In this episode, experts from Stony Brook Medicine guide listeners through the full skin cancer journey — from recognizing early warning signs and understanding the ABCDEs of skin cancer to diagnosis, treatment options and reconstruction.
The discussion covers common skin cancers, as well as one of the most dangerous types of skin cancer, melanoma. Experts also take the time to debunk some common myths about skin cancer and share practical, actionable tips you can use right now to help prevent skin cancer.
For more information, call: (631) 444-4200.
The Experts
- Division of Plastic and Reconstructive Surgery
- Melanoma Management Team
- Hematology Oncology
- Melanoma Management Team
- Dermatology, Mohs Surgery
- Melanoma Management Team
What You’ll Hear in This Episode
- 00:00 Opening and Introductions
- 2:00 The patient journey for skin cancer at Stony Brook
- 3:02 Early signs and symptoms of the most common skin cancers (basal cell carcinoma, squamous cell carcinoma, melanoma)
- 3:55 ABCDEs of skin cancer
- 4:44 What are the most common parts of the body where skin cancer may develop?
- 5:30 When should I see my primary care doctor versus my dermatologist?
- 5:55 Removal of basal cell carcinoma and squamous cell carcinoma versus removal of a melanoma
- 7:00 Excision and reconstruction
- 8:19 What are the best prevention methods for skin cancer?
- 9:50 When does medical oncology get involved in a case of skin cancer?
- 11:18 Staging tumors
- 12:47 Immunotherapy versus chemotherapy for melanoma
- 14:50 Life expectancy for somebody diagnosed with melanoma
- 16:18 Debunking skin cancer myths
- 18:17 What are some things I can do immediately to prevent skin cancer?
- 19:26 Closing Remarks
Full Podcast Transcript
00:00 Opening and Introductions
Description of Video Studio: News desk with Stony Brook Medicine logo on the front. A big screen is behind seated experts with the HEALTH Yeah! logo (red uppercase lettering with a microphone at the top of the “L”). Music plays as the announcer introduces the episode.
Announcer
Welcome to HEALTH Yeah! where experts from Stony Brook Medicine come together to discuss topics ranging from the complex inner workings of an infectious disease to tips and tricks for staying safe and healthy all year long.
Tara Huston, MD, FACS
Welcome to HEALTH Yeah! I’m your host. Dr. Tara Houston, a plastic surgeon at Stony Brook Medicine. Today, I’m joined by two of my colleagues, Dr. Amna Sher and Dr. Jordan Slutsky, and we’ll be discussing an important topic: skin cancer.
Before we dive in, I’d like to give my guests a chance to introduce themselves. Dr. Sher, could you start by telling our audience a little bit about yourself.
Amna Sher, MD, FACP
Hi everyone. I’m Dr. Amna Sher. I’m a medical oncologist, and I specialize in treating patients with skin cancer.
Tara Huston, MD, FACS
And Dr. Slutsky, would you mind introducing yourself as well?
Jordan Slutsky, MD
Sure. Dr. Jordan Slutsky, I am a dermatologist, but I practice dermatologic surgery and a specialty called Mohs surgery, so I specialize in removing and treating skin cancers.
Tara Huston, MD, FACS
Thank you both for joining me today. As the weather gets warmer, more people are spending time outdoors and enjoying the sunshine. Well, that’s something many of us look forward to. It also brings an important health concern to mind, skin cancer.
Skin cancer is the most common form of cancer in the United States, affecting millions of Americans each year. Among the different types of skin cancer, melanoma stands out. Although melanoma accounts for a relatively small percentage of all skin cancer cases. It is responsible for the majority of skin cancer related deaths. It is also one of the fastest growing cancers in the United States and one of the most common cancers affecting young adults.
The good news is that when melanoma can be aggressive, it is highly treatable when detected early. In today’s conversation, we’ll discuss how skin cancer is detected, review current treatment options and answer some of the most frequently asked questions about skin cancer and melanoma.
2:00 The Patient Journey for Skin Cancer at Stony Brook
Tara Huston, MD, FACS
Let’s begin by explaining our roles in skin cancer and where we enter a patient’s journey, and at what point a patient moves from one of us to the other. So Dr. Slutsky, you’re the front door.
