yeah, okay, that's insane to me. That that just shocks me. I had no idea about that, but it's an interesting fact too to think about because I do see a lot of people that we've got friends that are skin color and they don't ever wear sunscreen because they don't feel the burn, they don't see the burn, they don't think about the burn or anything like that, but it's definitely still there.
SPEAKER_00And they're they are they're less likely to burn, yeah. Um, and so I think that there sometimes that's the only motivating factor for sunscreen, right? Like I just don't want the discomfort of the burn, even as like the motivating factor. And so if you're not getting that, like I understand why there's a little bit of a lack of of motivation to do that, but the reality is is you're still accumulating that damage, and not just from a skin cancer standpoint, but also from like a photoaging.
Sun Safety Tools That Work
SPEAKER_02So I know that there is some good benefit to some sun exposure. So, what's the difference between healthy sun exposure and more damaging sun exposure?
SPEAKER_00Yeah, so we we kind of briefly touched on vitamin D. Um, vitamin D is really important to our body, and you do want to get a little bit of sun exposure. I as a skin cancer surgeon, I I sometimes surprise my patients and like, I don't want you to not go outside. I don't want you to not be because it's also very important to be active. Yeah. And if you get a patient that's had 30 skin cancers and gets you know so weary and scared of it, they'll be like, I'm just not going outside. And I'm like, don't do that because you need sun. But what you can do, what you can do to kind of minimize your risk, healthy sun exposure looks like not going out during peak times. Yeah, um, so not going out between 10 and 2 when the UV index is high, um, not going out for prolonged periods of time without sun protection. So, from a vitamin D standpoint, you really only need 10 to 15 minutes of sun exposure a day, and it doesn't need to be in peak times. And so get your 10 to 15 minutes, love a good walk in the dog at 8 a.m. and and getting that. That's great. Um, but try to avoid those more extensive, extended periods of sun exposure and avoid the burns and just that cumulative overtime, you know, one to two hours on the weekends doing things. Um, that can that can kind of increase your quickly, yeah.
SPEAKER_02See, and that's what I think about between my husband and my son and our friends. We're outside all the time.
SPEAKER_00Yeah, kids' sports, so that's really tough for parents because like you're sitting there just baking and this on, you know, watching your kids play sports, and I think that that's really easy. You you will do what you need to not get fried, but that cumulative sun exposure that you're racking up, and that can be that can be tough. And so that's where I love like sun protective clothing. Yeah, um, and so sometimes sunscreen is the answer, it's it's always helpful, but I am I'm a mom of two, like two little ones, and like some sometimes sun protective clothing is where it's at because you you get it on them, you've got the protection there, it doesn't wash off. I'm embarrassed you can keep clothes on your kids.
SPEAKER_02I'm gonna run around naked half the time if I let him and he's almost eight. And I'm just like, put clothes on before you go outside. Please do something. Yeah.
SPEAKER_00But I, you know, I'm pretty like naggy too with the sun. It's either the sunscreen, you get out, dry off, sit for 30 minutes, or you keep playing. Yeah, yeah. That makes sense. Yeah.
SPEAKER_01That kind of segues us into like other things we can do for like prevention. So you're talking about the clothing. What else is there that we could do? I've seen people, you know, with hats or different types of clothing, like what's going on.
SPEAKER_00Yeah, so I I love sun protective clothing. I think um you're not gonna get many cool points for it. And I and I hear that.
SPEAKER_02But these days, there's some pretty cool stuff for especially little boys. Like I went shopping recently and got some of those fishing shirts for my son. They're fun, he loves them.
