Disability and Progress-July 16, 2026-Skin Cancer

[00:00:00] Speaker A: KPI.org. [00:00:59] Speaker B: Greetings and thank you for joining Disability in Progress where we bring you insights into ideas about and discussions on disability topics. My name is Sam Jasmyn. I'm Charlene Dahl. Thanks so much for joining us. Want to remind you that we have archives that these shows stay on the archives for two weeks. Also you can hear us with listening to our podcasts. Thanks to Aaron, our podcaster. This week yet again, we're going to try this again and this one's going to be a keeper. So we are speaking and we'll be in this Week with Dr. Colby Presley. He'll speak speak with us about skin cancer and how to best protect yourself. Dr. Colby Presley is an assistant professor at the University of Minnesota Medical School and a dermatologist with M Health Fairview. Dr. Presley participates regularly in academic research with over 50 peer reviewed journal publications and his current research interests are in skin cancer prevention, treatment and the role of artificial intelligence in dermatology. Dr. Presley, thanks so much for joining us. [00:02:16] Speaker A: Thanks for having me. Happy to be here. [00:02:19] Speaker B: We really do appreciate your time. I've got my fingers crossed that this one will be great. We had a little bit of a kerf fluffle last week, but we're back. Can you just, we'll get into more in depth stuff later. But just as a little brief thing, tell people what skin cancer is and what the main types that people should know about. [00:02:49] Speaker A: Absolutely. So I think a lot of people are familiar with at least one type and that's when we all talk about being the most aggressive form, which is melanoma. That's the kind that when we talk about looking at your moles and if they change and it's a pigmented skin cancer and that's usually the one that most people are familiar with, but it's actually the lowest reported cases incidence really. And then actually there's two others that are actually far more common. They're called, we weren't very creative with the names are non melanoma skin cancer and that's basal cell carcinoma. Yeah, basal cell carcinoma and squamous cell carcinoma. The good thing about these is that they are not typically invasive. Squamous cell is a little more dangerous and can metastasize, whereas basal cell on average does not. But both of them are less aggressive than melanoma. [00:03:49] Speaker B: So I remember when we were reaching out to each other and you said you've seen so many cases, how common is skin cancer and what why has it become such a significant public health concern? [00:04:04] Speaker A: It Is an interesting thing that is occurring because every year it's more and more reported cases. And so overall, just looking at the numbers, last year it was 3.6 million cases of basal cell carcinoma. There was 1.8 million cases of squamous cell carcinoma. And overall, I think it's trends and public understanding. You know, with the boomers, we started to have the boomer generation. We started to have, really, the baby boomers is a lot more people going out in the sun, enjoying the sun, using different forms of becoming tan, you know, more. That trend of having a tan was more attractive. Well, we know that skin cancer is an accumulation of sun damage over time. And so it's leading to more and more of this occurring. There's other factors that I think we all talk about, you know, part of the ozone changing with our different environments. We're definitely feeling this week in Minneapolis. And as things are occurring, you know, there's more people that are being more exposed to different. More actinic damage, UV rays. So we're just seeing an increase and increase. And I think it's awareness, too. There's a question how much of it went undiagnosed before? Because we just didn't really have the knowledge of what we have now. Not nearly 50 years ago, what we have now. [00:05:22] Speaker B: Right. [00:05:24] Speaker A: I think it's all. As we're progressing, we're finding more. [00:05:28] Speaker B: Right. So can you talk a little bit about the exposure to UV rays or ultraviolet radiation? I mean, I guess, and how it damages the skin? I think people don't really think about that when they go out. I know when I go out and I've been in air conditioning all day and I feel the sun, I'm like, oh, gosh, this feels so good on my skin. But talk a little bit about how it can damage the skin. What happens? [00:05:53] Speaker A: Yeah, absolutely. So the sun rays that come, the rays that come that are solar, and the UV exposure that we receive, there's two forms that are a bit more damaging to our skin. It's different wavelengths, and so it's a UVA and uvb. And as they reach the skin, they cause enough damage that each part of your skin is built with skin cells. So the cells individually within them can't tolerate the damage that's being caused by that heat and energy coming from those rays damages the DNA. Skin cancer is usually the result of that damaged DNA unable to repair itself and just continues to accumulate. So I agree with you. It feels so nice. I've been inside all day, and so I Know when I walk to the car, like, oh, very nice. But you could still have that great sensation even when you wear sunscreen. [00:06:45] Speaker B: Yes, that's true. So are. Are some people more vulnerable to skin cancer than others? And if so, why? [00:06:56] Speaker A: Yeah, this is a great question. It's a difficult one, but I'll try to tackle it best I can. [00:07:01] Speaker B: All right. [00:07:03] Speaker A: There are a lot of factors. Definitely one of the first ones is just the skin type that you have. So if you have a skin type that is lighter, not. Not as heavily pigmented, a lighter skin type is going to feel the effects of that UV damage and put people with lighter skin tones are going to be more likely to develop skin cancer overall. They don't have that extra built in pigment to help protect against that damage because it's more damage that would have to occur for that to be occur for different skin cancers to arise. There are other factors. So somebody, for instance, who is immunosuppressed is going to definitely be more at risk. Somebody. Yeah, yeah. They can't really go through that natural. Okay, well, the skin DNA is changing. It's gonna fix itself. And then other factors are just other medications that you might be on that make you photosensitive. I