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Sanjay Gupta MD

Skin Cancer In-Depth

Aired August 05, 2006 - 08:30   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

TONY HARRIS, CNN ANCHOR: And good morning, everyone. In the Middle East, ominous messages from above. Israel's military is urging civilians to flee the city of Sidon in southern Lebanon. It's dropping leaflets presumably before more shelling.
And new explosions in Israel. Last hour we showed you live images of rockets slamming into the Israeli village of Metulla. Haifa has also been hit in recent hours. Israeli police say nine people were wounded there. Meanwhile Israel launches an aerial assault on the Lebanese city of Tyre. Israeli jets and gunships converge on the city as the offensive escalates. Israel says at least eight of its commandos were wounded while trying to disarm the Hezbollah stronghold.

Tour de France champ Floyd Landis vows to fight to clear his name. Results of a second doping test released just a few hours ago also show elevated testosterone levels. Landis was immediately fired by his Swiss cycling team.

Dr. Sanjay Gupta takes a closer look at how you can treat and prevent skin cancer. "HOUSE CALL" begins right now.

UNIDENTIFIED FEMALE: Coming up on HOUSE CALL, it's the most common cancer and the most treatable. Find out what you need to know about skin cancer.

And SPF, what do al the numbers mean? Find out how to pick the right sunscreen.

Plus, food, obesity, and cancer. Find out if it's the food you eat or your weight that puts you at greater risk.

DR. SANJAY GUPTA, CNN SR. MEDICAL CORRESPONDENT: Good morning, and welcome to HOUSE CALL. I'm Dr. Sanjay Gupta. And this morning we're talking about skin cancer. Now there are a million new cases every year and about 10,000 of those people will die. As with most cancers, prevention and early detection are key to keeping your largest organ, that's your skin, healthy.

As Christy Feig reports, the deadliest of skin cancers, melanoma, is on the rise, including in a population you might not expect.

(BEGIN VIDEOTAPE)

CHRISTY FEIG (voice-over): One year ago 44-year-old Elmer McNeal sought treatment for a rash on his foot, but he soon found out he had a much bigger problem. A mole there that turned out to be skin cancer.

ELMER MCNEAL, MELANOMA PATIENT: She didn't sugarcoat it. Right away she told me that it was a deadly form of melanoma and it needed to be addressed right away. It was something that was life- threatening, within a year it could be potentially fatal.

FEIG: Melanoma is on the rise in this country. According to the American Cancer Society, there are more than 60,000 new cases a year. Nearly 8,000 Americans die annually of the disease. Almost one every hour. The disease is more prevalent in whites but it is increasing in people of color, and for them it's often more deadly.

DR. PAULA BOURELLY, GEORGETOWN UNIVERSITY HOSPITAL: You need to be looking in areas that don't necessarily get the sun. For example, the palms, the soles, in between your fingers, in between your toes, and your nails. Because those are the type of melanomas that can be the most deadly. And they are the ones that most commonly affect people of color.

FEIG: Experts say genetics and family history most likely play a large role for people of color. But they still need to be concerned about the amount of sun they are getting.

BOURELLY: I don't want to lull people in a false sense of security and say, well, since the sun is not going to be my issue because I'm brown-skinned, I don't have to worry about protecting myself, I don't have to worry about wearing sunscreen.

FEIG: But whether it is exposure to the sun's ultraviolet rays, or genetics that is pulling the trigger, melanoma is the deadliest form of skin cancer. And doctors say early detection is key regardless of skin color. So if you have a mole that changes color, shape or texture, see your doctor because melanoma is almost always curable in its early stages but once it spreads the prognosis is poor.

Christy Feig, CNN, Washington.

(END VIDEOTAPE)

GUPTA: All right. Thanks, Christy. And just 4 percent of skin cancers are melanoma but they make up the majority of skin cancer deaths. So beware, if you have fair skin, have had excessive sun exposure, also if you've had severe sunburns as a child or have multiple or atypical moles.

Now as Christy also reported, a family history can also play a role along with environmental hazards like working around coal or tar. And joining us to talk about the latest news on skin cancer is Dr. Darrell Rigel. He is a dermatologist. He is also a professor at New York University Medical Center.

Welcome back to the show, Doctor.