SPEAKER_00Yeah, yeah. My husband actually um does some work outdoors, like doing mulching and things like that. And so he is out in the sun and he has ones that have hoods, and he really loves that because when he is like outworking the back of his neck, his mirrors, those things are all covered, and that's harder to reapply, especially if you like um dirty mulch hands, like to reapply sunscreen. So I think some protective clothing can be really helpful. It also has like little to no risk for um like skin reaction. Yeah, you know, that's one barrier to sunscreen sometimes, is some people have very sensitive skin and it can be difficult. And so I think also finding the right sunscreen for you. There are so many different ones. There's a few things that you want to look for. Um, so you want to have it be SPF 30 or higher. Okay, you want it to be broad spectrum, and then if you're gonna be out for an extended period of time with any kind of sweating or water water, then you want to look for water resistant. Um, but aside from that, you can find the one that works for you. There's kind of two different types there's physical sunscreen and chemical sunscreen. The physical sunscreen, like zinc and titanium, I tend to prefer those. Um, they tend to be a little bit more hypoallergenic and just a little better tolerated and inherently broad spectrum. Um, but at the end of the day, and I know there has been like some concern for some people about what's in sunscreen and is that bad for you? And I think that the if I'm being honest, I think the jury's still out, but overall, I think it's a lot of a lot of hype maybe about that and less meat of scientific data. However, um, if you're concerned about that, you can do the more um zinc or titanium-based. And if you're not as concerned about that, or if you are, but that's what you'll use, you gotta remember we know UV radiation is a problem. We know that that is, you know, a carcinogen that is gonna cause, you know, gonna cause trouble. And so sometimes you gotta say, hey, do I worry about this thing that may not have a lot of scientific data to support it, or do I worry about this thing that I know causes trouble and kind of choose what works for you. But I do I prefer the the um mineral-based sunscreens.
SPEAKER_02And I know that that's what we have our hope sunscreen sticks and things like that that we will be handing out soon at some sporting events, and we're excited about that. But um, they're all mineral-based, and that's what I strive to do too. But also the convenience of aerosol sometimes is but I know it's not the best. So talk on that.
SPEAKER_00Yeah, so aerosol, you know, I don't like I don't hate them, yeah, but there's a couple of things. So one, um, I don't I don't like the sprain because you're inhaling it. Um, so for the for the face, you should sprain your hands and apply that way. Um, the other thing is you got to be really mindful of where you're applying because I cannot tell you uh we were our family went on a cruise um for spring break, and I was just watching people put on sunscreen and they were doing this on the cruise, and you're on a cruise deck. There's a good wind, a good wind, and it's like that lady down there might be protected. You got sir, you are not.
SPEAKER_02It's when you see the people they they have the streaks and and it's not rubbing near the river, and a friend of ours went across her husband's back, and he looked like a zebra strip at the end of the day, and I'm like, that didn't we're just talking about that in our small in my small group on Sunday.
SPEAKER_00Like one of the guys was like, My wife did like this on my back, and she was like, No, you don't need to rub it in. And he looked like Zorro, like you know, and I and I was like, Can I not to be weird, but I was thinking so to me, I was like, Can I take a picture? He's like, It's gone, you can't. But next time it happens, take a picture. But yes, you do need to rub it in. So with spray, a lot of times people just spray and go, you gotta rub it in and you gotta sit. Because if it's wet and you're jumping right back in the pool, the reality is you're probably gonna wash it off, yeah, wash a lot of that off. So um, but also then don't forget about just like um basic shade structures. So if you if you're going someplace like a soccer game or something and you know it's just gonna be out there in the open, like an umbrella goes a long way. Yeah. Um, and that can be really helpful just to give you a reprieve.
SPEAKER_02And getting ready for baseball games or gearing up and excited about it, but have already decided I gotta take some of my sticks to my other team moms out there because we don't think of when you're in a rush and you're running out the door and stuff like that, and a bunch of them have other children too that are off to the side playing, and we kind of forget about them in the corner sometimes while we're yelling. But yeah, we've got to get these babies protected too. And yeah, ears. I forget about the ears.
SPEAKER_00Yeah, a good wide brim hat. Like I, you know, that it's tough because I know that they're they don't look as cool, but um, Sunday afternoon is one company I don't have any conflicts of interest, I don't own any stock in them or anything. Um, but Sunday afternoon makes a good wide brim hat called the Adventure Hat. Um, and it has it dries really easily, it breathes well, it goes like this, and then this part goes down. And I know that that doesn't look the coolest, but it's functionally really good because we spend a lot of time like this. And if we have a hat that goes like this, when we go like this, our neck is exposed, the back of our ears are exposed. And I do a lot of skin cancer surgery in that area. So I think that that's something to if you're gonna be out in the sun for a long time, you gotta make it easier on yourself and have those types of things. There also are supplements that you can take that decrease um kind of the damage from reactive oxygen species that form from and also provide a little bit of sun protection. Um, so like there's one called Helio Care Advanced, um, and it has niacinamide, which is a vitamin B derivative.