do have medications that I review with my patients that hey, this is going to be leading towards more skin cancer development just because you're photosensitive. So there's a lot of factors, but overall in the arching, I think it's just the skin pigmentation that you have and that puts you at a susceptibility of getting photo damage that would lead to skin cancer. [00:08:18] Speaker B: I'm guessing this also includes like treatment. If someone's going through treatment for cancer, that that could make them more vulnerable as well. [00:08:27] Speaker A: Yep. Yeah. Any reduction of that immune system. Absolutely. It would definitely cause them to be more susceptible. So, you know, we want people to be able to have that ability to. Because the body always goes through a natural ability to try to fix things. It's when it can't things get out of hand that we develop cancer. Same thing. So if someone's on a chemotherapy drug, reducing their ability to really fix what they need to fix to prevent the skin cancer, then they'd be more susceptible. [00:09:02] Speaker B: Well, let's talk about warning signs, warning signs on the skin that should prompt someone to see a healthcare provider or a dermatologist. So give us some ideas of when that should happen. [00:09:17] Speaker A: So, yep, the things that. There's a few different things. I know we're going to probably talk about the ABCDEs later. So I'll save that. That has its most important part. But I also talk about the ugly duckling method. So I think the first thing to think about is when, if you know your skin and you know, you see your skin when you're bathing, when you get out of the shower and you notice something doesn't look like the rest, you know, that's. We call it the ugly duckling method. And so that's probably something that should be checked. So I think that's one thing, because one thing that stands out against the rest is probably something that should be at least seen and evaluated. I think it's new lesions as well that you're seeing, or lesions. I can't tell you how often I hear, hey, doc, you know, I came in, I thought this was a pimple. And now it's been there for four months. It just keeps getting bigger. And it's. Now it's bleeding, it's getting really rough and crusty. So these are all different warning signs. So a new spot that won't heal, that is now becoming tender, becoming painful, bleeding, bleeding spontaneously, or you just barely wash your face and it starts bleeding or wash part of your body are usually some of the first warning signs that you can consider to be evaluated. [00:10:35] Speaker B: Dr. Presley, I'm wondering if you could talk a little bit about how to perform regular skin self examinations at home. Because I feel like people think, well, you know, my arms maybe get, you know, touched by the sun and my face would. But you really should be checking all over. Right? [00:10:57] Speaker A: Absolutely. Yeah. And that's something that, especially with there's genetic susceptibilities, when we know overall with melanoma that there's usually a genetic component, you'll often, if you come see a dermatologist, one of the questions first, you know, does your mom, dad, brothers or sisters have melanoma? And that may sacrifice even when the sun isn't shining in certain places. So my, what I talk to my patients about is especially during the time that you're bathing, so whether that's with a shower or with a bath and just kind of taking inventory of what does my skin look like, you know, what's occurring, you know, standing within a mirror and looking at your abdomen, looking at your chest, or taking a look at what the thigh looks like or the legs really seeing the different spots. And you know, I have some patients that feel like they just have a ton of moles or a ton of spots. Some of them will take pictures and just kind of like, oh, I haven't seen this one. Before. So I think if you're somebody who develops a lot of spots and you want to take used pictures, most difficult is always going to be the back. [00:12:07] Speaker B: Yes, I was just going to say that. That's so hard. [00:12:11] Speaker A: Yeah, the back is very difficult. If you have a significant other in your life, I definitely would say that, you know, that's one of your guys bondings. You can get to make sure you know the back. So that can be a date night. But yeah, that's something that at least if, if you have a significant other, have them at least checking. I cannot tell you the amount of husbands that come in and say, my wife saw this, I've never seen it. So will you check it? But you know, and if you're by yourself, then you can definitely have a friend take a picture of your back so that at least you can do a comparison. And there's always the reverse mirror trick that you can use so you're in the bathroom mirror and put up a handheld mirror to kind of look and see your back as well. So those are definitely good ways to take evaluation of what your skin's doing. I usually do recommend during the bathing period to do that. [00:13:07] Speaker B: Yeah, that's a good time. Good time to do all that and not feel bad about checking yourself out. So let's do it. Let's do the ABCDE method of identifying suspicious skin things or moles. What can you tell us? [00:13:29] Speaker A: Yeah, so I probably give this spill at least, I'd say 15 times a day. So the ABCDE method, what we use that for is just any spots that you're developing or that you already have. You know, my family is very prone to making moles. All of my siblings and I have moles. And so as you evaluate and look at them, A stands for asymmetry. So if you can't cut it evenly in half and it could fold on itself like a nice taco or pizza, whichever you're feeling Mexican or Italian that night. So if it can't do that and it's changed in that way, that that's a flag. B is borders. If the borders start changing, they're not nicely defined like they once were. Now you're seeing the borders kind of move around and either there's less pigment, more pigment at the borders. That's something to look for. Color. All of a sudden the color changes. You know, something that was once, you know, kind of a light brown now has all these dark spots in it, or it has red spots in it. That's something to consider. You know, it's not a nice uniform color anymore. And then D is diameter. So if it's getting bigger and bigger and bigger, that's something that we would want to consider. And then