Of course, Jim adds, his problems with the sun didn’t begin when he moved down south. Originally from New York City, his family had a summer home in upstate New York, and he spent hours and hours in the sun as a child. “From the time school let out until Labor Day, we were just at the lake,” he recalls. “We’d go out right after breakfast, come home for lunch, and then go back to the lake.
“And in those days, they didn’t have any sun protection stuff. I really abused my skin, to the point of getting blisters on my shoulders and things like that. And now I’m paying for it.”
Unfortunately, in Jim’s case, all of that exposure has resulted in numerous skin issues, particularly a large number of pre-cancers. Known as actinic keratoses or AK, these pre-cancers require him to be examined up to every three months, both to treat areas of concern and to watch for skin changes all over his body. “I have a lot of basal cell cancers on my arms, hands, face and neck,” he shares.
In addition to the pre-cancers, Jim also developed eczema about 18 months ago, and the combination of conditions led him to seek out a skin specialist. “I saw an article in Pinellas Health Care News, and that’s how I found Dr. Mahoney.”
Protecting the skin
Matthew H. Mahoney, MD, an experienced dermatologist and founder of Mahoney Dermatology Specialists in Largo, is dedicated to spreading the message about skin cancer screening and prevention. “I want people to be aware that pre-cancers exist, that they are very, very common. Early treatment is quick and easy and can prevent development of skin cancer, but they become progressively more dangerous and harder to treat later.”
One of the biggest incentives to catching and treating these pre-cancers early, Dr. Mahoney says, is the opportunity to avoid surgery. “We can treat them with cryosurgery, which is freezing with liquid nitrogen, or sometimes with topical creams,” he explains. “I’ve seen patients as young as in their thirties with these, and they’re extremely common in Florida, particularly in patients aged fifty and older.”
In fact, Dr. Mahoney notes, one of the typical ways a patient will describe one of these pre-cancers as a “little spot that I pick off, but it keeps growing back.” Sometimes, he informs, these spots are painless, but other times they are a little uncomfortable. “I think it’s important for people to understand that little scaly spot that’s not going away could be a skin cancer or pre-cancer.”
And when treated early, the doctor adds, it is possible to prevent these spots from progressing to squamous cell carcinoma, which can go on to require a much more involved surgery or potentially even spread to other parts of the body. “Rarely, squamous cell carcinoma can even spread through the lymphatics or blood stream to involve lymph nodes or other organs, even causing death.”
In Jim’s case, by the time he went to see Dr. Mahoney, he had already required skin surgery for both squamous cell cancers and melanoma. “We’ve prevented some surgeries by treating his pre-cancers, and the conversion rate for these into a squamous cell cancer is actually lower than you think,” the doctor informs. “But you can imagine if you’re someone like Mr. McNally, and you have twenty of them or a hundred of them and you wait ten years, then you start to have a very real chance of some of them progressing into a squamous cell carcinoma.”
Of course, as with many health issues, family history does play a significant role in determining a person’s risk factor. “These pre-cancers are very unusual in pigmented skin, like someone who is African-American or Indian, but they are still common in sun-exposed skin of those of Mediterranean descent, such as Italian or Greek. With their fair skin, fair eyes and fair hair, those at highest risk are probably the Irish, British, Scottish and other northern Europeans.”
Additionally, the doctor shares, patients with a personal or family history of skin cancers, dysplastic moles or pre-cancers are also at higher risk. “Patients with pre-cancers, a large number of moles, or a strong family history should be screened every six months. If there is no history of any skin cancers or pre-cancers, once a year may be enough.”
Obviously, Dr. Mahoney stresses, the very best approach is a combination of protection, screening and prevention. As a recommendation, he tells patients to use a sunscreen with an SPF of 30 or higher, something containing zinc oxide, titanium dioxide or avobenzone to protect against both UVA and UVB rays, and to reapply every two hours. Sunscreen is not the only answer, however.
“There’s more to it than just sunscreen, sunscreen, sunscreen, which is kind of the American approach. I also recommend protective clothing, like hats with a four-inch brim all the way around and swim shirts for people who are in the water.
“We also need to do things like going kayaking at eight in the morning rather than at noon and building shade structures over playgrounds rather than having to coat our children with chemicals,” he stresses, adding that he and his wife just built a playground for their children in the shade. “It’s right underneath a tree and it’s shaded all day long.”
“Be careful about the sun”
These days, Jim is feeling better about the state of his skin. “It’s an old skin,” he says with a laugh, “so I feel as good as I can feel about it. Dr. Mahoney prescribes a lot of ointments and creams to put on my back, neck, face and ears, and they really help.”
Mostly, Jim really wants to help others be aware of the consequences of sun exposure. “I’ve already abused my skin, as a kid and as a teenager. I just want to tell people that they have to be careful about the sun. They have to use sunscreen and apply it liberally and often if they’re going to sit out on the beach.”
In fact, because of his own experiences, he says he has turned into a bit of a watchdog for others spending time in the sun. “We just live a block away from St. Pete Beach, so when people come, I always caution them. I say, You cannot go down there until you slather your body with sunscreen.”
And to take it a step further, he keeps a selection of sunscreens on hand. “I have about three or four different strengths and if they don’t have any, I say, Here, put this on. The sun down here is deadly.” FHCN - Brenda Klettke