Jordan Slutsky, MD
Yes. So (as) dermatologists, patients come to us, we do skin cancer screenings from head to toe, and we’re looking for suspicious lesions to identify, biopsy and potentially treat as needed.
Tara Huston, MD, FACS
And then when you find a suspicious lesion and you biopsy it and it turns out to be a skin cancer, you will either take care of it through Mohs that we’ll talk about later, or if it needs a more extensive excision and potentially reconstruction, you’ll send to a general surgeon, plastic surgeon, such as myself, or a surgical oncologist. And then once I removed the tumor, potentially check the lymph nodes, I will then send the patient to you in medical oncology. Dr Sher.
Amna Sher, MD, FACP
Yeah. So I would get involved whether a patient needs additional therapy for a high risk melanoma, or if the patient has advanced disease and needs systemic therapy as their mainstay of treatment.
3:02 Early Signs and Symptoms of the Most Common Skin Cancers (Basal Cell Carcinoma, Squamous Cell Carcinoma, Melanoma)
Tara Huston, MD, FACS
Great. So Dr. Slutsky, from a dermatology point of view, what are the early signs and symptoms of the most common skin cancers that our viewers should know to look out for?
Jordan Slutsky, MD
Sure. So the big three skin cancers that we worry about most:
- Basal cell carcinoma, often in most skin cancer doesn’t present with any symptoms. So basal cell carcinoma can look like a pimple, for example.
- Squamous cell carcinoma, which is the second most common skin cancer, can look like a scaly bump, it can look like a rash.
- And then melanomas, of course, are the feared skin cancers. They often look like an atypical mole.
But I typically counsel patients to look out for the ugly duckling lesion, the lesion that’s either new, changing or different than other lesions that they might have on the body, which are benign and not worrisome.
3:55 ABCDEs of Skin Cancer
Tara Huston, MD, FACS
So back in high school health class, a lot of us, before medical school, and a lot of our viewers, learned about A, B, C, D, E, to look for skin cancer. What is that? Can you explain it?
Jordan Slutsky, MD
So it’s a mnemonic:
- A stands for asymmetry. So if a lesion is not symmetrical, if you can’t divide it in half.
- B is border irregularity.
- C is color variation. So lesions that have a homogenous brown color, it’s brown throughout. That’s okay, but if they have multiple colors, blues, blacks, whites, that’s concerning.
- D diameter. Typically, we worry about things that are larger than the head of a pencil or a pencil eraser. I don’t love that one, because skin cancers can be very small
- And E is very important that’s evolving or changing. So lesions that are doing that.
4:44 What Are the Most Common Parts of the Body Where Skin Cancer May Develop?
Tara Huston, MD, FACS
And are there certain body parts that men and women should worry more about?
Jordan Slutsky, MD
Definitely. So the most common places to get skin cancer are those that see the sun, because sun ultraviolet radiation causes most skin cancers. So sun exposed skin. The majority of the skin cancers that I treat are above the neck, but patients often forget about ears, backs of hands, shins, feet. Skin cancer can affect any body part. I treat nail lesions. I treat genitals as well, which is typically cancers that are not from the sun, but speaking specifically to melanoma, melanoma is most common on the back of men and on the legs of women.
5:30 When Should I See My Primary Care Doctor Versus My Dermatologist?
Tara Huston, MD, FACS
And when should someone see their primary care doctor versus a dermatologist?
Jordan Slutsky, MD
That’s a good question. Primary care doctors, some family practitioners actually are trained in dermatology and do skin exams. Others are not as comfortable with the skin exam. Typically, if there are lesions of specific concern, seeing a dermatologist is a good idea.
5:55 Removal of Basal Cell Carcinoma and Squamous Cell Carcinoma Vs. Removal of a Melanoma
Tara Huston, MD, FACS
Okay? And can you explain how removing a basal cell or squamous cell cancer is different than removing a melanoma and when we might consider Mohs versus surgical excision?