DR. DARRELL RIGEL, DERMATOLOGIST: It's a pleasure to be back. Thank you for having me. GUPTA: Thank you. And you just saw the piece as well. An African-American gentleman in this case got melanoma. They talks about the palms, the soles of the feet. What do we really know about the cause of Melanoma and where it can appear?

RIGEL: Well, the vast majority of melanomas have been really traced to sun exposure. So you typically see melanoma most commonly where the sun does shine, on the face, the head and neck, and where people get sunburned. So on the trunk in men, on the legs in women. But you can get melanoma where the sun doesn't shine. And again the theory is that you're getting hit with ultraviolet radiation. It is lowering your immune system, so you're at risk al over your body too.

GUPTA: OK. Well, let's stay on the topic melanoma. We have an e-mail question from a worried sister, frankly. Barbara writes this: "My brother was diagnosed and treated for early stage melanoma. Is this genetic and how does it affect his or her other family members?"

She is obviously concerned about her brother but herself as well. What do you tell someone like that?

RIGEL: Well, this is a question that we as dermatologists get a lot because the rates of melanoma are rising, so more people have relatives who have had melanoma. If you have a first degree family member who has had melanoma, mother, father, brother, sister, son, daughter, your chance of getting melanoma yourself is about five times increased over the general population. So it's not automatic, but it's certainly elevated.

GUPTA: OK. And we sent a roving camera out and got some questions for you on this particular topic. Let's hear one now.

(BEGIN VIDEO CLIP)

UNIDENTIFIED FEMALE: When I lay out in the sun and I burn, what is my risk of getting skin cancer?

(END VIDEO CLIP)

GUPTA: OK. Again, Doctor, I'm sure this is a question you get a lot of. She gets burns easily, it sounds like. What is her risk?

RIGEL: Well, the more sunburns you get, the greater the risk of getting skin cancer. We do know that you have five or more sunburns in your life, your chance of getting skin cancer doubles over time. So again the fairer-skinned you are, the more likely you are to get sunburn. The more susceptible you are to skin cancer. So you need to protect yourself. I think that's the bottom line.

GUPTA: That's pretty remarkable. You know, five or more sunburns, it seems like, gosh, you know, when we were kids, I mean, a lot of people just out in the sun a lot. Five sunburns doesn't seem like a lot.

RIGEL: No, it is not. And it doesn't take that much to give you skin cancer that way. That's right. GUPTA: OK. Let's keep on topic. Another e-mail now, this one from Maryann in Connecticut: "I've had surgery," she writes, "for several basal cell carcinomas. Am I more likely to develop melanoma than someone with no history of cancer?"

First of all, let me just explain that there are three major types of skin cancer, Dr. Rigel, as you know. Basal cell is the most common and least likely to spread. Then there is squamous cell, which is also slow-growing and very treatable. Then, of course, melanoma, which we have been talking about.

I guess, Dr. Rigel, is someone more likely to get melanoma if they have had the other basal or squamous cell cancer?

RIGEL: Well, they are. And it's not because the basal or the squamous cell cancers turn into melanoma. But if you have the other skin cancers, it's a sign you have had a lot of sun and you are susceptible to it, which are the same risk factors for melanoma. If you have had even one basal cell, your chance of getting melanoma is about three to five times increased over the general population.

GUPTA: Are there certain populations that are more likely to get basal or squamous versus melanoma, or is it the same, just the fair skin, the high sun population?

RIGEL: Basically it's the same. The more susceptible you are to the sun, the easier you burn, the more poorly you tan, the greater your risk. But as you saw from the piece earlier, even the darkest- skinned individuals can still get melanoma.

GUPTA: And we are going to talk specifically, because I know a lot of people are probably looking at their skin right now saying, well, jeez, I wonder if this is something. We'll talk specifically about what to look for. But time for a quick break right now.

When we come back, is your sunscreen doing what the label says? Some lawyers say no and they are suing some big names. Stay tuned.

UNIDENTIFIED FEMALE: The ABCs of SBF, 15, 30, 45, which is best and does waterproof really protect you better?

And later, how your weight affects your cancer risk?

First, take today's quiz. What does SPF stand for? That answer coming up.

(COMMERCIAL BREAK)

UNIDENTIFIED FEMALE: Before the break we asked what does SPF stand for? The answer, sun protection factor.

