How do people with skin cancer concerns choose the right doctor?

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KANSAS CITY, Mo. — Daniel Aires is director of the dermatology division at University of Kansas Hospital. Aires, a physician, grew up in Overland Park. His medical training includes Yale University School of Medicine, Brigham and Women’s Hospital and Harvard Medical School. Six years ago, after 24 years away, he returned to Kansas City to take his current job.

A lot of dermatologists specialize in cosmetic procedures. How do people with skin cancer concerns choose the right doctor?

Ask if the physician is board certified in dermatology. People are very interested in cosmetics, but that’s a fairly small part of dermatology. What I like about cosmetics is when people think about the way they look and that causes them to think about their health. Because to a certain extent looks are windows to health.

Q: What are some common misconceptions about skin protection?

A: One is that if you put on a moisturizer with SPF or a sunscreen every day, you are protected.

Q: Why is that not true?

Because when they measure SPF ratings in a lab, they apply it so thickly you almost can’t see through it. When people put it on in real life, they put on a lot less and they’re getting a lot less protection. And it wears off after a couple of hours.

Another misconception is, when people think of protective clothing, they mostly think of long-sleeved shirts. And that is almost the opposite of what they should think.

Q: Why?

A: The shirt leaves your head and your hands exposed. And those are two places where you don’t want to biopsy, because there’s not a lot of skin there. I’d rather see someone walk around outside in a swimsuit and a hat and gloves than in a long-sleeved shirt and no hat and no gloves. You can find SPF-rated gloves at any outdoor store.

The most important thing is to avoid sunburns. It’s generally not that 3, 4, 5 minutes of sun you get walking across a parking lot that is a problem.

Q: Do people need to worry about protecting the skin in cool-weather months?

A: Ultraviolet rays are still there on rainy days and in cool weather, and they can still cause pre-cancer activity. The risk is lower, but it is still there. If you want to run or walk the dog, wear a hat and gloves.

Q: Are people who have olive skin less at risk?

A: To a certain extent. If you have a Mediterranean background and there is no history of skin cancer in any family members, you do not need to worry as much. If you have light skin or light-colored eyes or a relative who has had skin cancer, you need to be more careful.

Q: What about African-Americans?

A: We recently found a melanoma on the foot of an African-American patient. African-Americans are less likely to get a sunburn and therefore less likely to develop skin cancer, but I have seen and removed lots of skin cancers from African-Americans and other people with darker pigmentation. No one is immune.

Q: How can people tell if a spot or mole needs to be looked at?

A: Anything that is strange or that is changing needs to be looked at. One of my residents uses the term “funky.” We normally teach the A, B, C, D and E rules, but I would add F for “funky.”

Q: What are “A” through “E”?

A: Asymmetry, Border irregularity (not uniformly round), Colors (more than one), Diameter (larger than a pencil eraser), Evolving.

Q: Are there male-female differences in where skin cancers occur?

A: Yes. Women get more on the legs and feet. Women, please don’t wear sandals to the beach — feet are a terrible place to biopsy.

Men get more on the arms and upper body from going shirtless.

Q: How often should people check their bodies and how should they do it?

A: People who are concerned should do a self skin exam once a month. If you look every day it’s like puppies: You don’t see them growing, but they are. The best place is a well-lighted area with a full-length mirror. Use a handheld mirror to check the back or have a partner check the back.

Q: What trends are you seeing in skin cancer?

A: Sadly, skin cancer rates are going up and up. Americans became sun worshippers in the ’60s, ’70s and ’80s, and there is generally a 10-, 20- or 30-year lag in when skin cancers appear. So there’s a hope that in 20 years it will start to trend downward as people became more aware.

Q: Those of us who were basting ourselves with Crisco by the pool in the ’70s are just doomed, right?

A: (Laughs.) No.

Q: Is there a reason for us to use sun protection now?

A: Absolutely, there is. There may have been some damage done in the past, but there’s no reason to add more damage. And there are ways of reversing some of that damage with prescription medications.

Q: Are there foods or vitamin supplements than can help ward off skin cancer?

A: I’m not a huge fan of vitamins or supplements except for vitamin D.

Q: How much vitamin D should people take?

A: If you don’t have kidney stones or some other reason you shouldn’t take it, the endorsed dose is 400 mg per day. You should take it with food.

Q: Anything else?

A: I’m not a fan of antioxidant supplements. But I’m a big fan of eating lots of fruits and vegetables, because they are loaded with all kinds of antioxidants. A tomato may have a thousand different kinds of lycopene.

Q: How dangerous is skin cancer? There is a perception that, except for melanoma, it’s pretty harmless.

A: That is unfortunately not true. There are some skin cancers that are less dangerous — basal cell cancers very seldom kill people. Squamous cell cancers, on the other hand, do kill people. And we all know melanomas are deadly.

Q: Is there anything to be optimistic about with squamous cell cancers or melanomas?

A: A lot. If you catch them early they are never deadly. The death rate for early-stage melanoma is around 1 percent.

Your best defense is aggressive surveillance and seeing a dermatologist regularly if you are at high risk because you are light-skinned, light-eyed, have had sunburns or have family history of skin cancers.

Q: And now a question that’s not about skin cancer, probably one you get asked at every party you go to: How can I prevent wrinkles?

A: I’ll give you a multipart answer. Number one: Stop smoking.

Q: Why?

A: It constricts the blood vessels in the skin. And it induces matrix metalloproteinases, or MMPs, that act like scissors and cut up the skin and increase wrinkling. And cigarettes contain all kinds of weird toxic things …

Number two: Wear a hat. Number three: Eat a lot of vegetables. Number four: Get enough sleep. Number five: Exercise.

Q: You didn’t say to “drink water.” I’ve often heard drinking a lot of water gives you healthy-looking skin.

A: I would characterize that as a misconception. There’s a lot of talk about it but not a lot of data about it.

Q: What do you think about tanning booths?

A: I don’t think they are evil incarnate. My problem with booths is they can put out a lot more radiation than natural sunlight. By definition, if they can give you a tan they can harm you. A tan is the body’s response to a low level of harm.

I have no objection to a light tan with no burning. But I would not encourage most people to tan. I would encourage people to be happy with the skin tone they have. Black is beautiful, brown is beautiful and pink is beautiful.