Jordan Slutsky, MD
So generally, with basal cell and squamous cell, the non-melanoma skin cancers, we’re not as concerned with by how far out we remove the skin cancers, as long as we remove them completely.
With melanoma, it’s more of an insurance policy. So we tend to take wider margins because melanomas can behave more aggressively, and we want to make sure to clean up potentially any cells that might have gotten away from the cancer.
Tara Huston, MD, FACS
Right, and we know with surgical excision, we can get our risk of local recurrence to as close to zero as possible. And just to add on for the surgical excision, because you and I partner on this frequently, when a melanoma hits a certain depth, then we worry about lymph node spread, and that’s the time in which that we will surgically check a lymph node to confirm that the melanoma has not spread.
Jordan Slutsky, MD
Exactly.
7:00 Excision and Reconstruction
Tara Huston, MD, FACS
So I think we can move on to discuss reconstruction a little bit, that again, Dr. Slutsky and I share. But at what point would you say a dermatologist is going to excise and close the skin cancer versus maybe I want to partner with a reconstructive or plastic surgeon on your case.
Jordan Slutsky, MD
Sure. A lot of dermatologists are very comfortable with excisions. I have a specialization in skin cancer surgery, dermatologic Mohs surgery. So for low risk skin cancers, ones that are small in diameter, that are low risk in microscopic behavior, that occur on the trunk and extremities, very often, those are taken care of by a dermatologist in the office, either with excision, destructive methods, where we scrape and burn or freeze them away. Sometimes we even use creams for more superficial, non-melanoma variants.
When we get into higher risk anatomy, so head and neck, if we get into skin cancers that are more aggressive and invasive, that’s when we start talking about either Mohs surgery or treatment with surgical — plastic surgical, surgical oncology, general surgical specialties.
8:19 What Are the Best Prevention Methods for Skin Cancer?
Tara Huston, MD, FACS
Great. Thank you. So one more question from the dermatology perspective, and then we’re going to move on to Dr. Sher.
What are the best prevention methods for skin cancer?
Jordan Slutsky, MD
So the best thing to do is practice sun safety. So daily SPF, we recommend, the American Academy of Dermatology recommends an SPF of 30 or higher, all sun-exposed skin on a daily basis. We used to think that it was really only the ultraviolet B, the UVB, light, that caused skin cancer. UVB is responsible for burning, but ultraviolet A is also responsible, and it penetrates cloud cover. It’s present year round. Of course, it’s, you know, higher intensity in the summer and the more tropical climates, but we do recommend sun protection on a daily basis.
Personally, I use a moisturizer with an SPF every day, and then if I’m going to be outside, at the beach or on the boat or spending more time outside, a proper SPF reapplied every two hours when swimming, sweating, and sun, protective hats, sun protective clothing, sunglasses and shade.
Tara Huston, MD, FACS
Getting back to sunglasses, we know that melanoma doesn’t just affect skin, but the eyes are anatomic risk for melanoma as well. So is there a special type of sunglasses that you think patients should wear, and would you recommend it in both summer and winter?
Jordan Slutsky, MD
That’s a good question. You know, anything that their patients would be comfortable with and they’re going to wear. Patients will often ask us what sun cream you prefer, and it’s really going to be the one that a patient likes cosmetically, that fits their budget. So as long as you’re using some form of sun protection, I’m good with that.
9:50 When Does Medical Oncology Get Involved in a Case of Skin Cancer?
Tara Huston, MD, FACS
Great. Thank you. So Dr. Sher, when do you like to get involved as the medical oncologist? If surgery removes everything visible, including some lymph nodes, a patient might say, Well, why do I need another doctor to oversee my whole body if the first two that I saw removed it?
Amna Sher, MD, FACP
Right, so as I mentioned earlier, usually I would get involved when there is a patient with a high risk melanoma, even if they’ve removed all the cancer, the lymph nodes are negative. There are certain features in the pathology which puts the patient at high risk of recurrence, and the biggest thing is the thickness of the tumor. So if it’s a thicker tumor, even without the lymph nodes, we know that giving additional therapy with immunotherapy has shown to decrease the risk of melanoma recurrence over five or 10 years.
