Safeguarding Your Skin from the Sun

Intro: This is Weekly Dose of Wellness brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell (Host): Hello, and welcome to the show. You're listening to Weekly Dose of Wellness brought to you by MemorialCare Health System. I'm Deborah Howell, and today's guest is Dr. Bonnie Cheung, who is board-certified and licensed by the California State Medical Board, and is a primary care physician at Orange Coast Memorial Medical Center. Dr. Cheung joined Beach Family Doctors in September of 2013 and provides total family care, including pediatrics and women's health. She's also an avid Chicago Bears fan. Go Bears! Welcome, Dr. Cheung.

Bonnie Cheung, MD: Welcome, thank you.

Deborah Howell (Host): Today we're going to talk a bit about safeguarding our skin from the sun and why that's so important even in places like Chicago. First of all, what is skin cancer, and how can it develop?

Bonnie Cheung, MD: Yeah, so skin cancer is actually the most common cancer diagnosed in the United States. Cancer in general is basically when the cells in the body grow out of control and they can invade other parts of the body. Skin cancer is cancer that originates in the skin. And the three main types are basal cell, squamous cell, and melanoma, that's deadly. And it makes up about 3.5 million people that are diagnosed yearly. So, you can get it by spending a lot of time out in the sun, using tanning beds or sun lamps, and living in areas with lots of sun.

Deborah Howell (Host): Sure. So those damaging rays from the sun can really contribute to skin cancer as you mentioned. So what are the best ways to protect your skin from UV rays?

Bonnie Cheung, MD: Of course. So the best ways to protect from the sun is to wear sunscreen that's at least got SPF 30 on it, to cover all the areas of the skin that are exposed to the sun. So wearing hats and sunglasses. There's even clothing that you can get with UV protection on it. And most importantly, trying to stay out of the sun from 10:00 a.m. to 4:00 p.m. when the rays are most intense.

Deborah Howell (Host): Does that clothing work, do you know? Has it been tested?

Bonnie Cheung, MD: The clothing has been tested. I know that they have to go through a process for them to be able to label it, you know, a UPF 10 or 15. But in terms of whether it's better than sunscreen, that I'm not sure of.

Deborah Howell (Host): But you can wear both of them and then be doubly protected. Okay. So what should we look for when choosing a sunscreen?

Bonnie Cheung, MD: Yeah, so when you choose a sunscreen, there's three main things really. You want to make sure that it says broad spectrum or that it says UVA or UVB on there. Those are the two types of sunlight that penetrate through the skin that can cause cancer. You want to make sure it's got SPF 30 or above. So SPF 30 blocks about 97% of the sun's rays. So the higher you go, it blocks more, but it's never 100%. So there's no need to really get anything that says SPF 150 on there.

Deborah Howell (Host): Somebody did say that after 45 or something like that, it's all the same, is that right? Is that accurate?

Bonnie Cheung, MD: That I'm not sure of. I just know that the higher the number, the more that it blocks, but in general, you know, it's never going to block 100%. So I think it's just one of those things that are marketed so that people think they get a little bit more protection. A lot of them also say water resistant. So it's really important now to look to see, some are water resistant for only 40 minutes, and others are resistant for 80 minutes. So they used to say waterproof or sweatproof, but they've taken that off the market because they're saying it's false advertisement because it doesn't actually protect fully.

Deborah Howell (Host): Yeah. And I've had mothers who, you know, they put the sunscreen on their children and then don't let them out into the sun until 20 or 30 minutes later.

Bonnie Cheung, MD: Yeah, no, so you do want to actually apply it 15 minutes before you get out in the sun so that it kind of soaks into the skin first. And for those that are mothers or fathers, usually you want to actually keep babies under six months out of the sun and don't put sunscreen on them because their skin's a little bit more sensitive to the chemicals in the sunscreen.

Deborah Howell (Host): Right. So just keep them in a bassinet with a nice hood on it.

Bonnie Cheung, MD: Yeah, or just an umbrella. I mean, they can enjoy the sun just like everyone else, but you know, under the shade so that they're not in the direct sunlight.

Deborah Howell (Host): Right. Okay. And so should we wear sunscreen every day even in the winter?

Bonnie Cheung, MD: Yeah, so definitely you do want to wear sunscreen. I mean, the main thing is going to be if you're going to be outside longer than 30 minutes, you do want to wear sunscreen because it takes about 15 minutes for your skin to be in the sun to get damaged by the sun. So even actually when we're snowboarding or skiing in high altitude, that's also an important time to wear sunscreen because 80% of the sun reflects off of the snow. So you don't only just get it from the sunlight, but you also get it reflecting from the snow.

Deborah Howell (Host): Interesting. And does the altitude itself have anything to do with how close you are to the sun? Does that make a difference?

Bonnie Cheung, MD: It does. So, you know, for about every 1,000 feet above sea level, the UV ray exposure increases four to five percent. So the higher you go, the more you're getting from the sunlight. So those that live in Colorado or anywhere where it's above sea level, you do have to wear sunscreen.