GUPTA: The American Cancer Society recommends you choose a sunscreen of SPF 15 or higher. And one that blocks those UVA and UVB rays. You've got to look for this. They are known as broad spectrum sunscreens. Also apply sunscreen 30 minutes before going outside, that gives your body some time to protect itself. About one ounce of a lotion should be enough to cover most of your body. That is quite a bit, actually, and that amount should fill a shot glass to give you a scale of reference. And don't forget to reapply it every two hours, more often if you're in the water or if you're sweating a lot.

We're talking with Dr. Darrell Rigel. He is dermatologist. He's a professor at New York University Medical Center.

Doctor, you get these questions all the time. We had a lot of viewers write in with questions on this topic. So let's get to Andrew from California who writes this: "How effective are 'waterproof' sunscreens while swimming?"

And, Dr. Rigel, let me just start off by saying CNN reported a major lawsuit involving the sun protection industry just a few weeks ago. One of the points in that lawsuit is that the language on some sunscreens can be misleading. Attorneys, of course, are using even stronger language. But the bottom line is that words such as "waterproof" are being called into question. So answering Andrew's question, how effective are these "waterproof" sunscreens?

RIGEL: Well, there really isn't truly a totally waterproof sunscreen, even ones labeled as waterproof probably last about an hour-and-a-half or so before you have to reapply. So I think it is important to realize you need to reapply sunscreen probably every 90 minutes or so if you are in the water.

Even if you are not in the water, sunscreens begin to lower in their effectiveness in about two hours or so. So you probably should reapply within two hours unless you have some of the sunscreen with some of the newer technologies that last a little longer.

GUPTA: OK. Well, let's stay on topic of the sunscreens here. We have a question from Kala (ph) in Georgia. This is our roving camera. Just take a listen.

(BEGIN VIDEO CLIP)

UNIDENTIFIED FEMALE: Is there a difference between SPF 30, opposed to 45? And if there is, what is it?

(END VIDEO CLIP)

GUPTA: I have to say, Doctor, this is a question we get all the time. I mean, is higher always better? Is there some point where you're just not getting any additional benefit?

RIGEL: Well, you know, there is some benefit to having a higher number. This is a question as a dermatologist I probably get five times a day this time of year, easily. What happens is if you use an SPF 30 and you use it correctly, that's plenty. But correctly means using in the way that the FDA tests the sunscreen.

When you look at studies, sunscreen costs money and people have to apply it. And they apply usually less than is rated. And probably people apply maybe 20 to 50 percent of the rated amount. So therefore, if you are putting on a 30, you're only getting the protection of anywhere from a 6 to a 15 on average.

If you use a 45 or higher, even if you skimp a little bit, you could still get that protection of a 30. So that is the real answer on why the higher numbers can be better in some cases.

GUPTA: You talk about skimping on it. Just a frame of reference again, a one-week long beach vacation, how much sunscreen should you be using during that time?

RIGEL: Well, typically it is one ounce for every application. And the typical bottle is four ounces. That's only four applications. If you are out more than four hours, that's two applications in a day. So use them up pretty quickly. I always laugh when people come in and say, I have had this bottle of sunscreen for two years, is it still good? Because it means they haven't been using very much of it.

GUPTA: Yes. That's a really good point. I think that's probably one of the most important points, a full ounce. I mean, a lot of these bottles, four ounces. That can be just a couple of days' worth of protection. Let's get to another question now, this one coming from Rick in sunny San Diego: "I've heard that over the long run, the chemicals in sunscreens are actually worse for you than moderate sun exposure."

Interesting question, Dr. Rigel, any truth to that?

RIGEL: Well, not really. There are two kinds of sunscreens. There are the screens that are absorbed a little bit into the skin that filter the sun's rays. And there are the blocks like zinc oxide or titanium dioxide that just reflect the rays. But there has really been no studies that show that it is dangerous in terms of the chemicals themselves.

On the other hand, we do know that exposure to ultraviolet light, even moderate amounts, increase your risk over the long run of skin cancers. So I would say I would still go with the sunscreen.

GUPTA: You know, you must have people come to you all the time, Doctor, and say, well, I mean, how much sun is OK? And I hear differing things on this, some people say there's no such thing as a safe tan. People in New York or places that there are not necessarily beaches close by, they say, I want to go out there and get some sun. What do you tell them?

