Dr. Pennoyer Discusses Skin Cancer on WDRC’s For the People

Transcript of Audio

JOHN VOKET, HOST: So it’s amazing that on average one American dies from melanoma every hour.  So it’s appropriate that as we sort of head into the official first weekend of summer that we talk seriously about melanoma and skin cancer.  Despite the efforts to raise awareness about the dangers of sun exposure many adults, especially young adults, are still not using sunscreen regularly.  So we’re bringing in a new friend and a resident expert on the subject.  Dr. Jennifer Pennoyer is with us.  She’s a dermatologist based in Bloomfield and a staff physician at St. Francis Hospital and Medical Center in Hartford.  She’s at the forefront of the latest advances in the field and she’s here to discuss the surprising facts about skin cancer and to share views about the latest, greatest ways to prevent it by protecting your skin this Memorial Day and all year long.  So good morning doctor, thank you so much for joining us this morning.  I know you’re quite busy.

DR. JENNIFER PENNOYER, ST. FRANCIS HOSPITAL: Thank you for having me.  I’m glad to be here.

VOKET: So as we mentioned, these current skin cancer statistics are staggering.  And it’s interesting that we’re bookending our program this morning, starting with you and ending up with one of your colleagues regarding some additionally staggering statistics about expected diagnoses of breast cancer.  So let’s start out talking a little bit about what the latest news is in your professional arena about melanoma and skin cancer.

PENNOYER:  Right now skin cancer is the most common cancer in the United States, with more new cases occurring than the combined incidence of breast, prostate, lung and colon cancer each year.  So the numbers are staggering.  More than two million people are diagnosed with skin cancer, and melanoma is the leading cause of death.  In Connecticut we actually have one of the highest incidence rates of melanoma.  So these are staggering numbers and one that make us take pause.  There’s new data from the American Academy of Dermatology that shows that Caucasian men aged fifty and older are at higher risk of developing melanoma than the general population.  And the statistics are demonstrating that the death rate from the melanomas in this group has been steadily rising to fifty percent.  And that’s shocking.  Rates for new melanoma cases have been rising on average two-point-six percent each year over the last ten years.  And the reason for that is simple, we’re losing our ozone, the sun is stronger.  This is not the same sun you and I grew up with.

VOKET:  But what explains the, if I understand correctly, a inconsistent escalation in diagnoses or anticipated diagnoses in women?

PENNOYER:  I think women are more attentive and I think that’s the reason we have a poorer rate in men, because they don’t look around as much.  Women are much more on top of things, I find.  You know, they’re looking around and knowing what’s normal for them and what might have changed.  Whereas a lot of men don’t present until something is bleeding or it’s getting in the way of putting on their clothes that they’ve noticed it.

VOKET:  And we are talking fifty and older I guess, incidence in women under age forty are higher for melanoma.

PENNOYER:  Correct.  And I think also, it’s the cumulative effect of your sun exposure, and that adds up from day one.  So back in, anybody over fifty, in our childhood we didn’t wear a lot of sunscreen.  Maybe an SPF4 oil, but there really wasn’t a lot of knowledge there about the sun.  So we all, to some degree, had a misguided youth.

VOKET:  So it’s completely related to sun exposure particularly for this fifty and over male group.  It has nothing to do with, and as you said, which is tied to environmental, but it has nothing to do with anything that we’re consuming or that we’re putting ourselves out there longer.  It’s really this kind of dynamic change in the atmosphere and the intensity of the dangerous types of rays that are hitting us from the sun.

PENNOYER:  Correct.  There are about twelve percent of melanomas that can be genetic.  That’s just a very small percentage.  But overwhelmingly the cause is cumulative ultraviolet exposure.

VOKET:  And let’s back it up a little bit and talk about melanoma, because while it was always commonly associated for me with surface or superficial cancers, am I correct that melanoma can also develop interior to the skin?

PENNOYER:  Well, you know, I probably get called to St. Francis once or twice a year for somebody who’s been admitted with a metastatic melanoma.  So it’s already on the inside.  The thought there is that a lot of primary melanomas can regress so your body can mount an immune response to it and start chewing that up.  So one of the signs I look for in a mole is if it’s got kind of a whitish or thundercloud gray appearance to it, there’s regression.  Your immune system recognizes these atypical cells and is actually trying to mount a response and so it can essentially chew up that primary lesion.  So, you know, it’s hard to say.  I don’t think particularly that it starts on internal organs.  I think primarily we think that the primary lesions are regressed and your body took it away.  That being said, I’ve seen them carried anally, carried vaginally, so that exterior surface can be what you and I call “where the sun don’t shine.”  And the thought there is that your body has some sort of clock and knows how much cumulative effect of the sun you have, so at a certain point it can pop a melanoma out anywhere.  It doesn’t have to be where you have had the absolute most sun.  It might be where you had a bad sunburn, could be between your toes, could be underneath your hair on your scalp.  Could be anywhere.

