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Introduction
Dr. Bob: And welcome to The Dr. Bob Show. Thank you
so much for taking your time to
Sit down and watch television, learn a little bit to help
your health and to help your happiness. I hope you have been
doing those things that we want you to do every week - exercising.
You need to exercise 20 minutes and try and make it seven
days a week if you can. It reduces stress, helps lose some
of those pounds. If you've got high blood pressure, it will
reduce your blood pressure. Start that day off with a breakfast
of fruit and fiber. And you know we need to start the day
off with a good breakfast. You will perform better and will
do better especially when you eat a good breakfast and you've
had eight hours of sleep. And that's the hardest thing to
do in our society is get eight hours of sleep. But all you
have to do is set the alarm clock knowing you are going to
wake up and go to bed eight hours before. You'll perform better.
You'll be happier. The people around you will be happier.
And most of all, what is it we like, well, it's laughter in
your life. Find that someone that you like to laugh with and
have a great time laughing.
I'm Dr. Robert Overholt and I'll be your host for the next
30 minutes. Have you ever noticed those little skin lesions
on your hand, or maybe a little mole on you? Could that be
cancer? Is it something new that you've got there? Is it changing
color or changing size? You know, skin cancers are becoming
more and more prevalent and we are going to be talking about
skin cancers. We're going to be talking about the most common
causes. I've got an outstanding guest. My guest is a board-certified
dermatologist, Dr. Colleen Shimazu, and you're going to love
what she has to tell you. Later on in the show we will be
talking about a form of anemia called pernicious anemia. What
is anemia? We'll be talking about atrial fibrillation and
its importance and also, when you exercise, do you cough?
Could you be having asthma and not know it? We've got a lot
to do. You'll want to stay tuned. It's going to be a great
show.
Dr. Bob: We're going to be talking about skin cancers.
Do you have any skin lesions that you've been looking at that
you've been afraid to talk to your doctor about? Boy, that's
one thing that you can't do. If you've got an abnormal skin
lesion, you be sure and see your doctor. They'll be able to
guide you as to what to do. My guest is Dr. Colleen Shimazu.
Dr. Shimazu is a board-certified dermatologist. She was on
the staff at the University of Alabama in Birmingham, Alabama
for seven years before going into private practice. And Colleen,
welcome to The Dr. Bob Show. Tell me about skin cancers. What
are the most common ones?
Dr. Shimazu: Well, Dr. Bob, there are three main skin
cancers that we need to know about. The first one is basal
cell. The second one is squamous cell and the third is melanoma.
Dr. Bob: Which one of those is probably the most dangerous?
Dr. Shimazu: I would say melanoma.
Dr. Bob: Melanoma. This is the most dangerous one.
How common is melanoma? How common are skin cancers in general?
Dr. Shimazu: Well, actually skin cancers are fairly
common. In fact, within the year 2001 we expect that there
will be at least one million new cases
Dr. Bob: Wow!
Dr. Shimazu: of skin cancers diagnosed.
Dr. Bob: A million new cases of skin cancers
Dr. Shimazu: Right
Dr. Bob: in 2001.
Dr. Shimazu: That's right.
Dr. Bob: That's pretty impressive. Since melanoma
seems to be the most dangerous, what is melanoma?
Dr. Shimazu: Well, a melanoma is a cancer that arises
in the skin from a cell that makes color and we call those
melanocytes. But most people would probably know the brown
spots or moles that all of us have as being the most common
presentation of what we worry about turning into melanoma.
Dr. Bob: Now, I've got a lot of freckles. Are those
likely to turn into melanoma?
Dr. Shimazu: No. Those are a little bit different
but sometimes it can be difficult to distinguish between the
two.
Dr. Bob: Let's take a look at the first picture that
we've got. It's a picture. Now, what is this right here?
Dr. Shimazu: Well, this is a melanoma. This is a lesion
that is on a person's arm. Now, as you notice, the color is
irregular. There seem to be two different colors to it. The
border is irregular and as you look at it, it just doesn't
look like a nice looking mole.
Dr. Bob: Now, are melanomas becoming more and more
common?
Dr. Shimazu: Yes they are.
Dr. Bob: How common are they and how dangerous are
they?
Dr. Shimazu: Well, I would say that we expect within
the year of 2001 to diagnose over 50,000 new melanomas and
that works out to at least one in about every 70 people.
Dr. Bob: That's really, really impressive, sorta scary.
Why do you think we are seeing, it's on the rise, isn't it?
Dr. Shimazu: Definitely.
Dr. Bob: Aren't we seeing more and more melanomas?
Dr. Shimazu: Oh, yes. Compared to, for example, in
the 1930's, we would say maybe one melanoma per, oh, I would
say 200 people, 250 maybe. But now, one in 70.
Dr. Bob: One in 70. Why do we think that is?
Dr. Shimazu: Well, I think it is a combination of
things. #1. We're probably being more vigilant looking for
melanoma. #2. There's been a lot more exposure to sun and
people are playing in the sun, working in the sun and I think
that also adds to the population of developing more melanomas.
Dr. Bob: You know, as I grew up, it was, we didn't
pay much attention to sunscreens and I got a lot of sunburns.
