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Diagnosing, Treating and Preventing Skin Cancer

Aired July 3, 2004 - 08:30   ET


DREW GRIFFIN, ANCHOR: Here's the news at this hour.
U.S. military raids may have blocked potentially deadly attacks around Baghdad. Military officials saying the raids uncovered rocket- propelled grenade launchers, explosives and bombs designed for use in roadside-style attacks. Soldiers also arresting 51 people.

An oil pipeline breached in southern Iraq today. A British military spokesman says there's no suspicion of sabotage here. Iraq's oil flow unaffected. Saboteurs have attacked pipelines repeatedly, impacting the Iraqi oil exports.

Back in this country, flags lowered to half-staff in honor of former President Ronald Reagan returned to normal today. President Bush had ordered flags flown at half-mast for 30 days after Reagan's death on June 5. But the White House says they're being raised a bit early for the Fourth of July.

HOUSE CALL with Dr. Sanjay Gupta begins right now.

DR. SANJAY GUPTA, HOST: Good morning. Welcome to HOUSE CALL.

The most common form of cancer is preventable, and yet it has been increasing at an alarming rate. We're, of course, talking about skin cancer.

Its deadliest form, melanoma, will kill someone every hour this year. And as Elizabeth Cohen explains, its victims are getting younger.


ELIZABETH COHEN, CNN MEDICAL CORRESPONDENT (voice-over): This is the story of a 15-year-old boy and the sunburns that nearly killed him.

ALEX LEVINE, SKIN CANCER SURVIVOR: I really spend just as much time as any other kid would spend. I went to the beach. Every summer I was always in the pool. I just wasn't very careful. I mean, my mom would always ask me to put the sunscreen on, but I really never knew why. I didn't care if I got a sunburn every once in awhile back then.

COHEN: Two years ago, when he was 13, doctors found a mole on Alex Levine's back. It turned out to be melanoma, the deadliest form of skin cancer, and the cancer had already spread to one of his lymph nodes. LEVINE: I never would have thought a kid would have it. I thought maybe when I was an old man I'd get it, that type of thing. But it never even phased my mind that it could happen to me.

COHEN: Apparently, most teens feel the same way. According to a report from the American Cancer Society, only one-third of teenagers use any sun protection at all. And when they do use sunscreen, most use it only when they go to the beach or the pool.

Alex's oncologist is one of the world's leading melanoma experts. He and others in the field say they're seeing something new.

DR. CHARLES BALCH, JOHNS HOPKINS INSTITUTE: Twenty years ago it was very rare we would see children or teenagers or a young adult with melanomas. But honestly, I'm really alarmed that today we are regularly seeing young people with melanoma, including children and teenagers.

COHEN: And he's frustrated, because skin cancer is often so preventable.

BALCH: You know, it makes no more sense to have a sunburn, which is an injury to your skin, than it is to put your hand in scalding water.

LEVINE: If you can protect yourself from one sunburn, you can protect yourself from so much later in life.

COHEN: Elizabeth Cohen, CNN, reporting.


GUPTA: Elizabeth, thank you very much.

Sunburns are just one of many risk factors for skin cancer. Some others: having fair skin that doesn't tan easily and spending a lot of time in the sun. Especially, of course, if you don't wear sunscreen.

Also, if you had severe sunburns as a child and if you have multiple or atypical moles. Your family history is also a factor, along with working with environmental hazards such as coal tar or arsenic compounds.

Of the skin cancers, melanoma is the one we talk about the most, but there are actually many types of the disease. The three most common are basal cell, which refers to the inner most layer of your skin; squamous cells, which involves the cells that make up the outermost layer of your skin; and lastly and most deadly, melanoma.

Here to talk with us about all forms of this disease and great ways you can prevent it, Dr. Carl Washington. He's co-director of the Dermatological Surgical Unit at the Emory Clinic. He's also an associate professor of dermatology at Emory University.



GUPTA: Thanks so much. You know, I've got to point out, your time is very valuable. It's impossible to get an appointment with a dermatologist. Why is that?

WASHINGTON: Well, part of it is because we are seeing so many people with so many types of skin cancer. That certainly is a large part of it.

But it's also the case that patients have very good access in the state to their dermatologists. They don't have to go to their primary care provider.

GUPTA: In Georgia, they can come to you directly.

