May 8

Skin Cancer or Just A Mole?

May is Skin Cancer Awareness Month and in an effort to help spread awareness, Dr. Palm was asked by Glamour Magazine to share not only her knowledge but also photos of her patients’ skin cancers for an article in their May 2017 issue.  As this can often be a confusing and sometimes scary topic, Dr. Palm is passionate about breaking down the information in an effort to educate as many people as possible and encourage patients to be proactive when it comes to their health.

While getting skin checks at least once per year is imperative, there are signs and symptoms that can be cause for concern. Here, Dr. Palm breaks down the differences between what is “normal” and what is cause for a visit to your board-certified dermatologist.

Normal Mole
Normal moles develop through our mid- to late-20s, and any moles that develop beyond this point in time should be evaluated by a board-certified dermatologist.
Art of Skin MD Normal MoleWhat a normal mole looks like:

  • Small, well-circumscribed
  • Brown or skin colored
  • Flat or raised

Actinic Keratosis
Actinic Keratosis  are commonly referred to as an “AK” and are precancerous lesions, precursors to Squamous Cell Carcinoma, or SCC.
Art of Skin MD - Actinic Keratosis What an AK looks like:

  • A rough, red patch
  • Typically found in an area of sun exposure
  • Often felt before they are seen, as they can be sensitive to touch or are easily irritated
  • Sometimes pigmented, they can appear as a brown, scaly patch
  • A subtype, Actiinic Cheilitis, appears on the lips most commonly as chronically chapped lower lips

Basal Cell Carcinoma
Basal Cell Carcinoma, or BCC, is the most common form of skin cancer and rarely spreads to other distant organs.
Art of Skin MD Patient's BCC

What BCC looks like:

  • A pearly, skin-colored bump with small blood vessels traversing the lesion called telangiectasias
  • Often appears as an acne-type lesion, but doesn’t heal and will sometimes bleed
  • Left untreated, can invade the tissue surrounding it and become ulcerated
  • Most often shows up in areas of the skin that have had intense sun exposure (think areas that have been sunburned)

Squamous Cell Carcinoma
Squamous Cell Carcinoma, or SCC, is the second most common form of skin cancer, and is a more aggressive form of skin cancer than BCC. It can spread to other organs, especially in areas such as ears, lips or mucous membranes.

Art of Skin MD - Squamous Cell Carcinoma

What SCC looks like:

  • Appears on sun-damaged skin as a red, rough and scaly raised plaque
  • Often bleeds or crusts

Melanoma
Melanoma is a deadly form of skin cancer that will claim approximately 9,700 American lives this year alone. It disproportionately shows up on people who are young and healthy and may spread rapidly from the skin to lymph nodes and other organs, leading to death. It’s imperative to detect Melanoma early for treatment and improved long-term survival.

Art of Skin MD - Melanoma

What Melanoma looks like:

  • Early Melanoma most commonly shows itself as a new black “mole”
  • With time, grows deeper, developing into a larger, multi-colored plaque or a black bump
  • Can display a variety of colors such as shades of brown, blue or white
  • Amelanotic Melanoma does not have pigment and can show up as a pink papule
  • Think of looking out for the “ugly duckling” among moles, one that doesn’t match the others
  • Can be sensitive, bleed or crust

Dysplastic Nevus
The classic ABCD’s accurately describe a Dysplastic Nevus, also known as an atypical mole. They are genetic, and increase the risk of developing Melanoma.
Art of Skin MD - Dysplastic Nevus

What Dysplastic Nevus look like:

  • Asymmetrical mole with an irregular border
  • Uneven or several colors
  • Large-size moles
  • Unusual shape, size, color patterns or just look “funny”

Whether it’s time for your annual skin cancer screening, you’ve never had a screening or maybe you just have questions about specific spots or moles you are unsure about –  call us to schedule your appointment with Dr. Palm and rest assured that your skin’s health is being looked after by an expert board certified dermatologist. When it comes to your health, it’s always best to be proactive. We are happy to schedule your appointment, you can reach us at 858-792-SKIN (7546).