VOKET:  And we hear so many, I mean, the clichéd conversation is often when the diagnosis of cancer comes, lung cancer, ‘I never smoked.’  ‘I never think I had exposure to asbestos, so what’s the deal?’  What is the incidence of melanoma developing in an individual who has been very, very loyal to at least protecting themselves from the sun with the advised course of, you know, sunscreen, or has even avoided a lot of sunlight because they may have that light skin factor.

PENNOYER:  I can’t say per se an exact percentage of that because that’s a hard controlled study to do, to really know somebody’s lifelong sun protection.  People will say, ‘Well now I don’t go in the sun,’ but I certainly will see effects of chronic sun damage on them.  And they don’t remember all their childhood and all the exposure they’ve had.  Do you know that one in five Americans will have skin cancer?  When I started off in practice it was one in seventy-five.  So it’s a huge change over the course of fifteen years.  So it’s just an escalating problem.  But I can’t say, there’s not a great study that I know of that would say there’s a very good control, lifelong, what your actual risk would decrease down to, versus that of the general population.  That’s a long study to do.

VOKET:  Yeah.  Let’s snap back to this fifty and over of male demographic that we launched a few moments ago.  Can you talk a little bit about, from your perspective and your practice and your immediate colleagues, especially here in Connecticut where the problem is apparently most acute for skin cancer development, at least statistically, where are the cancers developing, the majority of cancers on the body?  And I’m asking this because just the other morning at a staff meeting all of our people were kind of noticing that we all started having browner left arms because we had those few really sunny, hazy days and with our arms out the window we all started developing that kind of driver-side arm phenomenon.  So where are you seeing the manifestation of most of these skin cancers?

PENNOYER:  Exactly.  It’s the trunk and arms.  And you do get a lot more on the left side, twice as much on the left side from driving everyday.  And people don’t expect they’re getting sun exposure, because ‘Oh, I put on sunscreen when I’m out.’  You don’t realize you’re getting damage to your DNA in-and-out to the grocery store, in-and-out to the mailbox every day.

VOKET:  Good information.  I just want to let people know if they just tuned in, we’re talking on this Memorial Day weekend about the explosion of skin cancer, particularly here in Connecticut, one of the worst states in the country for incidence.  We’re with Dr. Jennifer Pennoyer.  She’s a dermatologist based in Bloomfield and a staff physician at St. Francis Hospital and Medical Center.  Dr. Pennoyer, a lot has been in the news lately, and there is that perennial move in the Connecticut legislature, to put more restrictions and inforamtion and instill more protections for tanning beds, but also from a recreational exterior tanning perspective, or just for folks that are working out in the sun.  What are a few points that need to be made about using sunscreen regularly?

PENNOYER:  You know, the facts about sunscreen use are terrible.  The American Cancer Society says only thirty-two percent of adults have used sunscreen regularly in the last twelve months and that number drops to ten percent for high school students.  The numbers are even lower for good sun protection habits like wearing hats or long sleeve shirts.  That’s about twelve or thirteen percent.  So we know that people aren’t protecting themselves well enough.  But we also know that our sunscreens aren’t that great.  They really haven’t changed that dramatically and that’s why this Sunscreen Innovation Act that was recently passed should help us out in getting better and more efficacious sunscreens passed.  You know, in the U.S. we’re unique in that we consider sunscreens a drug; the rest of the world does not.  So all these new ingredients have been held up with the FDA, and hopefully with the Sunscreen Innovation Act we’ll get those to market sooner.  And we want things that are safe.  If we’re asking people to use sunscreen more, we want them without chemicals that are going to harm us, so it’s always going to be more safe to use the physical sunscreens.  And those are easy to remember because those are the ones that contain zinc oxide or titanium dioxide.  That’s going to sit on the surface and reflect off the sun.  The chemical sunscreens, you know, you got to worry about absorbing some of those chemicals, so you want things that are safe especially if I’m asking you to do that on a daily basis.  And those won’t let the sun be absorbed into your skin and then protect you.  And a lot of the problem have been that there’s a breakdown of those chemicals.  They’re not as photo-stable so when they’re exposed to sunlight, actually they can break down, which is not what you want in a sunscreen.  There’s also some research about the damaging effect of infrared rays which can cause inflammation and photo-aging, so there may be some sun protection for that.