It's interesting, because there's more preventative measures for skin cancer. There's more education, I think. Yet there's an increase in scan cancer. Those things don't jive. Why is that increase? What's the disconnect there?

WASHINGTON: Well, I think part of it is because it's difficult, sometimes, especially when we're targeting younger people, to convince them that one day they might have a skin cancer.

Most of the behavior, at least with respect to melanoma, that contributes to skin cancer is related to exposure that comes earlier in life. And so we really rely on the parents to try to teach the children certain behaviors early in life that we hope will stick with them throughout life.

GUPTA: Targeting the youth, as Elizabeth mentioned in her piece.

Lots of questions coming in on this topic. Let's get to one of them right away.

This one is from Kim in Pennsylvania, who writes, "I grew up in California and spent hundreds of hours in the sun with no sunscreen. I was sunburned most of my childhood. My grandmother died of melanoma. I am very fair skinned, and I never tan. And I'm wondering what my risk now that I'm in my late 30s of developing skin cancer?"

I guess this is just what you were just talking about?

WASHINGTON: Right. That's a good question. It's always difficult, however, for us to predict a person's risk based on one or two bits of information.

Certainly we look at sun exposure history. The person who's had lots of particularly blistering sunburns early in life is a significant factor. We also look at family history. And that's another very important one. So the combination of those two things together really does speak to someone who has higher risk.

GUPTA: A lot of people go out there and get suntans. A lot of young people probably watching right now. How much sun exposure? I mean, if someone burns every summer or someone burns a few months every year what is the -- when do you start to get concerned?

WASHINGTON: Well, it's hard to know exactly how much is too much or how much is enough. But certainly, we don't like to see repeated intense exposures, those that actually lead to sunburns. And the amount that a person can tolerate is also related to their skin type and skin complexion. So darker skinned people actually can probably tolerate a little bit more, but no one's immune.

GUPTA: No one's immune. That's an important point. We're going to talk more about that.

We did send our cameras out to find what people on the street are asking about skin cancer. Let's take a listen.


UNIDENTIFIED FEMALE: What do I look for other than just a mole that changes? So that I would be able to discern when I have skin cancer?


GUPTA: You know, a lot of people try to self-diagnose. They look at moles. You probably get this all the time at cocktail parties. "Hey, Doc," you know, "Take a look at this mole."

Let's talk a little bit about some of these mole changes. And I think this is a very visual thing, so we've got some pictures. Maybe you can help talk us through some of these things.

The first one, let's start off by a basal cell. This is the most common form of skin cancer. Is this typical of something that you would look for? What do you see there?

WASHINGTON: Well, this is very typical. This is what we would describe as a well-circumscribed kind of pearly or waxy or shiny- looking bump that doesn't heal. And that's important.

So many times people would think this is a pimple. But if it doesn't go away after a certain period of time, then that may be important.

GUPTA: Dangerous?

WASHINGTON: Can be, but generally very easily treated early on and doesn't tend to spread or cause much significant loss of life.

GUPTA: Let's go to the next one, a squamous cell carcinoma. This looks a lot uglier, I think, on first appearance. What do you see there?

WASHINGTON: Well, this is a typical squamous cell carcinoma that you tend to get a little central ulceration. It looks like it's kind of scooped out in the center.

GUPTA: Right in the middle. WASHINGTON: Exactly. And these tend to be a little bit more firm to the touch and they grow a little bit more rapidly. And these definitely have the potential to spread inside the body or metastasize. And that's why these tumors certainly can lead to death.

GUPTA: OK, and the last one, I think the one that most people have heard about, actually, melanoma. Irregular borders there. As a dermatologist, what makes that -- you concerned about this?

WASHINGTON: Well, we talk about the ABCD's. We look for asymmetry, border irregularity, color variability, and then "D" for diameter if it's larger.

And so certainly that image there certainly has all of those features, so that certainly gets my attention. Particularly the image on the left. I would say it would be very difficult to convince myself that that's a benign lesion under any circumstances.

GUPTA: You'd take that out no matter what?

WASHINGTON: That's coming out.


WASHINGTON: And the other thing that we like to emphasize is "E", which is not one of the official acronyms that we look for, but it refers to evolution.

And we try to emphasize to people not to get hung up really on any one feature, but is it changing? So you have all or some of these other changes and is it growing or changing with time? And that might be also be important.

GUPTA: Observe it over time. Not encouraging anyone to be at- home doctors, but this is all good information.