Is that dangerous if I got sunburned back in childhood now
that I'm a more mature adult? Is this dangerous for me now
to have sunburns then?
Dr. Shimazu: Yes it is. There's been a lot of studies
that show sunburns during the earliest years of life can be
one of the biggest risk factors for developing skin cancer
later.
Dr. Bob: Yeah and that's why I sort of inspect my
skin frequently. Now, can a person inspect their skin good
or does it take a professional to do that?
Dr. Shimazu: Well, I think any person can look at
their skin on a regular basis, get to realize how their regular
or normal moles look like and notice if there are any changes.
Dr. Bob: Now, I can't see my back though. Are melanomas
common on the back or on the waist? Where, is there any area
that we need to worry about more?
Dr. Shimazu: Well, I think that males tend to be more
commonly affected by melanoma than females and a common location
is on the back. Now, females do develop melanoma and a common
location for them would be the lower extremity.
Dr. Bob: Now, let's talk about, if I've got a little
lesion in my hand or on my leg or on my back and it looks
a little dark and maybe it's changing. What are some of the
characteristics? Let's look at the next, they're called, do
you call them A, B, C, D's?
Dr. Shimazu: That's right.
Dr. Bob: Is that what it is? Let's talk about the
ABC's of melanoma. Let's look at the first picture here. Now,
that's A, that's asymmetry, what does that mean?
Dr. Shimazu: That's right and that just means that
if you look at something and it looks dissimilar or unlike,
one side looks unlike the other. If you were to try to cut
that in half, neither side would look similar.
Dr. Bob: And most benign lesions in general would,
one side would look like the other?
Dr. Shimazu: Exactly.
Dr. Bob: It would make you think it wasn't as dangerous
possibly. You can never say all or none I realize. So, we've
got asymmetry and boy, that one is really asymmetric. The
outer borders look a little different color than the middle.
Is the melanoma on all parts of that lesion?
Dr. Shimazu: It probably is on all parts of that lesion
by now.
Dr. Bob: Let's look at B. What does B mean?
Dr. Shimazu: B stands for border and that reminds
us that moles that are more likely to be dangerous have a
very irregular border. As you notice here, it's kinda shaggy
and it goes in and out as compared to a normal or happy mole
that would just be easily bordered.
Dr. Bob: So, if anybody has a mole that looks like
this that's got an irregular border, that one side is different
from the other, it's time to see the doctor immediately.
Dr. Shimazu: I think that would be a reasonable…
Dr. Bob: A, B, C. What's C?
Dr. Shimazu: C stands for color and of course, one
of the main things about melanoma is the color is different.
There is, you see black, you see red, sometimes you can see
white and that would be an important characteristic that would
tip us off to that kind of mole.
Dr. Bob: So a lesion may have more than one color
in it?
Dr. Shimazu: Yes.
Dr. Bob: Oh, that's very, I thought a melanoma would
be just a dark mole all over but if you look carefully, it's
got different colors.
Dr. Shimazu: That's right.
Dr. Bob: So, we've got A, B, C, that leaves D. What's
D? Let's……..
Dr. Shimazu: And D stands for diameter. And as you
can see here, this is a very large dark looking lesion on
a person's face. I guess the cut off that we like to think
about is the size of a pencil eraser. That's about 6 mm and
this, of course, goes way beyond that but remembering that
something larger than a pencil eraser might be at increase
risk of developing into a melanoma or being a melanoma is
a good guideline.
Dr. Bob: Can people tell if they've got a lesion that
growing? If they can tell that it's growing and getting bigger,
that's obviously a dangerous sign. But is it too late if they
notice it's gotten bigger and bigger and bigger?
Dr. Shimazu: Oh, not at all. The sooner a person goes
for evaluation when they notice change, the better it is.
Dr. Bob: Now, we're having less people die per melanoma
found. What is that? We're finding them early.
Dr. Shimazu: I think that would be the main reason.
Yes.
Dr. Bob: How do you make the diagnosis? You see somebody
that has a very suspicious lesion, what do you do?
Dr. Shimazu: I think the first thing that I would
do is, I would make sure that a biopsy is performed and I
would try, if possible, if it's in a location that's amenable
to it, to remove the whole thing.
Dr. Bob: Now, the treatment in general very quickly
as far as surgery goes…..there's no medicine, you can't
put a cream on it, can you?
Dr. Shimazu: No.
Dr. Bob: The treatment is excision?
Dr. Shimazu: That's correct.
Dr. Bob: And when you excise it, how do you tell how
much to take out?
Dr. Shimazu: Well, it depends on the depth of the
melanoma and that's only measured under a microscope. So,
the lab is very helpful in determining how much we have to
get around a melanoma in order to make sure that we have cure.
Dr. Bob: Now, if it's spread, if it gets into the
lymph nodes or into organs, is there any treatment for that?
Dr. Shimazu: There is treatment and that is usually
handled by a specialist such as oncologist who deal with cancer
and I think that is something that is a little more complex.
Dr. Bob: Yeah, it really is and we're going to be
coming back talking about, hopefully not as bad as melanoma,
some other skin cancers but first, we want to talk about a
patient who did find that suspicious lesion.
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