Deborah Howell (Host): Interesting. Now how often should we reapply sunscreen?

Bonnie Cheung, MD: Yeah, so you should reapply about every two hours or so. And if you're going to be out in the water or if you're going to have any intense sweating, then you kind of want to dry off and reapply right afterwards as well because a lot of times it will slip off of your skin even though it's saying water resistant and sweatproof.

Deborah Howell (Host): Right, right. Okay, this might be elemental, but are there other parts of the body that the sun can damage besides our skin that we should protect?

Bonnie Cheung, MD: The eyes are probably the most important aside from the skin because you can get melanoma in the eyes. So you do want to wear sunglasses when you're out in the sun, and you want to make sure that it says UVA, UVB protection on it.

Deborah Howell (Host): I have never heard that you can get melanoma of the eyes. I can't imagine anything more dreadful.

Bonnie Cheung, MD: Yeah, so it's really important. I know a lot of people don't want the raccoon eyes, but you do want to make sure that the inside of the eye is protected too.

Deborah Howell (Host): Yeah, absolutely worth it. Yeah. Especially if you have light eyes.

Bonnie Cheung, MD: Yeah, exactly. I mean, for skin cancer risks in general, unfortunately for those that are lighter skin it is going to be a little bit more important because they are a little bit more at risk for getting skin cancer. I mean those with fair skin or those with green or blue eyes or the blonde hair, and those that can freckle easily as well.

Deborah Howell (Host): Right, right. How often should somebody get their skin checked with their doctor?

Bonnie Cheung, MD: So at least once per year you want to get the skin checked. I mean, it's really going to kind of depend on what risk factors you have. Aside from being fair skin, you know, those that have maybe 50 or more moles should definitely get checked at least once per year if not more depending on what they see in their skin. Or those that have close relatives with skin cancer should be a little bit more aware, or those that have any chemical exposure to certain chemicals like coal or tar or arsenic.

Deborah Howell (Host): Mm-hmm. Oh, interesting. And this is a little bit off script, but what is a mole?

Bonnie Cheung, MD: A mole is an area in the skin that's basically got more pigment to it. So melanocytes are the cells that create pigment, and there's places in the body where there's just more pigment on there.

Deborah Howell (Host): Okay, okay, interesting. I also wanted to ask you, what should one look out for as far as changes in their skin?

Bonnie Cheung, MD: Yeah, so changes in the skin, I mean, we classically go with the acronym ABCDE. So if you think of A as asymmetry, you're looking at changes in the shape of the lesion. So if you were to cut it in half, does one side look like the other side? B is going to be borders, so you're looking to see if it's uneven all the way around or whether there's a notch in it. C is the color, so you're looking to see is it all one color or is it uneven? If it's uneven in color, that's a little bit more concerning. D is for diameter, so you're looking to see if it's larger than a quarter inch or the size of a pea. It's not necessarily most diagnostic because skin cancer does grow in depth and that's the more dangerous part, but on top that's all we can see. So that's kind of a good at least an indication. And E stands for evolving, so you're looking to see if there's any change in the skin whether it's crusting or whether it's bleeding or whether it's itching.

Deborah Howell (Host): Okay. Okay. And certainly if a doctor finds something like that, they will take a biopsy, and then what happens?

Bonnie Cheung, MD: Yeah, so we take a biopsy, we send it off, the pathologist will kind of let us know what is seen. I mean, if the whole lesion is taken off and we have clear borders, meaning the edges of it are just normal skin, then we're safe. But if there's any edges where there's still cancer on it, then you do have to go back in and grab more of the tissue. So a lot of it, you know, if it turns to be something deeper, then we do send that out to dermatology because they're definitely the experts at removing the skin cancer.

Deborah Howell (Host): Sure. Now there's also something, I'm sure my term is wrong, but something like cryology where they freeze the...

Bonnie Cheung, MD: Yeah, cryotherapy.

Deborah Howell (Host): Cryotherapy, that's it.

Bonnie Cheung, MD: So we use liquid nitrogen often for the basal cell and squamous cell, sometimes you can just freeze them so that you can kill the cancer right on the spot and the cancer will die and eventually crust off.

Deborah Howell (Host): And good riddance!

Bonnie Cheung, MD: Yeah, we do that quite often in our clinic.

Deborah Howell (Host): Well, thank you so much, Dr. Cheung. The time has flown. It has been great to have you on the program today to talk to us about safeguarding our skin from the sun. To listen to the podcast or for more info, please visit memorialcare.org. That's memorialcare.org. Thanks again, Dr. Cheung.

Bonnie Cheung, MD: You're welcome, thanks for having me.

Deborah Howell (Host): I'm Deborah Howell. Join us again next time as we explore another Weekly Dose of Wellness brought to you by MemorialCare Health System. Have a great day.