RIGEL: Well, you know, you've got to be realistic. There is no such thing as a safe tan. You have to think about why you're getting tan. When the ultraviolet rays hit the skin, the first thing they do is they damage the cells in the skin. And your body produces the pigment in the tan, the melanin, to try to protect it from further damage. So have to get damage to get tan.

If people really want to get tan, the best way to do it is with a self-tanner, an artificial tanner, because all that really does is put a stain on your skin, it's safe, it's a protein. It comes off in about five to seven days. And if you really want that tanned look, that's the safe way to do it.

GUPTA: OK. Well, that might be good advice. A lot of people paying attention to that. We have got time for another quick question. This comes from Brenda in Virginia: "What's the youngest age I can start applying sunscreen on my baby? She is now three months old. Which sunscreens are safest in protecting baby's skin.

Doctor, what do you say?

RIGEL: That's a great question. Because that's a common one, too. You know, we always say that you could theoretically use sunscreen even when somebody is first born, in a child. But the problem is, is that newborns might lick it off and it might get in the mouth. Nobody really knows what the ramifications of that are.

So typically what we recommend is up until six months, protect with natural protection, shade, big hats, cover the baby, whatever. Above six months it's pretty safe to use sunscreen. And beyond that, you really can use any sunscreen. The ones that are formulated for kids, the only difference primarily is the fragrance. They smell more like baby powder, but they have the same protection and the same ingredients as adult sunscreen typically.

GUPTA: That's good advice. And as the father of a 1-year-old, we had a lot of big straw hats and light colored clothing. That seemed to do the trick as well. We're talking with Dr. Darrell Rigel about skin cancer.

Coming up, can you be addicted to the sun? Find out.

UNIDENTIFIED FEMALE: Food and cancer, is it the blueberries, the green leafy veggies. Tune in to a surprising look at what impact your diet has on cancer.

First this week's medical headline in "The Pulse."

(BEGIN VIDEOTAPE)

JUDY FORTIN, CNN CORRESPONDENT (voice-over): Post-traumatic stress disorder and depression were lingering effects of the 2004 tsunami. Researchers say nine months after the disaster many victims showed elevated rates of mental health disorders.

New information on the causes of autism. Doctors at the University of Washington revealed different genes may cause autism in boys and girls.

The Centers for Disease Control used ferrets to study how deadly bird flu might be transmitted from human to human. When they mixed a certain strain of avian flu virus with a common human flu virus, they found little evidence that the hybrid virus passed more easily between animals than the ordinary virus alone. The CDC studied ferrets because they are susceptibility to flu is similar to humans.

Judy Fortin, CNN.

(END VIDEOTAPE)

(COMMERCIAL BREAK)

GUPTA: We're back with HOUSE CALL. We've been talking a lot about skin cancer. But for the moment, let's expand that to all types of cancer. Are there foods out there that you could be eating that help prevent cancer in the first place? Or is it activity in the food you don't eat that matter the most?

We investigate in today's "Fit Nation" report.

(BEGIN VIDEOTAPE)

GUPTA (voice-over): We have all seen the headlines, green leafy vegetables keep cancer at bay. Blueberries, a cancer cure. Or how about this one? Eating and drinking your cancer away, a beer and pizza prevention plan. Despite the headlines, new research shows your diet doesn't really impact most cancers that way.

DR. WALTER WILLETT, HARVARD SCHOOL OF PUBLIC HEALTH: There is not really one type of diet or one magic pill or one magic food that's going to prevent cancer.

GUPTA: Dr. Walter Willett is a Harvard nutrition specialist who co-authored the book "Eat, Drink, and Weigh Less." He suggests about 35 percent of cancers in the U.S. are due to nutritional factors. Most, he says, because so many Americans are obese and so many don't exercise. Obesity is a proven risk cancer for colon, breast and ometrial, esophageal, and kidney cancers. But it's our approach to eating that's our real downfall.

WILLETT: We don't pay enough attention to the quality of our food. We seem to be enamored of super-sizing large amounts in place of really high quality foods. And that of course leads to excess calories and overweight and obesity.

CHEF SCOTT PEACOCK: I do think that like food is like a shark. And it can smell fear. You know, it has a sense about it. And you have to be fearless when you're cooking.