SPEAKER_02I put a lot on my face in the morning. I'm one of those people.
SPEAKER_00Yeah, so the other name for it's nicotinamide, same thing. Um, but there was a study that showed that if you take 500 milligrams of that twice daily, that that can decrease your non melanoma skin cancer risk. And so it's a supplement that has that and also another um uh plant extract that helps decrease um the DNA damage that you get. So it's kind of like an oral sunscreen in a sense.
SPEAKER_02Oh, I love that.
SPEAKER_00And that's available over the counter. I was gonna say it's over counter.
SPEAKER_02Yeah. That's very helpful for sure. Yeah, yeah.
SPEAKER_00Yeah.
Building A Daily Sunscreen Habit
SPEAKER_02What are some of the biggest challenges or barriers you hear when it comes to sun safety? Like I think about my dad drives a dump truck. Yeah. Arm out the window. Yeah. Yeah. And we have a lot of Indian in us, so he tans really well. So he didn't burn. And he looks great. He has a great farmer's tan. And he's got a white t-shirt on when he takes his shirt off, still is what it looks like. But um that arm is always out the window and it does make me paranoid sometimes.
SPEAKER_00Yeah, well, I think that's fair. Um for him, I would say those UV sleeves. Um, so like I have lots of guys um that I see that are either golfers or they're drivers and they have that arm. Um, and having a UV sleeve in your golf bag or having a UV sleeve in your console of your car that you just throw on like this, I mean that's easy, it's not greasy, and you can just keep it there. That can be really helpful. Um, I think barriers, one is just what you've always done. Yeah, you know, I think I I was a lifeguard, my brother was lifeguard, my mom was lifeguard, I think my granddad was a lifeguard. Like I grew up in a family where tan was attractive, tan was healthy, and it really took a mental shift for me when I was in medical school to understand that like tan skin is kind of like the black lung of a smoker. Like, that is a sign of cellular damage. And so, not not if you have natural melanin from the way, you know, from your skin type, but tan to skin is damaged skin. And so that shift in your mind of like, oh, tan isn't isn't good, um, is one thing that can be a barrier. I think just um ease, you know. Uh if you're doing something like golf or something where you're working with your hands, you don't want your hands greasy. And so finding workarounds for that, like a stick sunscreen um that you can keep in your bag. And for golfers, they should reapply at the turn because if you want to do it every one two hours. Um, so if you're playing 18 holes, you need to reapply. But um I think just the ease of that, and then um skin sensitive skin sensitivities um can sometimes be an issue. So, you know, if you're if you can't find one that doesn't burn or doesn't um cause a rash or something like that, that can be discouraging. Um, but your dermatologist can help you. Um, there are so many options out there, and there are ones designed for more sensitive skin, and so I think that that that's one that can be overcome. Um, and then just occupations um that put you at risk for that, and like construction workers, for instance, like they couldn't, I I would I would love to see like a nice like wide-brim hard hat, you know, in our community bike riding. Um, and I do have some patients who have gotten to wear like a neck gaiter to protect the back of their neck or the arm sleeves to protect their arms and things like that. But those adaptations to keep you doing what you need to do or what you want to do, but still keeping you protected, I can be helpful.
SPEAKER_01Yeah, you talked about kind of forming a routine, staying consistent. I have tried to incorporate um a sunscreen into my like skincare routine in the mornings, and so I'm really proud of myself for that. But it it took a little bit to like form that habit, and just like I tell my patients that are working out in the gym, you know, it's like small little steps. So if you had like a recommendation for like one thing that somebody could start doing, that's a that's probably it, yeah.
SPEAKER_00Um, adding a daily sun sunscreen is hugely important because a lot of people think, oh, you know, I work in a building, I don't go, you know, I don't go outside. I put it on when I'm going to a soccer game, but day to day I don't do it. And again, it's about that cumulative UV radiation. Right. And so one day of going to the mailbox, driving to the grocery store, doing those errands, like the the UV exposure that you get, which a lot of people think in your car you don't get it, the glass doesn't prevent that. So, but you know, or a cloudy day or something like that. But um, but one day of that doesn't really matter, you know. But if that's a lifestyle change that you make, a modification that you make over the span of time, that makes a huge impact on your cumulative UV radiation. Um, and so I think you know, a daily sunscreen is a great intervention.
