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>> And good evening.

Thank you for watching HealthLine on PBS Fort Wayne I'm your host Mark Evans sitting in for Jennifer Blomquist tonight and a very important topic because we're getting into that season.

>> It's the season of Suneung laying out in the sun and enjoying that and getting all the vitamin D it can and toning our skins down a little bit.

It's also Skin Cancer Awareness Month and the main reason why we are doing this topic is because of that it's melanoma and considered to be the deadliest form of skin cancer but is highly treatable if detected early according to the American Cancer Society.

And cancer of the skin is by far the most common of all cancers in the United States.

Joining us tonight Dr.

Robert Bednarik.

He is a doctor of Micro graphic surgery and dermatology oncology.

Great to have you back on the show today.

Thanks, Mark.

It's been about five years since it has been.

>> Yeah.

Yeah.

Well, welcome back and I'm so glad you're here for this.

A very important topic and during the month of May yeah.

>> We're going to go ahead and just preface what's going to happen on the show.

We're going to talk about melanoma, what causes it the the treatments and so forth.

>> But we also want of course audience interaction and we have a couple of ways to do that.

You can give us a call and you can either stay on hold for a short time and air your call live and we love hearing your voice.

>> But if you just want to leave your question with us by calling us, we can transcribe that for you another way a fairly new way here at PBS for Wanis to Texas.

Your question and that text number is on your screen as well.

Now when you do that, please give us at least your first name and the town from which you're texting.

So we can give you a nice shout out because we appreciate your viewership.

>> So Doctor, let's go ahead and talk about melanoma.

What is melanoma?

>> What causes it and let's throw in some risk factors.

Absolutely.

So melanoma is like any cancer is is kind of described by where you have like growth growth abnormal growth of cells, so to speak.

So in this case it comes from it's derived from the melanocytes.

So the Molana site is there's there's three layers of skin so there's the epidermis, there's the dermis and then we have kind of normal fat.

So generally those melanocytes kind of reside in the bottom portion of that top layer of skin.

The epidermis is kind of their normal home so to speak.

So they play a really important role in protecting the skin.

So we usually think of them as tanning.

So what tanning actually is is the melanocytes reacting to ultraviolet radiation and it's the body's attempt to protect the rest of the skin.

So what melanoma is is when we get aberrant growth or mutations in that Molana site that subsequently leads to abnormal growth and subsequently a melanoma.

>> So Lanta site does it give up?

I mean is there a void there?

Is that the reason why the melanoma does form?

>> Why is that?

No.

So actually and funny enough if you if you look at normal skin biology we all regardless of what skin color you have, we all have the same number of melanocytes.

So whether you are, you know, fair skin white or have black skin, the number of melanocytes is generally unchanged from person to person.

The reason we get some people get darker is that there is an increased number of what is called the melanin which is the byproduct of the Molana site that's again kind of making that skin darker and it transfer those to the other cells of the epidermis called the keratin side.

So yeah.

So we all have pretty much the same number of melanocytes.

It's when we get that increased growth.

So an appearance if you get a again we'll talk about risk factors here shortly but again the big biggest one will kind of hit on is ultraviolet radiation where it causes the kind of the stock factors of growth to go way so to speak or causes the promoter.

So things that want to push that cell into making more cells so bad cells I should say that's what leads to the melanoma.

>> OK, and so we're not only talking about natural sunlight, we're talking about tanning beds as well.

Correct.

Which one is safer so there's really not a safe one of either one.

So ultraviolet radiation if you look is the tried and true number one most I guess controllable factor for skin cancer in general but also melanoma.

>> The way I kind of look at risk factors for melanoma, I kind of characterize them as genetic or things you can control and then there's the environmental things or those are the things that you can control, the genetic ones that you cannot control.

So in terms of environmental ones, the ones that you can control, most of them are going to be looking at our ultraviolet radiation.

>> So sunlight that you're getting outside UV light or ultraviolet radiation that you may be getting from a tanning booth, those are primarily kind of the two big main ones that we were seeing and then we kind of had the the non controllable ones or ones that you're kind of born with.

So intrinsic factors that you can't control having blue eyes, having fair skin, being more prone to freckling some patients or people are born with decreased immune systems.

