Dr. Jonathan Wolfe is an Associate Professor of Dermatology at the University of Pennsylvania and Division Director of Dermatology Einstein Medical Center Montgomery. In addition to serving as editor for Practical Dermatology®'s Oncology department, Dr. Wolfe has authored numerous publications and presented original research at national meetings. Ahead he shares perspective on the state of skin cancer awareness as well as lessons he's learned in his years of experience working with patients.
What are some of the biggest misconceptions you've heard from patients when it comes to skin cancer?
Patients' misconceptions about skin cancer, UV light, and sunscreen are sadly quite prominent. Here are several examples of things Dr. Wolfe has heard from patients, followed by his responses:
“Tanning salons act as preventative measures prior to travel.” Tanning beds can raise the risk of melanoma by 59 percent, which, according to Dr. Wolfe, may be a reason melanoma is increasing faster in young women (ages 15-29) than in young men of the same age (70 percent of tanning salon patrons are white young women). “The indoor tanning industry's revenue was estimated to be $2.6 billion in 2010. Indoor tanning equipment includes all artificial light sources which emit UVA and UVB. The amount of radiation produced during indoor tanning may be stronger than natural sun and does not lead to epidermal thickening which can occur with isolated UVB exposure,” Dr. Wolfe explains.
“Sun can't get through clouds.” Even on cloudy days UV rays can penetrate the skin, according to Dr. Wolfe. “On a cloudy day, up to 80 percent of the sun's UV rays can pass through the clouds.”
“Spray sun screens work just as well.” Not necessarily, argues Dr. Wolfe. “As soon as a person pushes on the button to use a spray on sun screen, 50 percent of the sun screen evaporates into the air. That immediately changes the presumed SPF of a sunscreen,” he says.
“I need to purchase the most expensive cosmetic products to prevent aging of my skin.” Says Dr. Wolfe: “There is no magic way to stop aging of the skin. In fact, sunscreen and moisturizers are the two most effective anti aging products you can buy. Tretinoin is the only prescription treatment approved by the FDA to prevent photoaging of the skin.”
Going forward, what would you say are the greatest challenges with regards to facilitating a greater public awareness of the dangers of UV light and skin cancer?
Although the might of the tanning lobby is beginning to diminish somewhat (Hawaii recently became the tenth state to outlaw indoor tanning for minors), Dr. Wolfe notes that it still poses a significant threat. “Smokescreens created by tanning salons are beginning to be eroded but still pose a huge challenge,” he says. Moreover, sunscreens are still hampered by regulatory inaction. “The FDA dragging on the approval of updated SPF rating scales is concerning—most people still do not understand the difference between UVA and UVB, as well as SPF values.”
Dr. Wolfe therefore recommends that dermatologists take as much action as they can themselves, including signing up for volunteer screenings, educating primary care physicians in addition to the public, and stressing sunscreen use whenever and wherever possible.
What's one of the most important lessons you've learned about the specialty of dermatology in your many years treating patients?
Whether you're treating skin cancer or performing cosmetic procedures, creating realistic expectations is critical, Dr. Wolfe notes. “Nothing is perfect. Nothing is ideal. We deal with probability and statistics only. We like to think we have control, but we don't sometimes,” says Dr. Wolfe. “It is important to educate our patients constantly just as we constantly educate ourselves.”