SPEAKER_02I can see I'm really good about putting it on my face. I do one every single morning and then I use the tinted moisturizer that's got the SPF in it. But I don't do it to my body, I'll just be real honest. That's hard to question.
SPEAKER_00Yeah, I don't either. Okay. That makes me feel better. You know, I should probably be like, you should, you know. Um, but I think it's about finding what works and doing the best that you can. And the the reality is that like you're you have you have better control over like what the rest of your body is exposed to with clothing and things like that. Um, that's why though, when you think about it, like there's a couple things. One, you can most reliable place to age a woman is look at her chest. Yeah. Because we start taking care of our face and our neck, but we don't do our chest, and it usually gets the same sun exposure. And so there are there are signs of this habit that we have, and so you might throw that into your a little bit lower. Um but also if you think about like the elderly, um, one of the places that they most readily show the signs of their sun damage is on their arms, um, you know, where you get the bruising and the wrinkling and the thinning of the skin, the skin tears, the sunspots, um, always much higher on the arms because of that practice, because we don't sun protect the arms. And so um, you know, I if I know I'm like going on a road trip or something like that, like if I'm gonna be in the car for hours, I will throw it on my arms and hands. Um, or if I'm gonna be outside, of course, I will. But uh yeah, on a day-to-day, I usually do my face and then I think I do this with my hands too.
SPEAKER_01Yeah, I'm like, that's too expensive to want to get it on the hands at least.
unknownYeah.
ABCDE Checks And Photo Tracking
SPEAKER_02Okay, well, let's jump into the A B C D E's then and kind of talk about like I've seen the charts for it, I know a little bit about it, but I don't know a lot about it, and I'm sure most of our listeners probably don't either.
SPEAKER_00Yeah. Well, skin cancer is like it's the cancer you can see. And so that's a really unique aspect of skin cancer, right? Like other cancers, it's really hard to see, especially in the early stages. And so um, for a lot of our patients, we're seeing if they don't have a skin cancer history or they're not high risk, we're seeing them once a year. And so the role that they play in doing a self-skin exam, similar to how you do like a self uh like breast exam or something like that, is hugely important because that gives them a chance to find something so much earlier. And I I, you know, I would encourage patients to think about that more as like noticing a difference rather than like trying to figure out what it is and going to chat GPT and like going down into a wormhole because I think that can be really dangerous, also. Um, but yeah, there's this the American Academy of Dermatology um kind of uh encourages this ABCDE uh for self-skin checks, and then it's a it's a mnemonic to kind of remember what to look for. So A is asymmetry. So if you have a lesion that if you draw a line down the middle, one side looks one way, the other side looks different, that can that can catch your attention. Uh B is border. So if it's not a nice smooth border, if it's a little bit irregular or scalloped or asymmetrical border, even can be important. Uh C is color, so looking at at a lesion and seeing variations in color across the lesion rather than a uniform color. Um D is diameter. So most melanomas are um over six millimeters when they're diagnosed, although they certainly can and are diagnosed at a smaller stage, and which is wonderful. Um, but that if you notice a lesion that's a larger lesion, E stands for evolution. So if it's a larger lesion and it's continuing to enlarge or change, or I also call it like the ugly duckling sign. So, like if you're doing a regular skin check, your job is just to take inventory of what you got. And if you see something that's an ugly duckling, then that's something to pay attention to. So if you see this spot and you're like, is that bad? And you look and you see the same spot here and the same spot here, that's reassuring because the chances of you developing a skin cancer in those three spots at the same time, like and they look the same, is really low. Um, but if you see something that doesn't really look like anything else or it's changing, um, there's a couple of things. First, I would say make an appointment to have someone who's trained to look at it, um, kind of weigh in. Also, I would encourage patients to take a picture of it and choose a place to do it, your bathroom, someplace with lighting's consistent. Take a picture of it a month later. You can take another picture, compare the pictures rather than saying, I think that's changing. When you look at it every day, it's very hard to notice changes. But if you compare a side-by-side photo and you say, Yeah, this little spot, this area wasn't there a month or two ago, that can be really helpful. Now, I would I would still encourage you to make the appointment earlier because I don't want to delay diagnosis if you're concerned. But if you're if you're thinking, yeah, I don't know if this is something that can be a tool that you use to kind of be a little bit more objective about it.
unknownYeah.