>> So immunosuppression is also something that can be attributed to the factors that you can't necessarily control for yourself but that may also contribute to increasing your risk for melanoma and you know, melanoma is also it could be evident not only on the skin and we're going to talk primarily about skin but I wanted to throw this into you can have it in your eyes or in places that you can't even see .

>> Absolutely.

So you know, we always talk I talked about the melanocytes in the upper layer of the skin which is where they normally like to come in and but during embryology we also find them in other places too.

So as you hit on in the eyeball so occasionally a lot of times people that are diagnosed with melanoma are encouraged to see an ophthalmologist to make sure that they're getting there the back of their eye exam to make sure there's not something called alluvial melanoma.

We can see under the nail beds and other places that you may not expect to be exposed to sunlight.

So as you kind of hit on earlier kind of the mucous membranes so the oral mucosa or even the genital skin at times again areas that you may not necessarily have exposed to sunlight but we also have a home for the melanocytes so to speak.

So whenever that home exists there's also the potential for those becoming neoplastic or becoming cancer.

>> And you mentioned some of the reasons for people getting melanoma but the exact cause I guess has not really been pinpointed.

>> Yeah, yeah.

I mean we know some genetic things that can potentially lead to certain melanomas.

We also know that UVA or ultraviolet radiation causes and damages the DNA structure not just you know, the melanocytes but really all the cells has the potential to damage all the cells in the skin so to speak.

So yeah, we can't always pinpoint exactly what the mutation is that leads to subsequently forming the melanoma.

>> But we know kind of the contributing factors.

OK, and we talked about some of the risk factors the skin, the burns easily having exposure to UV light.

I noticed another risk factor what I was doing my research earlier today that having many moles that aren't typical and we're going to take a picture take a look at a picture of some of those moles in a minute living closer to the equator or higher elevation which makes sense to me.

>> Yeah, but are there any people and I don't mean to throw you off guard but is there a particular place or places in the United States, for instance that melanoma is more prevalent?

>> Yeah, and I think a lot of times we see it more in the again the South if you look at the incidence rates it's going to be higher in the south and as you might imagine, there's a higher burden of ultraviolet radiation in those areas.

There's sunnier climates.

There's sunnier longer throughout the year.

So subsequently we're seeing probably a higher incidence of melanoma in Florida than we may perhaps in Alaska so to speak.

So no, absolutely.

I think again I can't necessarily say with certainty but I can only imagine if you look at the incidence of melanoma comparing those populations of people that is certainly going to be higher in the sunnier states.

>> Do you see a lot of it here in this area?

We do, yes.

We see a high burden and I think again a lot of it comes down to at least in in our community we're certainly in probably in excess restrained area where patients may not have or people may not have as good of access to care as other areas.

So I would say the incidence is is probably what would be expected for other Midwest areas.

But I will tell you that because we live in a Midwest and rural area, we tend to see them when they are more advanced than perhaps when they are thinner and a lot more treatable.

>> So no, absolutely.

OK, I want to move on.

>> I want to take a look at some photos that you brought along.

We're going to take a look what melanoma looks like and if you don't mind, you can go through those.

>> Absolutely what's going on?

Absolutely.

So these are these photographs that we have here are true ones taking taken from people in our community.

So this right here I think the biggest thing when when we are evaluating our providers evaluating a spot or a mole of concern on a patient a person is we kind of go through what is called the ABCs criteria.

>> So ACE stands for asymmetry.

So am I able to cut this mole in half and does it look the same on both sides in terms of border we kind of look for is it a clear cut border or do I know exactly where that that border starts and stops or is it perfectly round?

Does it have a little bit more of a scalloped appearance compared to being more even a smooth border in terms of the letter C?

C stands for color.

So we generally try to look for one one or two pretty uniform colors but melanoma will oftentimes have three sometimes even four or five.

>> So a lot of times we think of normal MO moles is as being kind of a white skin color slightly off skin color tan or brown.