Coming up on HOUSE CALL, cutting-edge treatments for this deadly disease. Stay tuned.


BRETT SMITH, MELANOMA PATIENT: Now I can live a normal life. Just by taking a pill in the morning and a pill at night.

ANNOUNCER: From pills to vaccines, we'll bring you the latest treatment options for skin cancer.

Plus, how often should you get those moles checked? We'll get you all the answers.

But first, take our "Daily Dose" quiz. What is the shelf life of a bottle of sunscreen? The answer, when we come back.



ANNOUNCER: Checking the "Daily Dose" quiz, we asked what is the shelf life of a bottle of sunscreen?

The answer: the FDA requires that all sunscreens be stable and at their original strength for three years, unless indicated otherwise by an expiration date.


GUPTA: Better go through your medicine cabinet on that.

One in 37 Americans will get melanoma in his or her lifetime. And because it can spread more easily into your blood stream and nerves than any other skin cancer, it's all the more dangerous and important for researchers to find treatments.

Holly Firfer takes a look at some cutting-edge progress.


HOLLY FIRFER, CNN MEDICAL CORRESPONDENT (voice-over): Brett Smith was told he had less than a year to live with tumors in his liver, lungs and adrenal glands, melanoma was ravaging his body. Until he met this Dr. Keith Flaherty, who entered him into an experimental trial for a new melanoma therapy, using a drug called Bay 439006.

DR. KEITH FLAHERTY, UNIVERSITY OF PENNSYLVANIA: It's a drug that blocks the function of an enzyme. And in this case, it's an enzyme that we know is abnormal or mutated in the majority of cases of melanoma.

FIRFER: By blocking that enzyme, it prevents melanoma from growing and spreading. Early study results show that the drug, in conjunction with traditional chemotherapy, shrinks tumors and keeps them from recurring.

SMITH: Now I can live a normal life just by taking a pill in the morning and a pill at night.

FIRER: Although this experimental therapy is showing promising results, Dr. Flaherty warns it's not a cure for cancer. It's a way to treat melanoma as a chronic disease.

That's why the medical community is looking at other trials. Dr. Frank Haluska is working on an individualized vaccine using cells from a melanoma patient's own tumors and adding a gene which stimulates the body's immune system.

Those treated cells are reinserted into the tumor with the hope that the recipient's own immune system gets a boost to destroy the cancer.

DR. FRANK HALUSKA, MASSACHUSETTS GENERAL HOSPITAL: And what we hope is that the vaccine makes them immune to melanoma so that the melanoma doesn't come back.

FIRFER: Dr. Haluska adds it's important because right now there are no proven treatments to help melanoma patients like there are for some other cancers.

He says patients like Don Anderson would not alive today if not for this experimental vaccine.

DONALD ANDERSON, MELANOMA PATIENT: Until he tells me that there are no other alternatives, then I will keep fighting and keep fighting and keep fighting.

FIRFRE: Holly Firfer, CNN, Atlanta.


GUPTA: Holly Firfer, thank you.

Now if you're diagnosed with skin cancer, there are some standard treatments you can expect, ranging from freezing off early skin cancers to excisional surgery, in which your doctor cuts out the cancerous tissue and some normal tissue surrounding it.

Also, for early cancers, a doctor may use a laser to vaporize the growth. For more difficult cancers, doctors may do something called Moh's surgery, where the growth is removed layer by layer and examined until there are no more abnormal cells.

And as with other cancers, radiation and chemotherapy can be used to kill cancerous cells.

We're talking with the doctor, dermatologist, Dr. Carl Washington. He specializes in skin cancer.

We received lots of questions on skin cancer, lots of people concerned about it. A lot of survivors out there as well.

Let's get to an e-mail from Bonnie in New York who writes a particular question, "In the past nine years I've had three melanomas. The last one was stage three. It seems like there are so many advancements in other areas of cancer, but not in the fight against melanoma. Is there any new hope for melanoma patients?"

This is your field. What's on the forefront for Bonnie?

WASHINGTON: Well, there really is quite a bit. I mean, the good news remains that early detection is very important, because they're so curable if we catch it early on.

But certainly, for more advanced cases, it is a case, that that is a difficult area. And there are a number of very interesting and innovative strategies being looked at now that largely involve manipulation of the immune system. And it does appears that at least in many patients that that offers some amount of hope.

GUPTA: So basically, it means you take some of their melanoma cells, and you inject it with a chemotherapeutic agent? Is that what you're talking about?