E is kind of like a catch. All we call it evolution. So just over time is, how has this mole change? You know, if you used to be really small and now it's gotten bigger, it changed colors. So it kind of encompasses all of it. What we throw into the E is also if that's become painful. So evolution has also become painful, or it's become scaly, more rough. That's something also to consider. [00:15:14] Speaker B: So I feel like there's probably some amount of people listening to this who have some disabilities who may be. It may be more difficult for them to do the examinations or exploratory, whatever. How often should an adult have a professional skin cancer screening? [00:15:37] Speaker A: This is a great question, and it's one of the most difficult to answer as a dermatologist. And the reason being that we don't have a set guideline. So we know by certain ages you should have colon cancer screenings. We know by certain ages you should be checking for this. You should have a mammogram. You should be doing a colonoscopy. We actually don't have set guidelines. So the task force within the USPS task force that kind of puts together these health guidelines hasn't found enough data. And what that means is that there hasn't been enough data to suggest this timeline or this screening period is how we can catch skin cancer and prevent it. But if you. And it's perfect that we talked about who's susceptible and who's not, right? So the lighter skin tones are the most susceptible. So those guidelines haven't been established because the population overall is taken into account of the United States. The United States is a diverse place with multiple different skin types. So there's not an equal set of screening. That being said, I think if we always invite people that if they are want to establish, they want to just know where they're at. I have patients from all ages that come in after they turn 18 and just want to know because, you know, maybe grandma had something that was taken off. [00:16:58] Speaker B: Right? [00:16:59] Speaker A: You know, you work with your dermatologist, they'll check your skin. And, you know, from there, we usually say, you know what? You don't probably need to see us unless something pops up or, you know what? You have enough sun damage, enough spots that you should be seen a little more often. I mean, if you develop a skin cancer or we see anything Changing that. We are like, you know what, we need to see you this often based on what we're seeing. You know, it is a kind of a judgment call made on your dermatologist's behalf. But we're always happy to give that evaluation and then make a recommendation. [00:17:33] Speaker B: I feel like too, you know, if people are decent about seeing their healthcare provider, that it should be okay for you to say, hey, just look up and down my body. You know, you're in a vulnerable state anyway, and check and see if there's anything that you think is abnormal. Would you think that would be a good time? [00:17:56] Speaker A: Yeah, I think, absolutely. I think to bring up another good point, we, we. I can't tell you how much I give my hats off to every primary care provider who do screenings like this all the time. And when they do notice something, say, you know, we need to get you over to dermatology. So we're happy to also have that. I. Unfortunately, there can be a bit of a wait. So if you just want to establish a baseline, absolutely fine. And you might have a little bit of a wait to get into a dermatologist, but we will definitely do that and we'll help give recommendations. But also, if you want to talk to your primary care provider, they will always kind of help, can help assess you and say, you know what? Yep, let's get your dermatology. That's okay. So I think you have two avenues that are completely available to each patient, and we're happy to help in that way. [00:18:46] Speaker B: So how does. How does diet or, you know, play into the role of sun protection? Or does it. [00:18:56] Speaker A: Yeah, and this is. It's funny because your questions are great because they're the ones that we're asking in dermatology. We recently had a study that came out that was very big news about nicotinamide. Not niacinamide, nicotinamide, because those two get kind of interchanged. [00:19:16] Speaker B: What is that exactly? [00:19:18] Speaker A: It's a vitamin that can be used and taken in certain quantities, and you can use it in order to. What we saw was a certain amount of reduction in the production of skin cancers, specifically those non melanoma skin cancers. This vitamin supplementation was found to help reduce down the amount of skin cancers that some patients would produce. The data now has gone back and forth on the different studies, but overall the most common theme is a diet that is less inflammatory and more focused on whole grains. That's focus on vegetables. Healthy proteins tends to be the less inflammatory, so it will result in less skin cancer. And that's Pretty much. Overall, I think all the specialties pretty much say that. And because it's a less inflammatory diet. But nicotinamide is the one that we tend to recommend for our patients who already have made skin cancers. And we say, you know, you might just want to start with this supplement to help reduce the further creation of these. [00:20:24] Speaker B: Okay. And so now we come to everyone's favorite tanning beds. Are they bad? And are there any that are okay? Is any amount okay? You know, a lot of people, it used to be that I'd hear some of my friends say, well, I'm going to so and so place. And I know the sun is really intense there, so I'm going to tan a couple times just to get my skin used to it. It is that, okay, go ahead and just carry it away. [00:21:00] Speaker A: So overall, no. The answer is going to be no. So the problem that. So when we talk about the different rays that we. And I'm so glad that we started with that, you know, how does this occur? Why do we have this damage that's occurring from the sun rays? Well, that UVA and UVB rays cause these problems. So the issue that arises with tanning beds is that they are super concentrated. So imagine there's at least some amount of energy loss of what we see when the sun travels down and hits our skin. Right when you have those rays right next to you, only, you know, six, eight inches from the skin, or if you're laying on the bottom there, that energy is being delivered so forcefully to