So that is generally when I would see a patient, if surgery is done and lymph nodes are negative. And then in more advanced stages, if it’s the lymph nodes are positive, the risk of recurrence is as high as sometimes 50 to 60 percent in stage 3C, or C melanomas, and we have very strong data supporting that additional immunotherapy for a year decrease the risk of recurrence, as well as the risk of cancer spreading over time.
And lastly, I would get involved when the patient is unfortunately diagnosed with an advanced melanoma which has already spread to other parts of the body.
11:18 Staging Tumors
Tara Huston, MD, FACS
Can you just take one minute to go back and discuss the staging for our listeners? You mentioned that the thickness of the tumor is one factor that’s important to staging, but this is a concern for a lot of patients.
Amna Sher, MD, FACP
Sure. So you know, when we stage any tumor, particularly for melanoma, there are three different factors which we look at. The T is the tumor size, N is the presence or absence of lymph nodes, and M is the presence or absence of metastases. So in general, just to sum it up, I mean stage zero is inside the tumor. Stage one is a smaller tumor, less thick. Stage two is a thicker tumor, between two to three millimeters without lymph nodes. And stage three melanoma is generally when, regardless of the thickness of the tumor, when the regional lymph nodes get involved with cancer. And stage four is when the cancer has spread to other parts of the body. For example, if it started on the back and it has spread to the liver or the lungs. That would be a stage four melanoma.
Tara Huston, MD, FACS
And would you say that, fortunately, most patients present with early stage zero or one or two?
Amna Sher, MD, FACP
I think so. With the skin cancer screening, most of the patients are diagnosed with early stage disease, where, even if it’s a thicker tumor, lymph nodes are positive, we are able to cure the cancer with appropriate treatment, with reception and lymph node evaluation.
12:47 Immunotherapy versus Chemotherapy for Melanoma
Tara Huston, MD, FACS
Now you talked about the first line of treatment that you give. You called it immunotherapy. So can you explain to our viewers what immunotherapy is and how it’s different from chemotherapy, which a lot of people associate with cancer?
Amna Sher, MD, FACP
Sure, immunotherapy has actually been around for melanoma for over a decade now. I mean, the first immunotherapy which was approved is ipilimumab, which was in 2011, and what it does is it’s basically stimulating your immune cells to attack the cancer cells.
In easy words, I explain the patients, because there are various checkpoints in our body to prevent autoimmunity. So when we use these checkpoint blockers, they release the brakes on the T cells, and then those T cells cause direct cancer killing. There are several medications out there, such as pembrolizumab, nivolumab, but that is the main action of these and how they differ from chemotherapy.
Tara Huston, MD, FACS
Now, the term immunotherapy does sound a little kinder and gentler than the term chemotherapy, but there are significant side effects with these medications as well that patients need to be aware of.
Amna Sher, MD, FACP
Absolutely. I think in general, immunotherapy is very well tolerated compared to chemotherapy, but patients do need to be aware of some of the side effects which are very specific to this class of drugs. In general, people can experience some fatigue, skin rashes. But particular side effects of interest are what we call immune mediated side effects, such as inflammation of the GI tract, colitis, it can cause pneumonitis, can alter the thyroid gland or the adrenal and some of the rare toxicities, such as cardiac or liver toxicities.
I mean, they are not as common, but patients need to be aware of that as soon as they experience any of these side effects, they should promptly notify their provider.
14:50 Life Expectancy for Somebody Diagnosed with Melanoma
Tara Huston, MD, FACS
And now I understand that my next question is going to be a difficult one, but patients ask this when they see the word melanoma on a pathology form. Dr. Slutsky finds it for them, and their first question is going to be, can I survive this? What will my life expectancy with this be? And I know it’s improved significantly since 2011 when the immunotherapies were developed. But can you give some ideas of how much better life expectancy is now with early and even with advanced melanoma?
Amna Sher, MD, FACP
Sure. So I mean, I think I’ll start off with early, as we all know, with stage zero or one melanoma, we generally look at the five year survival rate, which is the number of people who were alive at five years after their diagnosis. For stage one, it’s, you know, 99 percent or so.