WASHINGTON: Well, you might -- Inject it with something that changes one of the proteins that's made to try to make the cell a little bit more visible, if you will, to the immune system.

And some involve manipulating the production of certain enzymes, which make the body a little bit more likely to recognize...

GUPTA: Sort of revving up the immune system against it.

Let's get to another e-mail about that. Dana in Indiana: "I recently had an excision done on my left arm due to malignant melanoma. I finished a year of adjuvant therapy" -- I guess chemotherapy -- "last June. I took interferon treatments. Are there any other therapies I should be doing as a preventative measure? Also what is the best treatment for malignant melanoma?"

There are many steps towards skin cancer. What sort of things does someone think about in terms of preventing a recurrence, specifically?

WASHINGTON: Well, certainly for preventing a recurrence in patients who have more advanced -- more advanced melanoma than adjuvant therapy, mostly with interferon these days is what is usually done.

GUPTA: Interferon is?

WASHINGTON: Interferon is a protein, essentially, that stimulates the body's immune system to hopefully recognize and destroy any residual recurrent melanoma cells.

GUPTA: So if you think of chemotherapy sort of attacking the cancer, lots of the new therapies sort of boosting up the immune system to fight off the cancer.

WASHINGTON: That's right. That's right. That's right.

GUPTA: Very interesting stuff.

WASHINGTON: It's not chemotherapy.

GUPTA: Not chemotherapy.

We've got to take a quick break now. When we return, are tanning beds safer than lying in the sun? Good question. Dr. Washington's going to fill us in. Stay with us.


ANNOUNCER: From tanning beds to self-tanners and laying out. Can any tan be a healthy one?

Plus, can the clothes you wear save your life? That answer, when HOUSE CALL continues.



GUPTA: Welcome back to HOUSE CALL.

For many years, tans were touted as being a sign of health and vitality. But dermatologists have been fighting that perception and trying to get people to beware of the effects of that tan. Besides aging the skin, it can also cause deadly skin cancers.

Talking with us this morning about it, Dr. Carl Washington. He's an associate professor of dermatology at Emory University.

Doctor, many people ask about the safe tan. Is there a certain amount of sun that's OK? We've got an e-mail question on that very topic. Let's get to one of those questions now.

Lauren from sunny Texas asks, "Is there any such thing as a safe or healthy level of sun exposure? If so, is there any recommended duration, and should sunscreen always be used?"

Lots of questions on this thing. Is there any amount of sun that's OK without sunscreen?

WASHINGTON: Well, certainly, I think a small amount is probably OK, but for those who are going to be out for a longer period of time, we do feel that every bit of ultraviolet radiology kind of contributes ultimately to a risk of skin cancer. So we really feel like there really is no safe tan and that regular use of sun screens and protective clothing really are beneficial.

GUPTA: Do you wear sunscreen every day when you...?

WASHINGTON: I probably wear it most days when I'm going to be out for any length of time, sure.

GUPTA: Really good important information. When it comes to sunscreens, well, the American Cancer Society recommends that you choose one that blocks both UVA and UVB rays. They're known as broad- spectrum sunscreen.

Also, apply the sunscreen 20 to 30 minutes before going outside and make sure it's SPF 15 or higher. About one ounce of lotion should be enough to cover most of your body.

Don't forget to reapply it, though, every two hours, more often if you're swimming or sweating a lot.

Lots of questions on sunscreen as well. This came from our roving camera. Take a listen.


UNIDENTIFIED FEMALE: What are the best steps I can take to protect my children? At what age can I start using sunscreen on them?


GUPTA: A lot of parents curious about that. Young children, use sunscreen? What do you tell parents?

WASHINGTON: We tell people after about six months of age it's probably safe to apply a sunscreen. And before that, it's probably best to just try to protect them from direct exposure.

GUPTA: Everyone wants to look healthful and vital, you know, full of vigor. And that's why they get the tans. And tanning beds are a big topic. Let's get to a question now about that.

Connie from Ontario writes, "I'm a regular at a tanning salon. I go three to four times a week. The staff reassures me that the risks are minimal of getting skin cancer." I'm sure they do, Connie. "They say the bulbs are low in UVB rays and they also produce vitamin D. Should I be concerned, or am I fairly safe tanning this way?"

