I wish u knew… Skin cancer 101

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Tim.Hampshire

Tim Hampshire

As a skin cancer specialist, Dr. Chris Miller battles more than just skin cells. People come into his office with all kinds of malignancies–from the pink, shiny basal cell cancers to the rough patches suggesting squamous cell cancers to the dark, changing melanomas. He knows what to look for and touts an accuracy rate “in the 90s.”

But he has two enemies that can’t slay with a scalpel. One is the sun, and the other is society. (He’s hopeful despite the odds.)

“One element that’s unique about sun protection is that you’re fighting societal trends, too,” he told me. “There’s this societal idea that if you’re tan, you look healthy.”

Skin cancer 101 from OncoLink on Vimeo.

Many of us have to admit to that kind of thinking. “You look pale” has been a synonym for “you look ill” for a long time. We have the words “pallid” and “pasty” that suggest the faces of the living dead. Tan is well-exposed; tan is well-traveled, like the burnished leather of an heirloom valise.

“If your skin is tan, it’s damaged.” refutes Dr. Miller.

The problem is that many of us don’t know that. We’re all familiar with the fact that some moles can be cancerous and we should try to get them checked out. But if a person has tan skin with no obvious malignant marks, they’re just outside a lot and getting adequate protection, right? They probably wear plenty of sunscreen, right?

Wrong. More words of wisdom from Dr. Miller: “We try to counsel our patients to use sunscreen as a last resort, because it’s the least effective of the things you can do to protect your skin. For sure, the most effective way is to try to avoid the sun during peak hours….But when you’re out in the sun, all you have to do is wear clothing. I don’t care if you put sunscreen on every 30 minutes, it’s not gonna be better than the shirt.”

There are a lot of problems with sunscreen. We apply it incorrectly, it doesn’t block UVA rays unless it’s “broad spectrum,” it’s much less effective than clothing, we don’t know if the spray is better than the lotion, and so on. As far as Dr. Miller is concerned, we need to combat skin cancer in other ways.

“We can change through better health policy how we view the sun,” he said. Health policy improvements regarding sun exposure are not happening how they should. In some places (guilty: the USA) they aren’t really happening at all. Dr. Miller points to Australia as an exemplar, citing the Australian Open as a place where we can see what is becoming common sense among outdoor enthusiasts. “All the ball boys and ball girls are in long sleeves with broad-brimmed hats. At the US Open in New York City, they wear t-shirts and shorts.”

So the lack of encouragement to avoid the sun is really a sin of omission. But the government and the media (look at John Boehner and every news anchor on TV) are still actively making people think that being tan is looking good. It just isn’t the case. Dr. Miller thinks we can turn things around by looking at smoking and lung cancer as an example. Fifty years ago, smoking was no big deal. Everybody did it. But then cartons of cigarettes started coming with warnings from the surgeon general. And restaurants started banning smoking within their walls. And people started smoking a lot less.

You can’t ban people from being in the sun, but you can stop making magazines that exclusively feature ads with pictures of well-tanned people. You can start issuing warnings. You can educate the public about the dangers of sun exposure. Dr. Miller sees these as steps in the right direction.

The best thing for people to do now is to “monitor their skin closely and regularly themselves,” he says. If we would only make it a habit to observe ourselves more carefully, and look for the signs that Dr. Miller outlines in the video (pink, shiny, rough, dark, changing)–we will all be better off. With some luck, perhaps one day we’ll start seeing benefits in both the short and long term. “I wish people knew that what they do now can have a huge effect on what happens later,” Dr Miller said as we brought the interview to a close, and he went back to his windowless office to battle society and hide from the sun.



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