SPEAKER_01Okay. I'm going through in my mind right now, I'm like, is there anything that I've noticed that you talked about?
SPEAKER_02I need to go take my own inventory.
SPEAKER_01But like you talked about people coming to see you once a year, doing their annual checkup. Um, how often should people be doing their like self-checks? I guess.
SPEAKER_00Well, we like monthly because anything more than that, and I think you're just not going to notice changes as much. Um, and then anything longer than that, I think you missed the chance to catch something earlier. Um, but uh as far as like some of my patients, I will tell them, hey, like one of for like basal cell carcinoma, for instance, most common type of skin cancer, most common type of cancer, um, that comes up a lot of times like a little pimple. And so I can't tell you like how many times I've had a patient be like, I thought it was a pimple, um, but it just like kept coming back. Well, if you have a pimple that doesn't go away for more than six to eight weeks, then I would say, hey, give us a call. Let's take a look at that and make sure that's a pimple. Um, because anything inflammatory or anything that's not worrisome that's new, um, is gonna be it's gonna be steady or it's gonna go away. And so I think once a month is kind of a sweet spot where you're taking enough inventory to notice if something changes, but not doing it so often that you that you get a little numb to it.
Treatment Options And Mohs Surgery
SPEAKER_02So thinking about some of these different skin cancers, and we see different kinds of cancer patients all the time in their journeys. What is treating skin cancer look like on just yeah for the common, let's go common skin cancer, okay?
SPEAKER_00Yeah, yeah. So it has a lot to do with like where we like what stage it's at when we find it. So early detection is really helpful, which is why it's so great to do the skin checks and do the self-checks. Uh, because if we find things early, skin cancer, it's like most times we can cure it. Yeah, you know, that's and I think that's both the the blessing and the curse of skin cancer, right? Because I think a lot of times people are less concerned about skin cancer because we've gotten really good at detecting and curing it, and it's you know, it's relatively um easy to do that compared to some other cancer types. However, when it's left untreated, it it can really um wreak havoc on people's quality of life and their life. Um, and so I think that for the average skin cancer patient, they come in, we identify a spot, we biopsy it, um, we get the results back from that, shows a skin cancer. Depending on what the skin cancer is and kind of how deep it is in the skin, we'll determine kind of what the treatment options are. So if we catch it earlier and it's kind of skirting along the surface of the skin, sometimes we can do less invasive things like a topical cream or scraping and cauterizing the area to cause superficial tissue destruction. Those are that's a very quick procedure, 10 minutes and you're done. Um, and so that's great when we can do that. If it's a little bit deeper in certain certain locations, we'll do a standard excision. So just getting a margin around it, that margin is determined by the type of skin cancer and research. Um, and then we will cut that out and sew it up. That's usually a separate appointment from um a regular skin check, but um does well. And then if it's skin cancer on the head, the head, neck, hands, feet, genitalia, places where real estate's kind of at a premium and you want to take as little as possible and and make it look as nice as possible. Um then for the for the non-melanimous skin cancers, we will sometimes do MOSE surgery, which is what I do. Um surgery is a different way of processing the tissue where you look at 100% of the true margin while the patient's waiting. So you take it out with a very tight margin and look at it under the microscope. So the surgeon is the person who's also reading the slides for for that. And so you're looking at that and getting live feedback of oh, there's a little bit right here at eight o'clock on the I'm gonna go back and take a little bit more at eight o'clock. And so you kind of do that process until it's all out, all done in a day, usually. Um, and then we do those repair after that.
SPEAKER_02So and what's a repair? Like is that like a skin graph sometimes?
SPEAKER_00Yeah, yeah. So it really varies. I mean, it's as simple as uh, you know, linear so stitches sometimes and a lot of times, um, but we certainly do flaps, grafts, um, and sometimes we have to send patients in to the OR for, you know, to take some bone out because it's going down to that or um or more extensive things. It just depends on kind of what we what we encounter at surgery.