the skin, it is just delivering so much that it's overly potent, causes damage to the skin. Once again, skin cancer usually occurs as just over a lifetime of being exposed to those sun rays and to that UV ray. Well, now we're sending a hyper concentrated amount during that 10 minutes we're in the tanning bed. So we know that the risk of a skin cancer in someone significantly increases just from one session. [00:22:16] Speaker B: Right. [00:22:18] Speaker A: I know this is probably breaking a lot of people's heart right now. I have to do this a lot in my job, but unfortunately there's not. I've learned to just be more direct about it. [00:22:27] Speaker B: Yep, that's the way to do it. And it's interesting because I don't do them because I've always kind of felt like I need to be a little more ultra careful. And I do have friends that notice. How come your skin's good? I'm like, well, while you were laying out tanning, I was smothered and swimming in sunscreen. [00:22:53] Speaker A: Exactly. And. And that's A huge generational thing that we're seeing a shift in right now. You know, my, my patients that are from the era of going out with baby oil. [00:23:02] Speaker B: Right. [00:23:02] Speaker A: And just baking now have skin that's had quite a bit of change to it. Whereas, you know, there's whether you were someone who didn't really want to go out in the sun, didn't want to tan, but you also retain the youthful collagen presence and reduce actinic damage to remain that young, beautiful gleam. So I always tell patients, I was like, well, if you're not going to do it for skin cancer prevention, you can at least do it as anti aging. And sometimes their ears perk up more. [00:23:31] Speaker B: Yeah, well, it's not like I never had any of my time where I did slither on a little bit of baby orl, but I remember it was very short lived and I'm like, oh, okay, I get it. All right. Talk about some different ethnicities, you know, that might be more or less. You know, you kind of talked about skin types. So we would presume maybe that a darker colored skin person would be less affected by the sun. [00:24:06] Speaker A: Yeah. So they're still going to have the same amount of UVs race that everyone's experiencing. Right. So certain ethnicities have darker skin tones. We call them skin types. I mean, rate that one to six. And so certain, like one can barely tolerate any sun without a sunburn, whereas six can tolerate very much without a sunburn. And so these fall into different ethnicities. So if you take somebody like me, I'm Danish by descent and Norwegian and so my skin can't tolerate anything. And so I'm pretty much always out. It was sunscreen. Whereas you take somebody who perhaps is Latino or somebody who is Native American, they are going to tolerate it better just because they have a better ability to create pigment and protect themselves without the DNA being damaged. And so the just lighter skin tones overall are going to be and those ethnicities connected to those different skin tones and skin phototypes are going to have the different variability. [00:25:11] Speaker B: So, Dr. Presley, so I want to talk about treatments, but I'm presuming that different skin cancers may have different treatments. Also I'm presuming maybe I'm wrong that the different stages could have different treatments. [00:25:30] Speaker A: You know what, I like that you're using the word presume because sometimes when we use the word assume, there's that old breakdown. I can't do that with presume. And you're right. You're absolutely right. So if there is a skin cancer that's caught and it's caught. We call that in situ, the top layer of it or of the skin, or we call it superficial, where it's not very deep. And usually a lot of the skin cancers that we're looking at, the level of how they dive into the skin is very important on how we decide on treatment. So there are some forms of treatment that we can do with a topical. So we can use topical chemotherapy drugs if it matches the skin cancer type. And that's something that your dermatologist, if they biopsy something and find it, they'll consider. And I have those conversations with patients about it. I say we talk about the cure rates. Topicals are a little difficult because we can't really do any further pathology on it. So for instance, if it's a skin cancer and we do a surgery where we remove it with a little bit of extra skin, right? And we get it all. So we get past that iceberg effect where, you know, where everything might be hiding underneath more, you know, the. We can't really do that with our topicals. And we talk to our patients about that and say that would be a risk. So we'll treat it and we'll keep an eye on it afterwards. But unfortunately there's not really confirmation. Whereas the next step would be using, like I said, just surgery with what we have are called clear margins. And so there's enough data by the National Cancer center to know how much in general we need to take of extra skin to clear a skin cancer. And that's what your dermatologist will do during an excision. They will take well established guidelines with thousands of cases of these types of skin cancers, use those margins and remove it. And then what occurs? I think the big thing there is, well, what if it happens on my forehead? You know, there's not a lot of extra skin up here. I mean, I have a big forehead, so there is. But, you know, in that instance, you know, I can't take a big. If I have a little tiny skin cancer and I have to take these margins, man, that's going to leave a big, a big hole where I don't have a lot of extra skin to put. So what we do in that instance is something called Mohs surgery. Some people will be very familiar with it if their parents or grandparents have gone through it. But it's where we do real time processing and check margins and take as little skin as possible. We call it tissue sparing. That's a long day with us. But, you know, we do take care of it. And then we try to do a cosmetic repair, is what we say, where we try to make it look as nice as possible. Going and working with the skin. You know, I always tell patients when we're doing a skin cancer surgery, I say the skin is telling me how it wants to close, so. And it will let me know. And so those are the ways that we would do the treatment is either we do some topicals, we do a surgical excision. If it's somewhere that doesn't need tissue sparing, and if it's a site like