How Not to Get Skin Cancer

Three dermatologists who’ve beaten the disease share their (sometimes unconventional) approaches to staying healthy and preventing recurrence

By Michele Bender
Photograph: Photo courtesy of Iphoto

A sobering statistic: You have a one in two chance of getting skin cancer by the time you’re 65—even
if you haven’t baked at the beach in decades. But America’s most common cancer is usually treatable and, even better, it’s still preventable (even af

Cheryl Karcher, MD, 50 
Cosmetic and general dermatologist
New York City
Growing up in Daytona Beach, Florida, Cheryl Karcher was a sun worshipper who walked around with a tan nearly 365 days a year. “I never wore sunscreen, and as a teen, I magnified the sun’s rays with baby oil and a reflector,” she admits. And although she eventually put down that reflector, she remained careless throughout her twenties. By the time she started protecting her skin in her thirties, she was a newly minted dermatologist—but she had already set herself up for cancer, because she’d been exposed to a great deal of sun both as a child and as a young adult.While conventional wisdom has long held that only childhood sun exposure (which causes changes in skin cells) counts in the development of cancer, experts now believe that continuing exposure after age 18 is most likely to transform your damaged cells into cancerous ones.
For Karcher, the first damage took place during childhood, and the second in her twenties. Whatever her history, at age 46 Karcher discovered a skin-colored, pencil eraser–size bump on her chest. “To the untrained eye, it would look like nothing,” she recalls. “But as a dermatologist, I knew it was a basal cell carcinoma.” Basal cell carcinoma (BCC), the most common form of skin cancer (diagnosed in one million Americans every year), is rarely fatal but can cause disfigurement.

How she treated it

Knowing that surgical removal of the cancerous bump was likely to leave a scar (the skin on the chest is
very thin and typically heals poorly), Karcher opted instead to treat the spot with Aldara Cream, a prescription medication that’s approved by the FDA to treat superficial BCC, common precancerous spots (called actinic keratoses) and genital warts. The drug works by activating the body’s immune cells in a specific area of the skin.For up to five nights a week for about six weeks, Karcher slathered the bump with Aldara, which left the area temporarily red, itchy and swollen. “It wasn’t pretty,” Karcher recalls. “But once I knew the Aldara had produced an ulcer deep enough to get rid of the basal cells, I stopped applying the cream and let the area heal. I do have a tiny scar, but it’s barely noticeable.” Just three weeks later, she used the same cream again—to treat a BCC she discovered on her left arm. “It’s been three years and neither skin cancer spot has returned,” says Karcher, who cautions that people who do not hold medical degrees should only use Aldara under a der­matologist’s supervision.

How she prevents it now
Aggressively removing skin that may become cancerous is Karcher’s number-one priority.
• Regular self-exams Karcher gives herself the once-over at least twice a year. She tells her patients to come
in for a full-body check at least once a year. And they should make an appointment right away if they notice a spot that is new, asymmetrical, has uneven borders, has a strange or uneven coloration, grows in diameter or bleeds regularly.
• Light to medium peels every four to six weeks You won’t read this in medical textbooks, but Karcher has been doing salicylic and lactic acid peels on her face once a month for years and has never had an incidence of cancer there. While she says there is no data proving a connection, she believes peels may help the body shed precancerous lesions before they become a problem. The American Cancer Society does not take a position on face peels as a skin cancer–prevention tactic, so discuss with your doctor whether this procedure is right for you.
• Aldara—twice a year In another unorthodox move, Karcher applies Aldara Cream every six months on
her face and chest in an effort to prevent a recurrence—and she has not had one. She says the Aldara helps identify potentially problematic areas by turning them bright red. She then treats those spots for six weeks, as she did her BCCs. Karcher also uses this approach on higher-risk patients (those who’ve had extensive sun exposure or who’ve been previously diagnosed with skin cancer).

Vivian Bucay, MD, 48 
Medical and cosmetic derma­tologist, San Antonio; clinical assistant professor at the University of Texas Health Science Center
San Antonio, Texas

After three pregnancies (and C-sections), Vivian Bucay thought she knew her belly button inside and out—literally. So she wasn’t that concerned when she saw a dry, whitish discharge on a dark top she was wearing one day. “I didn’t have any pain, tenderness, bleeding or a dark mole that would suggest a can-cerous growth, so I thought it was just psoriasis or eczema,” Bucay says. But just to be on the safe side, she decided to have the area biopsied and was stunned when the pathol­ogist called her to say she had melanoma. The deadliest form of skin cancer in this country, melanoma claims the lives of 3,000 American women every year.

Weeks after the initial diagnosis, follow-up surgery revealed the cancer had also spread to nearby lymph nodes. “I was classified as a stage III cancer patient with a five-year survival rate of 50 percent,” says Bucay,
who then endured three months of high-dose interferon treatment while she waited to en­roll in a trial of
an experimental new melanoma-prevention drug.