But in the case of melanoma you can have dark brown so you can have light browns, you can have reds, blues whites so really held no boundaries in terms of what color it decides to go to D stands for diameter so anything larger than six millimeters which equates to about the size of a pencil eraser tends to make us look a little bit more closely at that spot and I think probably the the criteria I usually hang onto the most is evolution.

So E stands for evolution in the ABCDE.

So in terms of evolution especially if they're over 40 and a person comes in talking about a mole that's changing it definitely gets a little bit more concerned in terms of worrying about some whether something has a potential to be malignant or not.

>> OK.

And I want to stress to our viewers those dots around the moles those are for the doctor or for correct those treatment.

>> Yes, those are those are dots that are identifying the location that we would some subsequently go on to to examine.

>> OK, very good.

All right.

And those moles are certainly nothing that you want to take your like your fingernail and try to scrape off or anything you want to leave those alone, correct.

OK.

All right.

I just want to make sure we mention that yeah.

>> OK, we have a text coming in and it is a very interesting one and don't know who where this is coming from but we thank you for your text anyway.

Do redheads get melanoma more often?

>> What sunscreen would you also recommend?

Yeah so redheads do get melanoma more often compared to darker skin phenotypes.

So a lot of times we kind of group redheads with kind of ferrum freckled skin versus somebody that might have darker eyes or darker complexion.

>> There's the main reason for that is that there's different types of melanin.

So there's something called melanin.

Again, this kind of goes back to the basic science of melanocytes and how they make that melanin again.

We kind of talked about how all even somebody with fair skin and red hair has the same number of melanocytes but they don't necessarily make the same number of the melanin and they don't make the same protective type of melanin or somebody of darker skin.

>> So there's two types of melanin called feel melanin and you melanin.

So you melanin is a lot more protective compared to something called feel melanin in people that have red hair, fair skin.

They are having a higher proportion of that less protective feel melanin which subsequently is not as protective and leads to a greater amount of potential damage from from UV radiation.

>> They are at higher risk so they are at higher risk.

Correct.

So we're talking about redheads here.

What about people with blond hair?

Same thing the blond hair and red hair kind of go hand in hand in terms of being more of being more of a former of that probably less protective feel melanin not not as much melanin.

>> OK, very good.

And I have a call coming in and Jack prefers to be offline, has a good question.

>> I believe it's called it's he's asking is fish oil good for the skin?

Yeah.

So I think in terms of yeah.

So there's a lot of research some validated some not validated in terms of what is a good supplement for skin health so to speak in terms of melanoma there's going to be I don't think that there is any research that shows that fish oil is going to decrease the risk .

I think the idea behind fish oil is that it helps increase the amount of lipid available to kind of form the protective moisture barrier but not necessarily in terms of forming the protective melanin barrier that might prevent melanoma.

>> OK, if you're just joining us, we're talking about melanoma tonight on HealthLine and Dr Robert Bednarik is with us today.

He's a microscopic surgeon surgeon I should say in dermatology oncologist.

So please call or text your questions and we'd appreciate that.

>> And we're here to educate you on something very, very important especially this time of the year.

>> So with everything that you've said so far, Dr and I think that I might have melanoma this looks strange on my I'm not saying myself but if I did, what do I need to do?

>> Yeah, so the first thing is letting your provider know that you have a spot that you're worried about so usually the protocol that that goes to places a person will contact their provider either their primary care provider or if they have an established dermatology provider that they're able to get in with, they have the area evaluated usually when they are evaluated again the provider is probably going through the ABC criteria that we talked about earlier to get a good idea of whether they think this is something worrisome or not.

If it is something that is worrisome, the mainstay to diagnose melanoma is by doing a biopsy.

So what the provider will likely do is advise having a biopsy and generally that's done in the office based setting under local anesthesia.

I think the key thing with any provider that is doing a biopsy is is to make sure that they're removing the whole thing so occasionally you will have people that will do partial samples or especially of a larger larger lesion and that can lead to false negatives.

So the most important thing is that you are getting biopsy by somebody that is, you know, mindful that they're taking taking the whole Molana Sidiq or mole that is of concern so to speak because ultimately that goes to the dramatic pathologists and they need all those clues to to best diagnose the melanoma underneath the microscope and just like any other type of cancer you have various stages and the correct.

>> Correct.