the face, back of the hands, you know, that would be somewhere we don't have a lot of tissue. And then you would see a specialist within our field called a Mohs surgeon. [00:28:58] Speaker B: Not any regrowing of the skin yet, huh? [00:29:02] Speaker A: No, we don't have that yet. But let me tell you, the person who gets it, they're gonna. They're gonna do well. [00:29:07] Speaker B: Right? Right. Oh, sounds also scary, especially on the face. You know, I think everyone can appreciate if you have it somewhere else, but on the face, it's just like. That's so out there. I'm wondering, you know, you always hear about the sun vitamin and that sometimes people can be very low on that when they're in a place that doesn't get as much sun in the winter like Minnesota. How much sun can one get without sunscreen? Is there a safe amount? I know I'm asking a loaded question, right? So do you still get those vitamins from sun if you have. If you're covered in sunscreen? [00:29:52] Speaker A: It's a great, great question. So you. So what occurs within with the sun is a vitamin D conversion, but the sunlight will help make. And there's this conversion that occurs within the skin. And the question has been for a while, well, what. But if I'm blocking everything, what's occurring? We're blocking it to a point with sunscreen. I know we're going to talk a little bit later about what it means to have an spf, but there's still a little bit of energy that occurs even with sunscreen that allows for that conversion. So in. The short answer is there's really not any time you should go out without sunscreen to protect from an over amount of damage occurring. And when it comes to your vitamin supplementation and you know what's occurring, are you getting enough. If you are being exposed to the sun and it's still occurring to where you're having enough, even through your sunscreen, you're making enough vitamin D3. Now, being in Minnesota. I'm a California boy at heart. That's where I grew up. So I have gone through my first Minnesota winter, though. So now I understand. When I first moved here, everyone said, well, wait for the winter. I've been through it now. So I think the big thing there is to know that even in the winter when you are driving your car, the left side of your face is still exposed, the back of your hands are exposed, and so you're still getting a certain amount of conversion and that those rays don't change. It doesn't matter if it's January and July, doesn't matter if it's overcast. Those rays actually are strong enough to come through the clouds. So while you know you have a certain amount that you might need, a little bit of supplementation if that is needed, it's something you definitely check with your primary care. Using sunscreen doesn't make a huge effect to the point where the skin cancer risk is worth it. [00:31:52] Speaker B: All right, I'd like to dive into sunscreens. Mineral based, non mineral based, or lotions or sprays or. I used to do sprays. I don't like them, really. I prefer a lotion. But talk a little bit about that. Differences between different ones. [00:32:10] Speaker A: I love, I love this question. It's one of my favorite ones to answer. So I tell everybody, you know, if you take the sunscreen and you spray it and you. Some people are going to spray it from this far. My hands are. My arm length is actually pretty long. I never played basketball or anything, but I have a longer arm length compared to just somebody overall that's just kind of spraying closer. The closer you're spraying, the more protection you're getting that's rubbing in. So that creates more protection. Unfortunately, there's not uniformity in those sprays. So overall I don't recommend them because people aren't getting the same uniformity. And I've had friends that are like, oh, I was out on the lake and I sprayed sunscreen and I got a little burn up on my shoulders, but I didn't get a burn on the rest of my back. I'm like, well, you probably weren't. You were too far away over here. Whereas you were closer trying to apply it to your back. So that's the first thing. So for more uniform protection, one that you rub in is more important. And it's my recommendation, I say that using one of the something that's more like a lotion is going to be able to give you the better protection. And then, yeah, there's a lot of talk between, you know, those that are chemical and versus those that are mineral. Mineral, yeah. So you have the titanium and zinc that provides further coverage and it provides a better absorption of those UV rays, so they don't damage. But the chemicals still do provide a pretty good amount. And the level that they are there, they usually provide. They just don't cover as many forms of the UV rays, but they still cover the main ones that we want you to be comfortable with. So patients will ask me, you know, well, what sunscreen should I use? And I always say, one you'll wear. At this point, I just want one that you'll wear. Because the problem while mineral, there's this argument that mineral's better. And if you really do want the best, mineral's probably the best to help get that most protection possible. The problem is that it's usually thicker. It usually has a white cast. [00:34:28] Speaker B: Yeah, people don't want that. [00:34:30] Speaker A: Yeah. And they. And the industry has done well at making these more tinted and trying to make them match skin tones. They are moving in the right direction, but they also feel a little thicker, a little more matted. And people will say, oh, I want that. You know, it depends which trend you're into if you want the matted look, if you want the dewy skin look. So if you're looking for that more dewy, youthful glow look, that's probably going to be more achieved with a chemical. And I will just take any sunscreen possible. [00:34:58] Speaker B: So let's. Let's talk about the number 20, 50, 80. [00:35:04] Speaker A: Yeah. Yep. This is a. This is always a fun one to talk about because people will say, oh, well, you know, which one should I. Should I be using? And so the guideline overall is that you should be using a sunscreen that has at least some form of the SPF, with the lowest being the 30. And so when you're looking at that, it's all about, okay, what is the maximum amount of time that you can be out in the sun before you start to get a burn? So if you are someone who burns, starts getting a burn and becoming red within 10 minutes, if