How she treated it
Bucay was finally approved to starttreatment with anti-CTLA-4 antibody, a drug that takes the brakes off the body’s immune response, increasing its ability to fight off melanoma cancer cells. However,
she had to drop out of the trial
• Topical antioxidants In addition to consuming a diet filled with organic antioxidant-rich fruits and vegetables, Bucay also applies topical antioxidants like coffeeberry and vitamin C on a daily basis. “These block free radicals, which are believed to not only break down collagen and elastin but also to affect the structure of your DNA and leave you more susceptible to skin cancer,” she explains. Her favorite: RevaléSkin Intense Recovery Treatment with coffeeberry extract ($130). To try it, go to revaleskin.com to find a physician near you who sells the RevaléSkin line.
• Rx tretinoin cream In our twenties, it takes just 28 days for epidermal cells to renew, but after 40, cell renewal can dramatically slow down and precancerous cells have more time to “sit around” and transform into
cancer, Bucay says. Using a product with tretinoin, the active ingre-dient in Retin-A and Renova, at least three times a week can help to accelerate that skin cell turn­over rate again.
• Sun avoidance Although her family still takes vacations, Bucay avoids the beach between 10 am and four pm. “I used to sit in the shade wearing sun block, but I learned that the sand reflects 30 percent of the sun’s rays,” she says. And don’t try to justify that twice-a-year tan. “Many people think they’re not at risk because they take just one or two warm weather vacations a year,” Bucay says. While the majority of nonmelanoma skin cancers are caused by continuous UV exposure, the latest thinking on melanoma is that it’s shorter, higher doses of sunlight that increase your risk.

Leslie Baumann, MD
42  Cosmetic dermatologist, Miami Beach; director of the University of Miami Cosmetic Medicine and Research Institute
Miami Beach, Florida

Getting Lasik surgery did more than improve Leslie Baumann’s vision; it opened her eyes to a potential
skin cancer. “When the Lasik doctor examined me closely, she saw a very tiny bump on the inside of my lower lash line,” Baumann recalls. Although it was still too small to identify, Baumann watched the spot grow to become a little pearly ball about the size of a pinhead. A biopsy confirmed that the growth was a basal cell carcinoma. “The rest of my skin is fine because I’ve always been careful, but I got cancer on the one spot where
you can’t wear sunscreen,” says Baumann, who believes sun-filled days growing up in Lubbock, Texas, are partly to blame. “I wore sunglasses, but back then they were not coated with UV protection the way they are today,” she says.

How she treated it
A busy working mom, Baumann waited a few weeks after the biopsy to schedule surgery to remove the  cancerous lesion. By that time her biopsy had healed so well that Baumann’s doctor couldn’t find where the spot had been. “Because the eyelid area is too small, you can’t just dig around and take out tissue to guess where the cancer is, so we had to wait for it to grow back before doing surgery,” Baumann says. Within a year, the cancer was about half the size of a mini M&M. “Unfortunately, it grew down in-stead of out, so it took up a quarter
of my eyelid,” she recalls. To remove it, Baumann underwent a four-hour surgical procedure, in which doctors took out tiny pieces of the lid, froze them and sent them to a lab to check for cancer. “The cancer had grown so deep that the surgeons had to do that four times to make sure they had got it all,” Baumann says. The operation was a success: “I look every day, and the growth hasn’t returned.”

How she prevents it now
Because her cancer popped up somewhere unexpected, Baumann has created a regimen that’s thorough and a little nontraditional.
• Sunglasses with UV coating Whenever Baumann is outdoors—golfing, playing tennis, even driving to work on a sunny day (UV rays can get through glass)—she wears eyewear coated to deflect UV rays.
• Anti-inflammatory pills Baumann believes Heliocare supplements ($115 for a six-month supply; heliocare.com), which contain Polypodium leucotomos (a type of fern with anti-inflammatory properties) can stimulate the anti-oxidant activity that helps ward off cancer cell formation.
• Self-checks in unexpected places You normally don’t think of the inner eyelid as a potential cancer site, but five patients who heard Baumann’s skin cancer story came in with similar spots on their lids—and three of them were malignant. And that’s not the only strange place lesions can pop up. She tells her patients to check out their scalps, the bottoms of their feet and even, yes, between their legs. “Now that I’ve had skin cancer, I know I have the genetics to develop more, so I’m extra cautious,” Baumann says. when scans discovered the melanoma had moved to her lungs. “It was shocking because I had no symptoms—I really felt fine—and I was working normal hours, planning my young­est daughter’s bat mitzvah and going about my life,” Bucay says. Her cancer was now stage IV and required two courses of interleukin-2, a toxic treatment that’s administered over a five- to six-day period in a hospital’s intensive care unit. “I prayed every day for membership in the six percent club,” she says,
referring to the tiny percentage of patients with stage IV mela­noma who have complete remission with interleukin-2.Those prayers were answered. Sixteen months after being diagnosed, Bucay’s cancer disappeared completely.

How she prevents it now
Because people who have melanoma are twice as likely to develop other types of cancers, Bucay is cautious about what she puts on—and into—her body.
• Daily supplements Each morning, Bucay pops 1,000 IU of vitamin D (the current Recommended Daily Allowance is 400 IU for ages 40 to 70, but she believes that is too low), which some researchers believe protects against skin cancer. She also takes coenzyme Q10 (200 milligrams), to help bol­ster her immune system, and omega-3 fatty acid (1,200 milligrams twice daily), which she thinks helps to minimize the appearance of sun
damage. Bucay also eats or-ganic food when­ever possible, “because we don’t know the role other chemicals have in terms of weakening the immune system and causing cancer,” she explains. And she recently added nicotinamide (vitamin B3) to her regimen. One reason: In a recent Australian study, researchers found that daily doses of between 500 and 1,500 milli­grams of nicotinamide helped guard against suppression of the immune system by UV radiation, which in turn helps to lower the risks of skin cancer.


First Published Mon, 2009-04-20 11:05

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