Well, first of all Connie, recent studies of women who tanned once or month or more showed they had a 55 percent greater risk of melanoma than women who did not visit tanning salons.

Doctor, tanning beds are obviously very popular. What is your best advice on this?

WASHINGTON: Well, compared to direct sun exposure, they perhaps do have a lower risk of forming skin cancer, contributing to skin cancer, but there is some evidence increasing that Ultraviolet A exposure, which is what you get from a tanning bed, followed by UVB may be harmful.

So we tell people if you're going from the tanning bed to a cave, you're probably OK. But if you have to get in your car and drive home, or you're out in the sun, then the damage is done, probably.

GUPTA: I can't imagine you ever tell a patient of yours, anybody, that a tanning bed is a good idea?

WASHINGTON: No, in general not. There are some certain skin conditions where actually a little ultraviolet radiation exposure is helpful. But for the most part with respect to skin cancer, it really is not beneficial in any way.

GUPTA: What about those self-tanning creams and lotions, things like that?

WASHINGTON: We're very big fans of those, and we feel that people who feel like they want to have a little color, why not try those?

And they're not like they were years ago where you get kind of an orange color. There really are quite a few products on the market now where almost anyone can find something that leaves them with a satisfactory color.

GUPTA: For the most part, totally safe. WASHINGTON: Totally safe.

GUPTA: Martha in Georgia, she writes an e-mail. She wants to know, "My son has many moles. We keep sun exposure to a minimum. How often should I have his moles checked?"

Mole checks, I mean, you can obviously do that yourself to some extent. But is there a standard minimum number of times?

WASHINGTON: It depends on the number of moles and how atypical or irregular they look. And so we, as a general role, do what's called mole mapping, where we essentially create a digital record of all the moles. And we can monitor over time whether or not they're changing.

And the frequency is more related to what their overall risk is with respect to family history and how many irregular moles they have and their sun exposure history.

GUPTA: This is all really good information, Dr. Carl Washington.

There are, of course, other ways, besides wearing sunscreen, to protect yourself, from staying in the shade and limiting your time outside during the peak sun hours of 10 a.m. to 4 p.m.

There's also protective clothing. Dr. Washington mentioned this. A question now comes form Susan in Connecticut regarding this: "There are many products on the market that add SPF to your clothes. Are they worth using? Do you really get damaging rays through your clothes?"

WASHINGTON: You certainly can.


WASHINGTON: And it depends on a combination of color and how tightly knit the fabric is. And there are some very good products on the market that actually can add some ultraviolet protection to clothing.

Additionally, there are wonderful lines out there that are sun protective and very good products that people can choose from that are not as expensive as they used to be.

GUPTA: Another option for people trying to protect themselves from the sun.

We, of course, are not done yet. This week's top medical news when we come back, including a new study, how young girls are starting to diet. Pretty amazing. Stay tuned.


ANNOUNCER: Coming up on HOUSE CALL, we'll tell you where to surf for more skin cancer prevention tips.

Plus, what's your sun safety I.Q.? You'll get a chance to test it after the break.




CHRISTY FEIG, CNN MEDICAL CORRESPONDENT (voice-over): Girls who show signs of being overweight by age 5 are likely to be fighting their weight by the time they are 9, according to a new study of 153 girls in the "Journal of the American Dietetic Association."

The Pennsylvania researchers urge parents to encourage physical activity and appropriate proportion sizes to promote healthy weight in their children.

And for those who want to avoid the effects of a hangover, try prickly pear cactus extract. The Archives of Internal Medicine reports a study found that cactus has compounds that can help the human body withstand stress, including the effects of alcohol toxicity, reducing the severity of a handover by half.

Christy Feig, CNN.


GUPTA: Christy Feig, thank you.

So are you feeling like a skin cancer expert now? Well, go to and test your sun safety I.Q.

Also click on to That's the American Academy of Dermatology. There you're going to find sun safety tips, links to free cancer screening facilities and more pictures showing what skin cancer looks like.

That's our show for today. Lots of good information. I'd like to thank Dr. Carl Washington again.

WASHINGTON: You're welcome.

GUPTA: Really valuable stuff. Thank you so much.

Also, thank you at home for all of your questions. Very valuable there, as well.

Next week we're going to be talking about organ donation, from preferential treatment to the rising number of people waiting. We're going to ask your questions to our experts.

Thanks for watching. I'm Dr. Sanjay Gupta. Stay tuned now for more news on CNN.


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