you. The mathematical breakdown of that should be that if you use SPF 30, that it should take you an extra 300 minutes to get the burn, to get that Same burn within 10 minutes. Now, some people will burn right away, start to get damaged right away. But I'm just using 10 as an easy number. And then if you look at 50, then you take 10 times 50, 500 minutes. Now, that's under the Same circumstances at all points. Problem throughout the day is the UV index changes, and then you have these different changes. You start to sweat, you're out and about. So that reduces the ability of the spf, but that's what the numbers mean. Now what's really interesting is when you look at what it really means for how much is actually absorbed between 30 SPF and 50 SPF. SPF. And so using UVB rays. So if you look at UVB rays, the actual amount absorbed that doesn't get blocked in 30 SPF is about 7%. So you block about 93%. And then when you move to 50, you block 95%. So it's not. You're already getting good coverage at 30. And that's why we are pretty okay with 30. And if you want to get the absolute best. Absolutely. You want to go to the higher to 70, and then it kind of just gets null at that point. But, yeah, that's kind of what you would be looking at. So overall, the UVB transmitted. Oh, I had those numbers wrong. I apologize. It's 97% gets blocked at 30. Oh, yeah. And so you're. And then it's 3% get through with 30 SPF, 50 goes down to 2% and 100 is 1%. So kind of negligible at that point. [00:37:34] Speaker B: Right. [00:37:36] Speaker A: So I just want to make sure I had those numbers. But yeah, so those are what you're looking at and how the SPF number. So I tell every patient at least 30, and they'll say, Doc, I'm wearing 50, I'm wearing 70. I'm like, Great, there's nothing wrong there because you're just reducing the amount. And please use what works. Use what you like. [00:37:58] Speaker B: So I want to talk a little bit about UBV and uba. And there's my understanding of this not maybe not the only kind of rays out there, but there was a new sun chemical that was approved. I'm probably going to butcher it. It was like bimitrismal or something like that that Europe apparently has been using for a while. And we have just taken our sweet time, as per usual, to okay it. But apparently we've okayed it. Now, can you talk about what that does and why it's so much. Is it so much better? [00:38:37] Speaker A: So, yes, dermatology is extremely excited about this. Now, this is a chemical sunscreen. Remember? That's kind of the ones that are usually have more of a cosmetic appearance there because they give that nice shiny glow. They look. You look very moisturized when you wear that Sunscreen. So it is falls into the chemical family of sunscreens. But we are so excited about it because it is very stable. And so there's only certain things that we can use within the chemicals, sunscreens. And like I said, they can only absorb so much energy and then they need a reapplication. Well, bimitris is very stable. It can with. It doesn't need. We still want you to reapply, but it's going to have a better blockage. And so because of that and it's so stable, we know we're going to have continued, continued, continue. And right. I was talking about. Well, the UV index changes throughout the day. Well, because it's so stable, it handles that change really well. So if you go out to go golfing at 9am and you're out golfing through till 12, you know that the bimitrismal is going to be more stable in the way that it works through the day or the leisure golfing time and can continue absorbing all those UV rays and prevent the skin cancer damage. Now, the other thing that we're excited about is because it's so stable, it's also got a great ability with less preservatives and less different other things connected to it. And it's usually considered, at least by the European market, the most cosmetically pleasing. So it's very exciting for when. For anyone who has facial sunscreens that they kind of use as their toners or their different, you know, background. I'm really bad at makeup. I should be better at this. I think I want to use the word foundation. [00:40:31] Speaker B: Oh, yes. [00:40:32] Speaker A: So it's one that can give a really nice foundation background. And so it's. We're very excited about it because anything that can encourage the population to use it more, you know, that's less the damage occurring. [00:40:48] Speaker B: I haven't seen it yet, but I'm hoping that it hits soon. [00:40:55] Speaker A: I think it's going. I know that from the meetings that we've had in dermatology, either the industry is already. So Neutrogena, La Roche, Posay are already working on formulations because these companies already have formulations in Europe and now that it's approved here, they're just waiting for that the rest of their product to be approved here. [00:41:17] Speaker B: Okay, give me some myths about tanning. [00:41:25] Speaker A: Oh, Doc. You know, it's gonna be really good for my skin. Oh, hold on, hold on. There we go. I just thought of the one that's my favorite. Well, I need to get a base tan first. Oh, boy. I couldn't tell you something that makes me cringe more than frying your skin first and then going out and, oh, I have a tan the rest of the summer. So what you're actually doing is causing severe damage to your skin. And when you have so much severe damage to your skin, yeah, it's going to respond, and you'll have a tan, and it's going to be more prepared. But you've actually caused so much damage to start with, that it's just a lasting effect. And that's something that I. You do not need a base tan. You can. I think the other thing is, well, Doc, you know, I want to look like I'm a little bit, like, go out in the sun. I don't want to be pale the whole time. So the myth, too, is that you can't get a little tan if you wear sunscreen. Wearing sunscreen and being out in the sun protects most a lot from that photo damage. Now, I don't want you out and about just having a great time outside all the time, but at least if you're wearing that, you still can. Your body does respond to the UV rays, like making a darker pigment. That's what your body does naturally. Your body makes that darker pigment that looks like a tan in order to protect itself, and that's triggered just by UV rays. So you can go out and you can still, you know, get a little darker if that's what you're looking for. I don't want to encourage that because I don't think that you should. But you can still get a little tan while wearing sunscreen. [00:43:06] Speaker B: I've always wondered how that whole trend came that it was cool to look tanned, because years and years ago, way back, it was cool to be really white. Women were considered, you know what I'm saying? Women that had pale skin were considered to be really beautiful and everything. Now you see a tanned person that, oh, she's beautiful. Beautiful. So it's just interesting how that has changed. [00:43:32] Speaker A: Yeah, well, and that's where I think we. When we were talking about why are we seeing such an increase? And if you really think about, like, back in the, you know, go back to the flapper era, the 20s, the raging 20s, you didn't really see a lot of people tanning. That wasn't the thing. 