Florida Dermatologist Tim Ioannides M.D. on the Importance of Skin Cancer Prevention
For many of us, we have had one chief health concern this year: staying safe and social distancing to avoid catching and spreading Covid-19. With the knowledge we now have that the virus spreads less easily in outdoor conditions, many of us have flocked outside to enjoy the stress-relieving benefits and gain sorely missed social interactions in a relatively safe and responsible way. However, while still taking the pandemic seriously, southern Florida dermatologist Tim Ioannides MD has also kept on the forefront of his mind in his life’s work of treating and preventing skin cancer. Skin cancer remains the most common type of cancer both in the United States and worldwide, with one in five Americans developing skin cancer by the age of 70 and more than 95,000 being diagnosed with skin cancer every day. Fortunately, unlike many other types we know the main cause of skin cancer: exposure to the sun’s harmful ultraviolet (UV) rays. This means that we are well equipped to exercise proper prevention tactics in order to stop from developing skin cancer in the first place.
When Dr. Ioannides graduated from medical school, he began his career at a dermatology practice that also offered cosmetic procedures. Although the plastic surgery industry is lucrative, Ioannides soon found himself frustrated with the lack of focus on medical dermatology. He desired to make a true difference in the lives of each and every one of his patients, so he quit the practice in order to form his own — one that would specialize in the treatment of skin cancer and other medical dermatological issues. His practice has since grown to five locations within the southern Florida area, serving counties with some of the highest rates of skin cancer in the country. Below, we explore the most common types of skin cancer and his information on preventing them.
Nonmelanoma skin cancer
Nonmelanoma skin cancer can refer to any cancer that forms in the basal, squamous or Merkel cells of the skin. There are multiple types of nonmelanoma skin cancer, but the main forms are basal cell carcinoma, squamous cell carcinoma and Merkel cell carcinoma.
The most common form of skin cancer worldwide is basal cell carcinoma. Beginning in the basal cell found at the bottom of the skin’s first layer known as the epidermis, basal cell carcinomas tend to grow slowly and most are curable and cause minimal damage when caught and treated early. They rarely spread beyond the original tumor site, but if they are allowed to grow the lesions can become locally invasive, growing wide and deep into the skin destroying it along with other tissue and bone. It is also more likely to repeatedly reoccur the longer you wait to treat it. Basal cell carcinoma usually develops on parts of the body that are exposed to the sun most often — the face, scalp, ears, chest, arm, back, and legs — but it can also occur on parts of the body that are usually protected such as the genitals. It can look quite different from person to person, but the most common form is a small dome-shaped bump with a pearly white color. It can also appear as a blue, brown, or black lesion with a slightly raised translucent border, with about half of basal cell carcinomas being pigmented in patients with darker skin. It may also look like a reddened scaly patch of raised skin, or a pimple-like growth that heals and then reappears.
The second-most common form of skin cancer is squamous cell carcinoma. Squamous cell carcinoma has increased up to 200 percent in the last three decades, with those who are middle-aged or elderly most likely to be affected. The risk increases further if they have fair complexions and experience frequent sun exposure. Squamous cells are found in the middle and upper layer of the epidermis, and like basal cell carcinoma timely treatment is very effective in preventing squamous cell carcinoma from spreading to other parts of the body. Cutaneous squamous cell carcinoma (differentiating it from squamous cell cancer that can be found inside the body such in the mouth, throat, or lungs) can appear as scaly red patches, open sores, rough, thickened or wart-like skin, or raised growths with a central depression, and they may crust over, itch or bleed. The lesions most commonly arise in sun-exposed areas of the body such as your scalp, the back of your hands, your ears, or your lips. The lymph nodes and other organs can be the target of spread in certain aggressive types of squamous cell carcinomas that are left untreated.
Merkel cell carcinoma is a rare form of skin cancer, but it is also extremely aggressive. It has a high rate of both returning and spreading, and is three to five times more deadly than melanoma. Early detection can lead to the successful treatment of Merkel cell carcinoma, but it becomes increasingly more difficult once the disease has spread. The lesions for Merkel cell carcinoma are much less distinctive than that of other skin cancers, but like the others they can often appear on sun-exposed areas of the body. They are rarely tender to the touch, and can appear a pearly pimple-like lump that is skin-colored, red, purple, or bluish red. Most often, it is the rapid speed of their growth that causes a patient and doctor to first take notice of them.
Melanoma may be less deadly than Merkel cell carcinoma, but it is far more common. An estimated 196,060 cases of melanoma total will be diagnosed in the United States in 2020, and the number of diagnoses are increasing rapidly each year. Melanoma develops in the melanocytes — skin cells that produce melanin which gives skin its color. When skin is exposed to UV radiation, the damage it causes to the skin triggers the melanocytes to produce more melanin which results in the skin darkening or tanning, but it can also damage the DNA and trigger mutations that result in uncontrolled cellular growth, or cancer.
The most common form of melanoma is superficial spreading melanoma, which can arise from a preexisting mole or appear as a new lesion. If it starts on a mole already on the skin, it will tend to remain growing on the surface for some time before moving deeper into the skin. It is most likely to appear on the torso in men, the legs in women and the upper back in both, and it may appear as a flat or slightly raised and discolored, asymmetrical patch with uneven borders. It can be tan, brown, black, red/pink, blue or white in color, or it can also lack pigment and appear as a skin-toned lesion.