SPEAKER_01Um so it feels like there's you know several different I guess uh methods of an invasion, or you know, some of it might be a little bit more than what a patient's looking for, but you know, you want to make sure you get it
Don’t Delay Care Final Takeaways
SPEAKER_01all. So I can see why some people might be a little anxious or nervous about coming to see you. What would you um say to people that are kind of maybe putting that appointment off because they know they're probably gonna have to have some type of surgery or yeah?
SPEAKER_00Well, I think that putting it off doesn't change what it is, is the is probably um the first thing. I understand that. I understand that that can be really and I and I I see and try and help those patients off, you know, often, but it doesn't change what it is, and putting it off only lets it get worse. Yeah, and so that would probably be my my first message is I I've just this week had a patient that had a spot that they they let kind of marinate, we'll say, um, for years. And man, if I could have, if I could have seen that patient five years ago, they would have been in and out in a couple of hours, but instead they spent the entire day with me. And and you know, I think that our the opportunity to try and treat things as early as we can is a great one. Um, but I understand that there are fears about that.
SPEAKER_02Secondly, I'd say we're really nice people, you know, like we're we're a lot of doctors considering like some of the it's not like going to what's the no dieters is the foot doctor, right? Oh, I'm not, I can't throw shade on any of my I'd rather say skin doctor than some other one sometimes.
SPEAKER_00No, no, we uh you know we try, we believe really strongly in treating people right and trying to do right by them. Um we're never gonna do something that we think is unnecessary. We're always gonna try and treat you like you're a family member, like we would want our family member to be treated. And so I think having having faith and comfort in knowing that is important because it can be scary. Um, but I think that also say we say you have a skin cancer and you just wanted to know it's a skin cancer, but then you don't want to do the treatment that I've recommended. Well, at the end of the day, I feel like my job is to give you all the information, be a resource to answer the questions that you have and a tool to help like facilitate treating it. But it's at the end of the day, it's your decision and it's your body. And so I I want patients to know that we're a resource, we're always going to give them our most heartfelt and thoughtful recommendations. Um, but that doesn't mean that they lose control over what happens to their body, right?
SPEAKER_01Right. Yeah, you're equipping them with the tools to make that decision, yeah, and then also feel confident in you wanting to do the procedure and trusting you.
SPEAKER_00Yeah, not knowing doesn't serve it, doesn't serve them any, and it sometimes creates more anxiety than actually knowing and feeling empowered to make a difference or make a change. Yeah, well, we just have a couple minutes left.
SPEAKER_02It's gone by so fast, to be honest with you. Um, what is one simple habit that someone can start this week to make a difference and try to prevent skin cancer?
SPEAKER_00I would say daily sunscreen. Yeah, I would say daily morning sunscreen. Um, I think that just decreasing your cumulative UV radiation can be really helpful. Um if I had to if I got to pick one more, it would just be it would be self-skin checks, you know. Um just making sure that you are taking inventory of what you have. Um and if you aren't in a position to be able to see your back or your back of your legs or those types of things, then come see us and we can help, you know, because those are areas the back and the legs are actually some of the highest sites for melanoma. And so that's important to be able to get that seen.
SPEAKER_02Hannah, do you have anything else to add?
SPEAKER_01I don't think so. We're super grateful that you came on our podcast.
SPEAKER_02No, I feel like I've been so I've learned a lot. I've learned a lot. I've got a lot of intel in my brain now to think about and go home and yell at my husband to put sunscreen on for now.
unknownGood, good.
SPEAKER_00Thank you so much for having me. This is awesome. I'm so thankful for the opportunity to get some education and awareness about skin cancer out there.
SPEAKER_02Yes, no, I appreciate it so much. Well, and on our skin cancer awareness month, everybody make sure you're doing your skin checks, putting your sunscreen on. If you have any questions, go see Dr. Book at True Dermatology or your local dermatologist. There's so many in this area that we partner with and we appreciate so much. Thank you, Hannah, for joining me today. It was so fun. If you guys felt inspired by today's episode, be sure to share it with someone else and tell them to put their sunscreen on, also. And thank you again, Dr. Book. I hope you guys tune in for the next episode of Hope Unscripted. Bye.