30s was the depression, and then we were in a war. And so it wasn't like a lot of time aside spent out there. And then we got into, you know, the more the. In the 50s, 60s, and more people were doing more Fun things outside and that that's where I think we are seeing just overall what behavior was. And so. But there is a pendulum swing and I love it because we. Being pale is coming back and I'm like, I'm very happy for that. [00:44:16] Speaker B: I wonder. So I remember growing, starting to grow up on a farm and our parents just tossed us out of the house. Go play. We don't want you. And they didn't slather us with sunscreen. I remember burning on my shoulders when I was pretty young. And I'm just wondering, like, what do you do? Like, what kind of skin? First of all, I'm sure that does some skin damage. Hopefully when you're young enough that there's ability to, you know, recover reasonably. But what do you do if somebody burns? What's the best treatment for that? [00:44:52] Speaker A: Yeah. And you know, the first thing to think about that when someone gets a sunburn is okay, what did, what. What's occurred. So you've had so much that sunburn is that those, that layer of skin is so inflamed. So that it is. There's been so much heat damage that's occurred to it that now it's just drastically burnt, which is inflammation. And so we need to calm it down. So the first thing that you can do, you know, you, you feel it when you get a sunburn. You're hot and so you can, you can do cool compresses and you can do like a cool shower. Now I don't want you to do ice because that kind of is the in too drastic of an inverse. But you know, and that would cause more of that skin. We want to try to preserve as much of the skin as possible. [00:45:39] Speaker B: You don't want it to slough off, right? [00:45:44] Speaker A: If we can preserve it. And because remember that skin that's so damaged that now the skin has to be sloughed off. So things like peeling, pulling actually cause even more damage. So the goal is hopefully it's not too damaged and it can stay on. Now if it starts peeling, that's a natural progression. The skin is going to get rid of itself, but we don't want to over encourage it. [00:46:05] Speaker B: Right. [00:46:06] Speaker A: We don't want to overdo that. It's like kids are doing good things, but you don't want to overdo it because then they might go the other way. Other things is if there's pain, know that it's completely fine to use Tylenol or to use Advil. I actually just had my cousin text me. She's. She was at the beach. And she said, oh, I read this sunburn. What do I do? And I was like, oh, well, if it's painful, definitely take Tylenol or an Advil. And she said, you do that with sunburns. I was like, oh, yeah, that's to help reduce down the pain. And then after that, right, it's going to like. Everybody wanted to use something that was more like aloe. That was very much. [00:46:48] Speaker B: I was wondering about that. [00:46:51] Speaker A: Right. Everyone. You know aloe vera, I grew up with it. Banana boat, be it food on there and use it to cool down. What you don't want to do is use a moisturizer that's occlusive at that point. You, you know, we use a lot of that during the winter to help kind of preserve the moisture layer in the skin. But in when a sunburn has occurred, you do want something that does have a little bit more ceramides. That's kind of the building blocks of our skin. So there's. I always talk about get the moisturizer, the moisturizer that comes in a tub because it's going to be a moisturizing cream. So I know it can only come in a tub. So it's in a tub and you lather that on because it's very, very, very enriching and moisturizing to restore integrity of the skin. It's got rich ceramides in it out, and that's what aloe vera is doing. So at that point, if you have done the cooling, you've taken any Tylenol or Advil that you need, you can use the. The aloe vera. I think I would prefer you to use something that I have that's definitely giving you the ceramides you need for your skin. And then that would allow you to kind of you to start to help the. Encourage the skin to rebuild its integrity. I definitely wouldn't recommend anything that has lidocaine in it. Sometimes people will buy kind of like topical lidocaine and place it there. It's actually really hard on the skin to process because it's so in inflamed, it actually can increase inflammation. So it's supposed to work as more of a numbing agent and it actually usually irritates the skin worse. So while aloe vera is not wrong, it's a good one. I do think a better option is like a tub of moisturizing cream to help restore that integrity. I think the other thing to consider with really bad sunburns and this is if you're really bad, you know you feel fatigued, you feel nauseated, you feel, feel lightheaded, bad headache at that point after a sunburn like that, you should probably seek medical care. After that. If it's more than just my skin is hurting and it's tingling and I can feel kind of that warm sensation from a sunburn and it's starting to become systemic with fever, with nausea, I would definitely say you need to seek medical care. [00:49:11] Speaker B: So if somebody is going from a place where they don't generally get as much sun and they know they're going to be out, out in the sun a lot in a place that maybe, you know, more sun is intense, what can they do to prepare? [00:49:29] Speaker A: Absolutely. So I, I like this question. So I think what's good to know is that if you, I mean, sunscreen is going to work in any instance. And so I remember I