GUPTA: Executive Chef Scott Peacock demonstrates how to make some of those high-quality food alternatives at an Atlanta area cooking class. Chef Peacock has earned an international reputation for the southern food he makes at his restaurant, Watershed.

PEACOCK: And it looks very unpromising so far. Not like something you would want to eat. I know. But cooking is magic. It is a lot of fun. It's a diet high in roughage and freshness, I mean, that emphasizes the shortness of the distance from field to table.

GUPTA: The shorter the distance, Peacock says, the fresher the taste of these fruits and vegetables.

PEACOCK: It is much more satisfying, so I don't think you need to eat as much.

GUPTA: And that is the other key to keeping the obesity away. Portion control helps even if you pick food that isn't low-fat.

PEACOCK: Very generous. But you don't have to eat everything. I think a lot of these people come and share, and that's a big part of the southern table.

GUPTA: So go beyond the headlines. Eat well and eat less. You may just keep cancer away.

(END VIDEOTAPE)

GUPTA: So the message is clear, watch those portion sizes and get moving. We're talking about tanning again when we return. Could it be addictive? Find out after the break.

UNIDENTIFIED FEMALE: From sunburn to skin cancer. How close is the link? More tips on keeping your skin healthy when HOUSE CALL returns.

(COMMERCIAL BREAK)

GUPTA: Before heading outside today, try checking out your UV levels at www.epa.gov/sunwise/uvindex, just put in your zip code for a local forecast. And for more information on skin cancer, click on cancer.gov, that is the National Cancer Institute's Web site. It has links to clinical trials and much, much more.

We have been talking about skin cancer on today's show. It's the most common cancer to be diagnosed with 1 million new cases every year. Remember, though, this is very treatable and very preventable, as well. Telling us how to do that is Dr. Darrell Rigel. He's a dermatologist who specializes in skin cancer.

Welcome back, Doctor. Let's get right back to our in-box now with a question from Reem in New York who asks this: "What is the best way to get tan in the summer?"

And, Doctor, we talked about this a little bit earlier. There is no such thing as a safe tan, but something we found could account for the people that -- people wanted to get that tan. It was a small study done finding that frequent users of tanning beds can have an endorphin like rush, almost like a runner's high, after being exposed to UV rays. Now could this be part of the reason for sun worshipping or sun addiction, even?

RIGEL: I think it probably is. It's very clear that there are some people who are addicted to tanning. This study just showed that it's out there. And it's more than just the warmth you feel when you go out in the sun and lie out there. There is more to it than that because even on cooler days where the warmth is not there, people who are really addicted to this want to be tan and will do almost anything to get tan, almost similar to cigarette smoking where you know it is bad for you yet you still do it.

GUPTA: And you say what to them when they say, but I get this endorphin-like rush? RIGEL: Well, I tell them to do it in other ways. You know, go out and run, exercise, there are other ways to feel good about yourself that are not negative to your health. And you only get so far. Unfortunately it is an addiction. You have to treat it with behavior modification to get people to do other things besides going and baking, avoiding the midday sun, using sunscreens, protecting themselves, lowering their risk.

GUPTA: OK. And good points, Doctor. I just want to make sure we are making that point very clearly. Another question now from our roving camera. Listen to this.

(BEGIN VIDEO CLIP)

UNIDENTIFIED MALE: The question I really have is would the removal of precancerous lesions actually lower the risk of cancer itself?

(END VIDEO CLIP)

GUPTA: Fair enough question. So someone sees something atypical. They go to their doctor. They have it removed. Does it reduce their chance of developing cancer later?

RIGEL: It actually does. Skin cancer is the most clear cut case of a cancer. If it is treated early, it's not a big deal. But once it spreads, basically nothing works. So if you have something growing, bleeding, crusting or changing, see your dermatologist, because, again, catching it early is the most critical thing you can do.

GUPTA: I hope we have made that message loud and clear today. Dr. Darrell Rigel, thank you so much for being with us this morning.

RIGEL: My pleasure, Sanjay.

GUPTA: Unfortunately we're out of time for today. Make sure to watch next weekend. We're going inside the mysteries of autism. E- mail us your questions about everything, from the causes to the treatments of autism at HouseCall@CNN.com.

Remember, this is a place for the answers to all of your medical questions. Thanks for watching. I'm Dr. Sanjay Gupta. Stay tuned now for more news on CNN.

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