Lentigo maligna is a form of melanoma that most commonly occurs in older people. It becomes lentigo maligna when it spreads beyond the original location and becomes invasive, and similar to superficial spreading melanoma it grows close to the surface of the skin first. However, this type of melanoma is most likely to be found on the face, ears, arms, or upper torso, and most of the time is black or blue in appearance, although it can also manifest in various shades of tan and brown.
Contrary to common belief, people of color can get skin cancer, including those of African ancestry. Acral lentiginous melanoma is the most common form of melanoma found in people of color, often occurring in hard to see places such as under the nails, on the soles of feet, or on the palms of hands. This type of skin cancer may appear as a black or brown area, and starts as an enlarging patch of discolored skin. It is often thought at first to be stain, and Bob Marley was diagnosed and eventually died from acral lentiginous melanoma when he believed the dark spot under his toenail was the result of a soccer injury.
Ten to fifteen percent of all melanoma cases are nodular melanoma, the most aggressive type. Like all the other melanomas, it is most frequently found on the torso, legs and arms, and can also often be found on the scalp of older men, but unlike the other melanomas it grows deeper into the skin at a more rapid pace. At the time it is first diagnosed it is usually already invasive. It is often recognized as a blue or black bump on the skin, but can also appear pink or red in color.
How to prevent skin cancer
So how does one stop these cancers from ever occurring in the first place? “Prevention means guarding the skin against the known causes of skin cancer,” says Dr. Ioannides. “Since the sun’s ultraviolet rays are the main culprit, the most effective preventive method is sun avoidance.” This being said, nobody can or is expected to completely avoid the sun 100% of the time. Rather, it is about being aware of the risk the sun provides and using the below tools and tips to minimize exposure to UV radiation.
Clothing is a good start
Everybody knows that sunscreen is an effective way to protect the skin against the sun’s ultraviolet rays, but what they may not realize is clothing provides a potentially more effective barrier. Its protection is more consistent over time than sunscreen, and you don’t run the risk of losing that protection when it wears off. It’s simple — the more skin that you cover the more you are protected, so a high neck, long sleeves, and pants are all going to be effective in protecting your skin. A wide-brimmed hat can also do wonders to cover your face and neck, and UV-blocking sunglasses can protect the delicate skin around your eyes (also aiding in preventing wrinkles).
Cover up the rest with sunscreen
In all likelihood, you aren’t going to be covering your entire body with clothing all of the time. For those exposed parts of your skin, covering them with a sunscreen that protects against both UVA and UVB rays will be an effective protection when applied correctly. Many people do not apply sunscreen correctly, missing spots, forgetting to reapply regularly, and not applying enough to adequately protect the skin. For the average adult, one fluid ounce (the size of a full shot glass) is what is needed to cover the entire body, and reapplication is necessary at least every two hours — even more often if you’ve been sweating or swimming. While sunscreens can be water resistant they can’t claim to be waterproof, so pay attention to the time they claim to be effective in water resistance (usually 40 or 80 minutes) and reapply at regular intervals. Finally, don’t forget to apply sunscreen in commonly missed areas such as the tops of your feet, hands, and eyelids.
Be aware of all sources of light
UVA rays have the ability to pass through windows, an important fact to keep in mind both at home and when travelling. While front car windshields are usually treated to block most UVA rays, the side, back, and sunroof windows often aren’t. The same goes for the windows on trains and buses, and airplanes in particular can carry an even higher risk as the farther you ascend into the earth’s atmosphere, the more you are exposed. In fact, airline pilots, crew members, and even frequent fliers may have a higher skin cancer rate than other people. When near a window, don’t forget to use protective protective clothing and sunscreen as you would when you are directly exposed to sunlight.
Made in the shade
It is possible for some UV rays to reach you in the shade, making it an imperfect barrier. They have the ability to pass through leaves and branches under a tree, as well as reflect off surfaces such as sand, water, glass or concrete, however it is still much better than direct sun exposure. The peak time of the sun’s intensity is between the hours of 10 AM and 4 PM, so especially in that time of day try to find shade whenever and wherever possible. You can walk on the shady side of the street, use an umbrella at the beach, sit under an awning when having lunch, or on a covered porch at a pool party. As stated before, even a tree can provide some respite for your skin from the harmful UV rays.
Pay attention to your body
As we learned earlier, many types of skin cancer are very treatable and have high cure rates if caught early. That is why one of the most important steps in skin cancer prevention is paying attention to your body and keeping on the lookout for any irregularities or changes in your skin. Skin cancer can come in a plethora of different shapes, colors, and sizes, which you should see a dermatologist anytime you notice unusual changes to your skin. Dr. Ioannides has dedicated his life to not only treating those with skin cancer, but also aiding in educating his patients on how to avoid getting it in the first place. More than 2 people die of skin cancer in the United States every hour, but with people like Dr. Ioannides working to spread awareness, that can hopefully begin to change.