went to Aruba and I went with a group of friends and they, they said, you know, you're already putting sunscreen on. We haven't got off the plane, but we're closer down to the equator. And my, my skin has to be prepared for that higher UV index. That higher UV index is going to now require this. So I think something that, you know, if you know that you're someone that needs. We recommend every two hours to reapply if you're swimming. And then we require, recommend at least applying twice a day when you're out doing your regular things. And so what you would need to do is be prepared when you're going down to Aruba or to close to the equator somewhere, you're going to get more exposure going to Florida. You need to be prepared and apply a bit more because that higher UV index is not what you're used to. And just overall be more prepared. One of the things I know some people ask about is, you know, well, what about my retinoid use? And because that can cause some photosynthesis. And so some people are very sensitive to the sun under the retinoid. And so you would probably like you're going on a vacation, you're going to Disney World down in Orlando. You know, you might want to back off a few nights off of it just so that you don't burn. And that's one of those things. Right. Who's more likely to burn? Well, if you're using a retinoid every night, you're probably more likely to burn if you're spending more time down in Orlando and out. I, I think so. Once again, I said, I'm from California. Disneyland has so many Trees. And what's funny about Disney World is there's no trees, there's no shade. So one go to Disneyland instead of Disney World. No, I'm just kidding. I know I'm gonna be in trouble there. I'm out of here. No, but being prepared and knowing that you're going to need more protection and whether that you'd want to achieve that with wearing a hat you don't normally wear or wearing sun reapplying a little more often, but just being prepared to apply more. [00:51:52] Speaker B: In other words, find a sunscreen that you can stand feeling on yourself when you apply every hour and a half, two hours. Because it does get, you know, your skin does change regardless of what you use. I feel like. So you got to find the one that you can stand to keep plying on. [00:52:12] Speaker A: Yep, yep. And if you do see a dermatologist, they usually have samples. I know we do have different ones that you can try. So before you make your big purchase and have to be committed to this whole bottle. So that's always something too that usually most dermatologists office have it out towards the front or as you're leaving in the back on the way out. They usually have samples and so you can try them too and see which ones you like. [00:52:36] Speaker B: Well, Dr. Presley, thank you so very much for doing this yet again for us. We really appreciate them. It's such a perfect time for this discussion. What are your final thoughts? What do you want people to remember from this? [00:52:51] Speaker A: Yeah, I think what I would want everyone to walk away with is that this is a long term thing. So this, you know, and I think it's both in skin cancer prevention and anti aging, I really think those protections are kind of looped together. So, you know, everyone's trying to stay youthful. Well, the good thing is if you're trying to stay youthful, then it's also to preventing skin cancer. So rather than sometimes what I tell patients is instead of looking, this is like, oh, I've got to wear this sunscreen every day. So I don't get, you know, basal cells, squamous cells, is that we also are preventing really damage that causes those lines to form and those spots to occur that we don't want to have. So that's one part. So if you're, you have to get through the mental block of, you know, I don't want to wear sunscreen. Well, it's anti aging for one. I think number two is that you can always find a dermatologist. I will apologize for the wait. I know that it's a little difficult to get in with us, but I promise that time's going to pass anyway, so just make the appointment if you want to see us. We're always happy to see our patients and help, you know, provide insight for your skin. And then I would also just put a plug in that at the University of Minnesota, you know, we're always doing a lot of work in this realm. [00:54:11] Speaker B: Right. [00:54:12] Speaker A: And especially our other colleagues of how to further advance the field. And, you know, I think that people should know that the, the Mhealth Fairview Health System with dermatology is here to provide as much help as we can. [00:54:28] Speaker B: All right, well, thank you again and have a great rest of your summer. [00:54:33] Speaker A: Yeah, absolutely. And you guys, too, and thanks. And I'm so glad that we were able to do this. I know that we had the mix up, but especially with the weather right now and everyone, you know, you do want to be outside because if you don't have very ac. But, you know, I, I think that everyone's trying to stay cool in pools and in the lake, and so I appreciate that we could prioritize this. [00:54:53] Speaker B: Well, it's been fun and very educational. Thank you. [00:54:56] Speaker A: Yeah. Take care. [00:54:57] Speaker B: Well, Charlene, we're going to take the rest of the summer off so we can enjoy our summer. But we are going to play some previews of different things that we've had throughout the year, including, I think we're going to do ticks. This, too, is an interesting season. I'm told there are more and more tick problems that we're seeing. So if you didn't hear that show, please tune in and finish off with listening to the rest of the summer shows. And we'll be back in September. All right, thanks, Charlene. [00:55:38] Speaker A: Bye. [00:55:44] Speaker B: And your Tundu, KFAI 90.3 FM, Minneapolis and KFEI.org the views expressed on this show are not necessarily those of KFAI or its board of directors. My name is Sam. I'm the host of the show. Charlene Dahl is my PR research person. Erin is my podcaster. Alex assisted us with setting up the show. Thank you, Alex. This week we spoke with Dr. Colby Presley. Dr. Presley talked about skin cancer and how best to protect yourself. If you want to be on my email list, you can email me at disabilityandprogressamjasma.com or feel free to suggest something you'd like to hear in the future on this show. Thanks so much for listening. Fresh Fruit is up next. Take care.