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Expert advice about detecting and preventing skin cancer

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Yacht crew spend a lot of time on the water and in the sun. But, as we know, too much sun can be deadly. For this topic, I consulted an expert, Dr. Joseph Francis, a board-certified dermatologist.  Here are his thoughts about the sun and our skin.

During my dermatology residency in Virginia, we sometimes had patients bused in from neighboring states. Medical specialists can sometimes be scarce in rural areas. I can remember one patient who took an 8-hour bus ride because he was concerned about a spot on his neck that I could easily tell was benign.

However, he did have a skin cancer on the bridge of his nose that he did not notice. This is a pattern that I continue to see in private practice. The purpose of this article is to help patients identify skin lesions that may be concerning. It is in no way a substitute for regular visits to a dermatologist. My hope is that it may help yacht crew identify skin lesions earlier or encourage them to see a local dermatologist who is board certified by the American Board of Dermatology.

Here are 10 things to look for:

  1. Anything that appears and grows quickly.
  2. A lesion that bleeds and doesn’t heal.
  3. Be suspicious of lesions in sun-exposed areas (scalp, ears, nose, lips).
  4. Basal cell carcinomas can often have a pearl-like appearance.
  5. Where something has been removed, be aware of changes around the scar such as redness, scale, or blood.
  6. Lots of patients with skin cancer tell me that they notice blood on their pillows or sheets.
  7. For pigmented lesions, look for asymmetry, uneven or notched borders, diameter greater than a pencil eraser, different shades of black, brown, tan, red, white, or blue.
  8. Some advanced skin cancers can be painful or itchy.
  9. Beware of hard, painless lumps beneath the skin of the neck. They could be enlarged lymph nodes.
  10. Any pigmented lesion that change over time, including bleeding, itching, growing in width or height, changing color.

Here are a few more answers to questions I get all the time:

  1. What kind of sunscreen should I use?
  2. First, it is important to understand the difference between sunscreen and sunblock. Take a look at the ingredients before using any product. Sunscreens contain chemicals that absorb UV radiation. Sunblocks (also confusingly called physical sunscreens) contain minerals such as titanium or zinc that block UV radiation from reaching the skin.

Sunblocks can offer broader UV protection than sunscreens. However, sunblocks are usually thicker and messier (think of the lifeguard with zinc oxide on the nose). Newer sunblock formulations offer transparency with broad spectrum protection, which is usually what I recommend.

I am also a big proponent of sun protective clothing. When I am out on the water, I wear a hat that covers my ears and a long sleeve, breathable, sun-protective shirt. This allows me to be comfortable without having to worry about painful sunburns the next day and skin cancers in the future.

Watch out for the ingredient PABA or para-aminobenzoic acid, which can stain clothing and cause allergic reactions. I have also seen people who have developed horrible skin reactions to old or expired products.

  1. Is SPF 100 better than SPF 15?
  2. Technically, yes, but the actual difference is miniscule. The AAD recommendation is to use a broad spectrum sunscreen that is at least SPF 30 and to reapply it every 2 hours.
  3. Is the sun bad for my skin?
  4. Lots of sun exposure can cause premature skin aging (sun spots, wrinkles, thinning of the skin, skin cancer). However, exposure to UV light can also be used to treat conditions such as jaundice, psoriasis, atopic dermatitis, lichen planus, etc. It is also how the body naturally produces Vitamin D. Sun exposure is OK in moderation.     

Joseph Francis, M.D., is a board-certified dermatologist and fellowship-trained Mohs surgeon practicing in Atlantis and Jupiter. He is also the captain of a 15-foot Mitzi Skiff but spends more time fixing it than fishing. Keith Murray owns The CPR School, which provides onboard CPR, AED and first-aid training as well as AED sales and service. Contact him through www.TheCPRSchool.com.

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