Pale is the new tan, dermatologist tells patients

September 11, 2017 by Richard Dymond, The Bradenton Herald

There's a framed picture in Dr. Terrence Hopkins' waiting room at his Manatee Dermatology practice that shows a little girl in a bikini on a beach with a jarring combination of words printed next to it.

The words: "Seashells. Driftwood. Skin ." Underneath that is the sentence: "It's amazing what kids pick up at the beach."

Hopkins is not hesitant to talk about its message to parents.

"We want kids not to come down with cancer," Hopkins said. "The more they protect themselves from early on, the better are the chances. What I tell parents these days is that protective clothing is the best thing they can do for their little ones. Little sun hats. Little protective clothing. Things like rash guard outfits like the surfers would wear are ideal. No one is born with freckles. They all develop freckles over time. Skin cancers form the same way. All that sunlight that accumulates over a lifetime from continued sun exposure, that's what gives you damage to your DNA and that's what gives you skin cancer."

"Pale is the new tan," Hopkins added. "Being tan is out. That's what we tell people."

Hopkins and his staff, including physician assistant Christa Lynn Hall, see about 50 patients a day, where his practice has grown since opening in 1998.

Using precise instruments like a dermatoscope, Hopkins is able to diagnose approximately 50 cases of melanoma, the deadliest form of skin cancer, yearly as well as hundreds of pre-cancerous moles and spots, and squamous cell carcinomas.

"If you catch them early, they are all curable," Hopkins said.

"Bob Marley, the great Jamaican reggae singer, had melanoma on his toe and did not get it treated," Hopkins added. "He died from it. But with treatment earlier he potentially could have been saved."

While the sun's rays are often the main culprit, Hopkins acknowledges that genetics also play an important role.

Hopkins said last week that people living in Bradenton, all of Florida and all of the sunbelt states must take precautions because the strength of the sun's rays in those areas are strong and increasing.

The American Cancer Society ranks California, Florida and New York as the highest producers of skin cancer and it estimates there will be 162,000 new cases of skin cancer in the United States in 2017.

"I think the biggest thing about Bradenton is that we have an elderly population," Hopkins said. "Whenever you have an elderly population you have more tendency toward skin cancer. The climate is extremely hot. Combine a hot climate with a lot of elderly people who have fair skin that makes for an increase in the incidence of skin cancer, period and I think that's what really makes Bradenton a hotbed."

The different skin cancers

The most common form of skin cancer is basal cell carcinoma, which can be connected to years at the beach or outside without covering, Hopkins said. Untreated, basal cell carcinoma, which forms in the basal or bottom layer of the epidermis, grows locally and forms wounds that do not heal. But it can easily be treated, Hopkins said.

Squamous cell carcinoma, which forms in the cells in the outer layer of the skin, is the second most common type of skin cancer and is also very much connected to sun exposure. It can be treated with minor surgery and/or medication, Hopkins said.

Melanoma, which often develops in a mole or inside a new dark spot, is also related to sun exposure and is the one that can progress to the lymph nodes and the other organs of the body, Hopkins said.

"It's the most dangerous form of cancer that we treat," Hopkins said.

Skin cancer survival starts with self-exam

Tourists and residents in Florida can avoid the possible fatal outcomes from with a game plan, said Dr. Nikhil Khushalani, one of the top cancer doctors at Tampa's Moffitt Cancer Center, which is the National Cancer Institute's only designated Comprehensive Cancer Center in Florida.

"Good screening and a daily prevention regime works," Khushalani said. "We recommend regular self-examinations, which can be done with the ABCDE formula."

The ABCDE formula for self-examination involves noticing the shape, border, color and diameter of moles and spots.

As for the "daily prevention regime" that Khushalani mentioned, it involves using sun screen, hats and long sleeve clothing during the sun's most dangerous periods of the day, between 11 a.m. and 3 p.m.

"We always say a sun screen with a sun protection factor, also known as SPF, of 30 is strong enough," Khushalani said. "There is no data to show that higher is better."

The sun screen should be reapplied every one and a half to two hours or after a person goes into the water, Khushalani said.

"We now have UV blocking clothing as well that is helpful, especially for people who may not tolerate certain sun screen containing cosmetics," Khushalani said.

Also, the doctor recommends use of a quality sunglasses with UV protection in the lenses which can help people prone to melanoma of the eye.

"Sunglasses also help prevent basal cell carcinoma and ," Hopkins said.

"This preventative methodology is especially important for high risk folks," Khushalani said, speaking of people who are light skinned and don't have as much melanin pigment in their skin that can give at least some protection from the sun's rays.


Although Hopkins doesn't practice at all at Moffitt, he says Bradenton residents with dangerous skin cancers like melanoma are lucky to have it if they need it.

"Years ago the Moffitt Center received a multi-million dollar grant to study melanoma," Hopkins said. "So we have some of the best minds in the Tampa Bay area just to study melanoma and we form little societies and groups to work things out with those guys, so when we have people with more advanced disease we definitely use them."

Khushalani is on the vanguard of immunotherapy, which is a new and promising treatment for melanoma that involves using drugs that work with the body's own immune system to attack mutated melanoma cancer cells.

"Moffitt has been on the forefront of the approval of all of the new immunotherapy drugs, like Keyruda and Opdivo, that have transformed the landscape of melanoma," Khushalani said from his office last week.

One way cancerous cells can operate inside the body without being detected and destroyed by the immune system is to give out signals to receptors at checkpoints on immune cells that they are normal and not mutated, Khushalani explains.

The drugs disrupt those signals and, instead, will encourage the immune system to seek out and destroy the cancerous cells, Khushalani said.

Before these drugs, a person with Stage IV melanoma, which is melanoma which has spread throughout the body, could expect to live seven to nine months, Khushalani said.

"But now we have tripled that survival rate," Khushalani said.

"Yes, we are talking Stage IV patients getting up to five years with these new drugs," Khushalani added.

If Manatee residents recall the drug Keyruda they may be relate it to former President Jimmy Carter, Hopkins said.

"Jimmy Carter had malignant which went to his brain," Hopkins said. "It was everywhere in his body. He had a drug that was not quite approved that was Keytruda. Keytruda is one of those that blocks the receptors. You see it used for lung cancer now. He wound up getting that drug and it reversed all of his metastatic disease. This is why we feel as if we have some hope."



A. Asymmetry. Skin cancer changes the usual symmetrical shape of moles. If a mole has become cancerous, the spots will not look the same on both sides.

B. Border. The edges of a mole can be a telltale sign of cancer. If they are blurry or jagged it can indicate the normal melatin is multiplying out of control.

C. Color. Usually, moles and other spots are one color. But if they become lighter or darker in some areas it should be evaluated.

D. Diameter. Size alone can indicate a problem. Most spots or moles should be about the size of a pencil eraser.

E. Elevation: If the mole is raised above the surface it can be a cause for concern.

Explore further: Melanoma isn't the only serious skin cancer


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