VOKET:  And let’s get out of the sun for a moment and talk about this escalating new phenomena of chemical tanning.  Have you and have your colleagues and any research been mounted on the risks of the chemical application of tanning color that folks are, I guess, starting to use much more frequently now?  Spray-on tans?

PENNOYER:  Sure, let’s break that into two things.  The spray-on tans are sugar molecules that are actually very safe.  That’s a sugar molecule that’s going to bind to your skin, and as you naturally slough and lose your dead skin cells in about eight days, that’s going to slough off.  What you need to remember with that is it provides no protection.  It is little sugar pigments and it’s adding to your skin; it is providing no protection against the sun.  And there’s nothing dangerous about that.  A sugar molecule is actually a very big molecule, not going to get absorbed, it is sitting on the outside surface.  No damage there.  There was some concern, however, about the aerosolized spray tans, that you shouldn’t inhale that.  To me that seems like common sense.  Let’s not inhale that, so just be sure to cover your mouth or look away when they’re doing that.  The other topic you brought up is the tanning beds.  The studies on that are very clear.  Any tanning bed use triples your risk of skin cancer long-term.  People say, ‘Oh, but I only did it a few times here and there.’  The study was very clear, it didn’t matter how many tanning bed sessions you had, one or a hundred.  That population who had been in a tanning bed had triple the risk of the general population who had not.  So there’s some strong evidence for not doing that.

VOKET:  In the last minute or so that we have with you, and I really appreciate the input.  I’m learning a lot, I hope folks who are tuning in are as well.  Let’s talk practically then, going to the store to arm yourself with the right tools to maximize skin cancer prevention.  What are the most important things people need to know?  And please differentiate if there are different requirements for infants, children, middle-age folks and seniors.

PENNOYER:  Okay, okay.  I think the major thing I want to emphasize is to wear SPF-30 and above.  Probably twenty years ago there was data that showed SPF-15, 30 and 45 were all the same.  That’s only if you use it the way they test it.  I think it’s critically important that everybody understand that when a sunscreen company tests a sunscreen they do it with a layer of white on the surface of the skin.  You and I don’t ever go out with a layer of white on.  That is ridiculous.  So at least five years old are studies which demonstrate that when you and I use the appropriate amount of sunscreen, which is a shot glass full of sunscreen, and we rub it in, in use we are getting a third of whatever number is on the bottle.  So we’re not getting our thirty because we’re going to rub it in all the way.  So in that respect it does pay to go higher.  As I said, I think it’s always safer to use the physical sunscreens such as titanium dioxide and zinc oxide because those don’t penetrate the skin and do a better job protecting, kind of, are harder to rinse off though.  But when you’re using those higher numbers I don’t want to create the next problem which could be acne on the face.  So in that respect I do recommend a facial sunscreen usually one with a moisturizer in it so you could put it on every day.  And those tend to be a little bit more cosmetically nicer.  You might pay a little bit more for that, but it’s not going to feel like toothpaste.  Nobody wants to put that on their skin.  And it’s going to do a nice, cosmetically elegant job so that you don’t look like you’re covered in sunscreen, and you could use it on a daily basis.  For babies, I definitely would recommend the physical sunscreens and that is primarily the basic ingredients of the baby’s sunscreen, is less chemicals, the physical sunscreens that sit on the surface.  I can’t emphasize enough that wearing protective the clothing and giving yourself less skin to deal with, with sunscreens, is a huge benefit.  It’s just always going to be better to block your sun exposure anyway.  So if you know you’re going to be sunning, wear the shirt in the water that has the SPF50 in it.  Then you only have to worry about your face and neck.  Did I hit all the topics, I think?

VOKET:  Yes, yes, and I appreciate that.  The sand is out of the hourglass, but we want to remind folks that skin cancer is the most common cancer in the United States.  More new cases occurring than the combined incidence of breast, prostate, lung and colon cancer every year.  One American dies from melanoma every hour, and in Connecticut we have one of the highest incidence of skin cancer in the nation.  We want to thank our guest, Dr. Jennifer Pennoyer, a dermatologist based in Bloomfield and a staff physician at St. Francis Hospital and Medical Center in Hartford, as we kick off the official first weekend of summer here on Memorial Day weekend.  We want to send you these critical, important reminders as the first of our two visits with St Francis professionals on our program this morning.  Dr. Pennoyer, thank you so much for your time.

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