Jul 4

New FDA Rules on Sunscreens – What San Diego Adults and Kids Need to Know

Lovetoknow.com recently contacted me (Dr. Palm) wanting to know the scoop on changes in Sunscreen Labeling for the coming year according to the new FDA 2012 Rule.  Here are some of their questions and my answers below.

  1. The FDA's new sunscreen regulations can make consumers worried and confused. How can they be sure they are choosing sunscreen that offers adequate and appropriate protection for their needs?   "There are two important things to look for...1. That the sunscreen is "broad-spectrum" meaning that it covers both UVA and UVB rays and that the SPF is sufficient. The FDA recommends a Sun Protection Factor of 15, many dermatologists including myself prefer at least 30 SPF." 2. Consumers could also be confused about UVA and UVB protection. Can you briefly explain the, and why people need to be protected from both kinds of rays?and UVB cover different wavelengths of the ultraviolet spectrum of light radiation.  UVA are longer wavelengths (340-400 nm)--I usually tell patients that the "A" in UVA stands for "Aging"--UVA can cause skin aging effects related to significant sun exposure and UV exposure. These include sun spots, pigmentation, and wrinkling related to sun exposure. UVA has been related to some melanomas."  
Melanoma screening by Dr. Melanie Palm, a cosmetic surgeon in San Diego diagnosed this melanoma early
UVB are shorter wavelengths (290-320 nm). UVB is blocked by window glass, but UVA is not. The "B" in UVB can bring to mind "Burning." UVB is related to the red sunburn response seen after significant sun exposure. UVB is strongly related to the formation of nonmelanoma skin cancers including basal cell carcinoma and squamous cell carcinoma. Because both wavelengths have carcinogenic potential, a broad band spectrum sunscreen protecting against UVA and UVB is necessary.
Squamous cell carcinoma in San Diego

Squamous cell carcinoma of the scalp

  3. Many people buy sunscreen according to the SPF level. Under the new guidelines, will the SPF level still be as important, or is it more important consumers purchase one labeled broad spectrum?   "As explained above, these labels mean different things. SPF refers to the level of UVB protection. Broad spectrum coverage refers to the sunscreen's ability to protect against both UVA and UVB. Both are important, and understanding the difference is crucial to selecting an adequate sunscreen." 4. How will consumers be able to tell the difference between a sunscreen that was labeled according to the new regulations?   "These are relatively subtle changes in nomenclature--the way of describing the sunscreens. Waterproof is gone, replaced by water resistant and very water resistant. Broad spectrum will mean coverage against both UVA and UVB." 5. Many budget-conscious consumers purchase sunscreen at discount and closeout stores. After the FDA deadline, will these places still be able to carry sunscreen with the old labels? If so, what should consumers look for in the labeling to be best protected?   "My understanding is that these products can still be displayed as long as they are not expired. Products manufactured after the new FDA rule is in place will have to abide by the new Rules. Consumers should look for labels stating both UVA and UVB coverage. Ingredients such as zinc oxide, titanium dioxide, Mexoryl, and avobenzone (oxybenzone) are key ingredients for adequate UVA coverage. An SPF of 30 or above should be sought for adequate UVB coverage." 6. The new rules won't allow sunscreen to be labeled waterproof, only water-resistant. How long does a sunscreen, even one labeled water-resistant, really last?   "Water resistant is defined as sunscreen effective for at least 40 minutes of activity in the water. Very water resistant allows for 80 minutes. Sunscreens are strictly tested to be awarded this designation. However, patients are encouraged to reapply sunscreens after heavy activity including water sports by many dermatologists. At a minimum, most dermatologists recommend reapplication every hour and one-half to two hours when outside." 7. Do you have any other tips on what individuals should consider when it comes to purchasing their sunscreen protection?   "Choose a formulation you will use. If a product is thick and a body area needing to be covered is hair-bearing, this does not make for a good outcome. Apply sunscreen evenly and liberally. Rub in spray on products. Furtermore, the vast majority of consumers under-apply sunscreen. A full one-ounce should be applied to the body with each application (size of a shot glass). This means a typical bottle of sunscreen should only last 4 applications."
Proper sunscreen application is explained by Dr. Melanie Palm, a board-certified dermatologist in San Diego, CA

Proper amount of sunscreen (1 oz.) for full body application