As we go into advanced stages, stage two is still over 95 to 97 percent. And moving on to advanced stage four melanoma, just to give a perspective, before immunotherapy, the median survival for stage four disease was about six to nine months, which was obviously not that great. But since we’ve been starting using immunotherapy, the median survival for stage four disease is about six years, which is unprecedented. So I think with that, we might be looking at potentially curing some of these later stage patients with these newer therapies.
16:18 Debunking Skin Cancer Myths
Tara Huston, MD, FACS
Excellent. Thank you. Now, one question for everyone, is there a myth about skin cancer that you would like to debunk? Dr. Slutsky?
Jordan Slutsky, MD
So the myth I would like to debunk is that skin cancer only occurs in light skinned individuals. It definitely occurs more frequently in lighter skinned people with significant sun exposure. The risks are sun exposure over time, and the darker skin is protective, but it doesn’t make you immune to skin cancer. So I treat patients that are Latino. I treat black, African American patients. I treat patients of every gender and ethnicity and age. So if there’s one myth I would like to debunk, it’s “it can’t happen to me,” it can happen to anyone.
Tara Huston, MD, FACS
Excellent. Thank you. What about you, Dr. Sher?
Amna Sher, MD, FACP
I think I would say, you know, people say when I’m out there on a rainy day or a cloudy day, I don’t need to wear sunscreen. I think that’s not true, because, you know, even if it’s cloudy, I mean, there are sun rays which can escape through the clouds and can still cause sun damage over time and increase the risk of developing skin cancer. So I think even if it’s rain or shine, put your sunscreen on.
Tara Huston, MD, FACS
The myth that I’d like to debunk are tanning beds. Some people come into my office and say, well, it’s different than the rays from the sun, so it must be safer. I’m doing this indoors with lights. And it’s absolutely not safer. It can almost double your risk for skin cancer later in life, the use a tanning bed in your teens or your 20s. So I strongly discourage young people and older people from using tanning beds. Not only does it result in skin cancers, melanomas, it also ages your skin and gives you wrinkles. We don’t want any of that.
Jordan Slutsky, MD
Definitely not.
18:17 What are Some Things I Can Do Immediately to Prevent Skin Cancer?
Tara Huston, MD, FACS
And then my last question for both of you is, what is one thing that our listeners should start doing this week to protect themselves against skin cancer? Dr. Sher, you first.
Amna Sher, MD, FACP
I would say, make sure you put on your sunscreen and put it on the proper way. And they should reapply every two hours, especially if they are, you know, planning to be out in the sun for a longer period of time.
Tara Huston, MD, FACS
Dr. Slutsky?
Jordan Slutsky, MD
Take a look at your skin. Go to a mirror. Look at your body. You know, if you have a partner or someone to help you with your back, but are there any lesions on your body that are worrisome, that are bleeding, that look different than your others? And just take stock of what’s on your body.
Tara Huston, MD, FACS
Two excellent points, thank you. And my suggestion this week is to call your local dermatologist and make an annual appointment. We go for our annual mammograms to check for breast cancer. We get our colonoscopies on time to find colon cancer early. And I think that a total body skin exam by a board certified dermatologist should be part of our annual health workup. So I encourage people to make those appointments this week.
19:26 Closing Remarks
So that’s all the time we have today. Thank you to Dr. Sher and Dr. Slutsky for your time. And thank you to our viewers and listeners. If you found this conversation interesting. Don’t forget to like and subscribe for more informative health related content, for more information, call Stony Brook Dermatology at (631) 444-4200. Thank you.
Announcer
Stony Brook Medicine is Long Island’s premier academic medical center. We transform lives through scientific discovery, education and care, and we bring together innovative research, advanced education and extraordinary healthcare expertise to set the standard for how healthy communities thrive. For more information, visit stonybrookmedicine.edu or follow us on social media.
DISCLAIMER: The information provided in this podcast is for educational and informational purposes only and is not intended as a substitute for professional medical advice, diagnosis or treatment. If you think you may have a medical emergency, call your doctor or emergency services immediately.