Absolutely yes.

So and that's a lot of what we kind dictate our management decisions is based off of the staging of these things.

So based off of at least the most recent guidelines, the dramatic pathologist or the pathologist.

And that's why it's so important to get that that full melanoma specimen if it is indeed a melanoma is because they are able to get all the clues to accurately diagnose the melanoma but they're also able to stage it appropriately .

So the prognosis of melanoma and the subsequent stage is generally highest has the most correlation with the thickness.

So the thinner the melanoma the better the prognosis.

It's when these things start to get deeper and thicker that is when we worry about having spread beyond the skin or even into distant organs.

>> OK, I was going to ask you when we say spread beyond the skin so it can actually spread like any other cancer getting into various organs and body parts absolutely can.

>> So the way we usually stage these the current criteria and again the DERM or the pathologists that's looking at it will give kind of the staging.

They usually stage these things after stage them after they've looked underneath the microscope.

The things to look at is the Breslov thickness is what it's called.

So that's what we talked about has the highest correlation with how patients are going to do in terms of prognosis.

They also look to see if it's ulcerated or not.

So funny enough when you were talking about picking a spot we actually don't want them to pick because having an ulcer underneath the microscope also is a poor poor prognostic factor versus so something that's mechanically manipulated versus the melanoma it intrinsically it's doing it intrinsically.

>> It's more of a poor prognostic factor than somebody that's picking at it and then what is called lymph node or spread to the lymph nodes.

>> So regional I guess metastasis is really the other big one.

So depending on the depth of the melanoma and the stage occasionally what will be recommended is called a lymph node biopsy, a sentinel lymph node biopsy and that's generally represents the first lymph node that a melanoma would spread had it spread beyond the skin.

>> I see.

So you just go to the nearest territory and then go from absolutely.

>> OK, very good.

We have another text from Wesley it looks like in Wesley is from Fort Wayne .

>> Thank you for texting us today.

He says I have dry skin and keeps returning back and healing and returning again.

Any ideas what I should do?

>> Yeah, so this is like dry skin in terms of this.

This is more of like a skin health type question but I think it's very important nonetheless.

>> So really it's moisturize, moisturize, moisturize in terms of what you're going to do to kind of maintain your skin health and prevent the dryness sometimes even three to four times a day minimizing hot showers afterwards.

What will kind of help with the dryness as well?

So yeah, very important.

>> And should you doubt yourself with some body lotion of some sort?

Absolutely.

I call it the so conceal methods.

Yeah.

So right after you get to the shower is the best time to put on your on your lotion or your moisturizer so kind soaks in seals and the the moisture that you got from the shower so to speak.

>> Well I don't want to mention any brand names public television but and I will mention Allo yep.

>> Is that a good product for you.

Yeah I mean Ello is there is a small proportion of people that do have a contact allergen to allow I usually recommend bland old petroleum jelly.

I know it's greasy but the greasier things are the more occlusive and better for the skin they are so things that you can scoop rather than squirt are generally better for for maintaining that moisture barrier.

>> OK that's good stuff.

Thank you for that information.

So let's talk about treatment options and I'm sure that the treatment is much simpler the earlier the stage.

>> Absolutely.

So go ahead and looking at the staging if you look at the what we have I think it's just so important is early detection.

It really is key.

So if you look at again we talked about that Breslov thickness and how it correlates with how well patients do the staging is generally based off of how thick it is so very thin melanomas the prognosis gets close to ninety nine to one hundred percent in terms of five year survival rates.

It's when it starts to spread beyond the skin that we that we start to worry about in subsequent treatment becomes a little bit more aggressive too.

So a lot of times based off of what we call stage zero and stage one melanoma.

So the really thin ones can be treated by an office base surgery and surgery really is the mainstay of melanoma when that is an option to treat it.

So we like to surgery try and Trud has the highest cure rate for melanoma.

So if we're able to utilize it that's what we try to do even when it is spread beyond the skin.

But again based off of that thickness surgery is usually recommended first line if it spreads occasionally what will be recommended is to sample a lymph node if it goes a little bit deeper to to accurately stage but then also potentially treat as well.

