Note: According to the American Cancer Society, skin cancer is the most common cancer in the United States, and women age 49 and under are more likely to develop melanoma than any other cancer except breast and thyroid cancers. Shawna Beechinor, PA-C, a Board-Certified Physician Assistant, sat down with us to talk about skin cancer, skin surgery, indoor tanning, cosmetics, and her favorite ways to help prevent skin cancer, including her favorite sunscreens. (Sponsored content by Dermatology Clinic of Idaho.)
Q. The people of Boise love outdoor activities. What can we do to help lower our skin cancer risk?
A. One of the best ways to help lower your risk is to avoid the factors that can cause skin cancer, the greatest of which is exposure to ultraviolet radiation. For example, try to avoid outdoor activities when the UV rays are their strongest, usually from 10 a.m. until 4 p.m. If you must be outdoors, use a combination of clothing, wide-brim hats, broad-spectrum sunscreen, and lip balm to protect your skin. For the most complete coverage against the sun’s rays, long-sleeve, and long-pant sun-protective clothing with Ultraviolet Protection Factor (UPF) of 30 or higher can protect against UVA and UVB rays. Use broad-spectrum sunscreen and lip balm with 30 SPF or higher. And don’t forget your eyes! Sunglasses can block 99-100% of UV light, so look for labels like “100% protection against both UVA and UVB” or “100% protection against UV400.”
Q. What skin cancer tips do you share most often?
A. A change in your skin is the most common sign of skin cancer. Be aware of new skin growths or a change in a mole and remember that while exposure to UV radiation is the No. 1 risk factor for developing skin cancer, it can also affect areas of the skin not exposed to sun. Finally, if you have a wound that won’t heal, have it examined by a doctor. This type of lesion is generally considered skin cancer until proven otherwise.
Q. Talk to us about tanning beds.
A. Just one indoor tanning session can increase the user’s risk of developing melanoma, squamous cell carcinoma, and basal cell carcinoma. As of 2014, the Food and Drug Administration (FDA) advised that indoor tanning beds and sun lamps emitting ultraviolet radiation must carry a visible black-box warning indicating no one should use them under 18 due to increased risk of skin cancer. Many countries now ban minors from the use of indoor tanning beds, and Brazil became the first country to declare a population-wide ban in 2002.
A tan may make you feel like you have a healthy glow, but your skin is damaged by UV rays every time you tan. A tan is a visible sign of that injury. As the damage builds, you accelerate your skin’s aging and your risk for all types of skin cancer, including melanoma, which is the deadliest form of skin cancer. According to the Centers for Disease Control (CDC), Idaho is one of five U.S. states with the highest skin cancer rates. Our state bans indoor tanning beds for anyone younger than 13 years old and requires in-person parental consent or a doctor’s prescription for minors aged 14 to 17 years old. So, I encourage banning the tan and growing the glow with sunless tanning products.
Q. Tell us about your favorite sunscreens.
A. There are two types of sunscreen – physical and chemical. Physical sunscreens may also be referred to as mineral or natural sunscreens and contain the active ingredients zinc oxide and/or titanium dioxide. These types of sunscreens work by sitting on top of the skin to deflect UV rays, which means they protect against UVA and UVB as soon as they are applied. While physical sunscreens offer the best protection, they are known to cause a chalky-white residue. Nowadays many mineral-based sunscreens are light, easy to apply, and come in various tints to match your skin tone. I prefer mineral-based sunscreens like Elta® MD’s tinted sunscreen, which I use every morning.
Chemical sunscreens work by creating a chemical reaction that changes UV rays into heat, which is then released from the skin. Chemical sunscreens can often be easier to apply, especially in spray-on form.
Whichever type you choose, the best sunscreen for you is the one that you will use routinely. As you search for your perfect sunscreen, be sure to check the label for the following information:
• Broad-spectrum (protects from both UVA and UVB rays)
• SPF of at least 30 or higher
• Non-comedogenic (won’t clog pores)
Q. How is skin cancer diagnosed? Discuss the process and expectations for skin cancer treatment.
A. To diagnose skin cancer, a biopsy must be taken and evaluated by a dermatopathologist. The type of skin cancer, and whether it has been detected early or late, will determine the type of surgery required to remove it.
If the skin cancer involves sites that do not have much redundant skin, such as the face, hands, and feet, a skin-sparing procedure known as Mohs Micrographic Surgery is often the treatment of choice. This outpatient procedure, which is performed under local anesthesia, is named after Dr. Frederic Mohs, who developed the precision technique in the 1930s. When using the Mohs technique, the skin cancer is removed using a scalpel, then immediately evaluated under a microscope to determine whether the excision was successful. This process continues, layer by layer, until the cancer is completely removed.
If Mohs Surgery is not required, a simple surgical excision will be performed. Regardless of technique, a patient who has had one skin cancer removed is at risk for developing another. Follow-up exams will be required every 6 to 12 months to keep a close eye on the skin.
Q. Tell us about cosmetic fillers and BOTOX® Cosmetic. When should someone consider getting them, and what they should expect?
A. BOTOX is an injectable medication used to temporarily relax the muscles that cause frown lines, crow’s feet, and forehead lines. You may see results as early as 24-48 hours, but its full effect will not be evident for up to 14 days. Because everyone’s skin is different, the choice for starting BOTOX is often personal and based on the depth of wrinkling. It is not unusual for people to start BOTOX in their early 30s. To achieve the best results, BOTOX should be injected every three months initially. Over time, injection intervals may increase.
Dermal fillers are materials injected beneath your skin and used to help smooth skin and wrinkles and replace volume loss that occurs with aging. There are multiple categories of fillers, and most of them are temporary, with results that last six months to two years.
Q. What do you think about the lip-flip BOTOX® procedure vs. cosmetic fillers?
A. The “lip-flip” procedure is performed using a few small injections of BOTOX just above the upper lip. This relaxes the muscle that encircles the mouth and allows the upper lip to roll upward, giving the appearance of a plumper upper lip. While dermal fillers may also be used to plump the lips, some patients prefer the more subtle results offered by BOTOX.
Shawna Beechinor received her Master of Physician Assistant Studies at the University of Utah and her Bachelor of Science Magna Cum Laude at Boise State University. After receiving her PA degree, she began her career in interventional radiology in Boise. She then went on to work in dermatology for approximately four years in Nampa, before joining the Dermatology Clinic of Idaho this spring.