So there's been new advances really within the last ten years.

It's really kind of changed the landscape of melanoma.

So it's always in the past been surgery and that if it's spread beyond the skin it was a lot difficult, really difficult to treat.

>> Are we talking about radiation and chemotherapy?

Yeah.

So with traditional radiation chemotherapy probably about 10 or 11 years ago something called immunotherapy came around and we use it for a lot of not just melanoma but it's also used for a lung cancer, G.U.

cancers and whatnot.

But what it does is it stimulates the body's immune system to fight off the cancer so effectively it's using your own cells.

>> What it does it stops the break to turn on your body cells to recognize in this case melanoma really that's pretty much the mainstay of treatment for melanoma when it's gone beyond the skin, if it's not a surgical candidate to get rid of it.

But it really has changed the game in terms of melanoma that's spread beyond the skin where a lot of times it was, you know, almost a death sentence.

I hate to say probably twenty or twenty five years ago whereas now we have like decent evidence that increased survival and durable responses to a lot of times these patients respond and they never see it again.

>> That's great news right now the text coming in and we talked about this a little bit earlier, Doctor, but the text is I've got to get new glasses.

>> My brother died from melanoma that's spread throughout his body.

I also had melanoma but ended up fine.

Both of us are the only redheads in the family of six kids.

How susceptible are my adult children to melanoma in general ?

None of them have red hair but have somewhat fair complexion and light eyes.

Great question.

Thank you for that.

>> That is a great question.

So your adult children more than likely are going to have an increased susceptibility to melanoma so again with the fair skin that we hit on earlier.

But family history is something we didn't talk about earlier that is important in assessing risk factors.

>> So having two or more first degree relatives that have had a personal history of melanoma increases in this case would be the adult children's risk of having melanoma.

>> And in fact sometimes when you have three or more we will oftentimes send those patients to or people to genetics just to make sure that there is no underlying genetic mutation that may be causing that their melanoma.

>> They're rare but they do happen.

All right.

We only have a couple more minutes in the program.

We do have another question coming in and that is a test.

If you can go and bring that text up right now, please, I'd appreciate it.

>> Thank you.

Is there much of a difference between sunscreen with SPF 30 and higher such as 50 or 100 as long as they are waterproof?

>> I think this is a great question so that kind of goes into the preventative aspects of melanoma.

So when we're in terms of surveillance for melanoma and this will kind of segue into answering this question, the most important thing is making sure that you're getting a full body scan screening after you've been diagnosed but then also doing preventative measures at home so in this case I'm an ardent you know, ardent supporter of some protection but feeds into this in terms of SPF with the American Academy of Dermatology recommends that you are using a sunscreen SPF 30 or higher.

It needs to be water resistant and it needs to be broadband which means it covers both UVA Ultraviolet A and ultraviolet B.

>> So as in terms of this question, there is really not a huge difference in how much ultraviolet light is being blocked believe it or not between a 30 and a 100 it's actually only a couple percentage points.

>> So the biggest thing I will tell you that where people tend to slack is the reapplication.

So you're supposed to put it on every two hours and or after you've gotten out of the pool or sweat you should reapply as soon as possible afterwards.

So if you gave me the option of saying put an SPF 30 on every two hours you're putting an SPF 100 every four you'll burn with an SPF one hundred at four hours.

>> But if you do it every two hours with the thirty you're going to be you're going to be golden.

>> That's good.

We only have about 20 seconds left.

How can I decrease my risk of getting melanoma?

Absolutely.

>> So again, sun protection, sun protection and some protection.

Absolutely.

So sunscreen we kind of hit on you can also if you're not a big sun sunscreen wear doing sun protective clothing and just make sure you're examining your skin that you know you don't see any new moles or anything like that.

>> So if you do you catch them early.

I'm so glad you were here tonight and talking about this very important subject.

Thank you so much, Mark.

Yeah, absolutely.

We've got to have you back again, Dr Robert Bednarik, an MD of micro graphic surgery and dermatology oncology.

And remember if you want to see this episode again or any other HealthLine episode, go to YouTube there for you and we'll be here for you next Tuesday night.

Until then, thanks for watching.

Good night.

>> Good