Lisa Nyanda-Manola, MD, double board certified in dermatology and pediatrics, was interviewed by Heidi W. Moore of Dermatology Advisor in May about her experience with skin cancer within her practice. She answered a series of questions related to Protection, Prevention and the incidence of skin cancer, including skin cancer in those with skin of color.
Dr. Nyanda specializes in pediatric, general, and cosmetic dermatology; she practices at both the New Port Richey and Spring Hill locations of Advanced Dermatology and Cosmetic Surgery in Florida. She is a fellow of the American Academy of Dermatology and the American Academy of Pediatrics.
May is Skin Cancer Awareness Month, and despite skin cancer being one of the most preventable cancers—although also the most common—there are still some knowledge gaps that need to be addressed.1
Of particular interest is the rising rate of skin cancer among patients with skin of color. Indeed, in the past two decades, melanoma diagnoses among Hispanic patients have risen 20%. Not only have the rates among the Hispanic population risen but a diagnosis of melanoma is more likely to be fatal.1
Q. What are the most common misconceptions about sun protection that you encounter in your patients? How do you address them?
A. The biggest misconception about sun protection is that most patients feel that they don’t need to use sunscreen because they don’t plan to be out in the sun for a prolonged amount of time. In addition, another misconception that I hear frequently is that patients with darker skin think that they don’t need to use sunscreen because they don’t get skin cancers.
I address these misconceptions by counseling the patients that they are still at risk for skin cancer due to the accumulation of sun damage that occurs over time. I encourage them to use sun-protective measures such as hats, sunglasses, and photoprotective UV clothing. I also remind them about the importance of reapplying sunscreen every 2 to 3 hours.
Q. Have you found that patients’ attitudes or practices have changed in the past few years, and if so, how so?
A. Yes, I have found that patients’ attitudes have changed due to the fact they are more aware of the risks of sun exposure and the risk associated with skin cancer development. Most patients are also receptive to the idea of photo protection.
Q. Do most of your patients think they are doing a good job of protecting themselves from sun damage? Are they, in reality?
A. Most patients believe that they are already doing a good job with photo protection. They conclude that wearing a hat or applying sunscreen once daily is going to be enough to provide adequate photo protection. Unfortunately, these are not sufficient to provide the necessary protection that our patients need. I advise them that instead of wearing a baseball cap to rather wear a wide brim hat for better protection. In addition, I encourage patients to re-apply sunscreen every 2 to 3 hours.
Q. Are there issues unique to your demographic or area that you routinely address? Universal issues?
A. The issues unique to the demographic area is that we live in Florida. We have continuous exposure to sun due the climate being mostly hot and humid. Most of these patients are involved in outdoor activities which can increase their risk for skin cancer.
Q. Describe your practice’s involvement with patients with skin of color. To what do you ascribe the recent finding that in the past 2 decades, melanoma diagnoses among Hispanic patients has risen 20%1?
A. The practice’s involvement with patients with skin of color has been focused on total body skin examinations. These exams encompass a comprehensive evaluation that allows for the inspection of areas that could easily be overlooked such as the scalp or the bottom of the feet. I believe that since there has been an increased awareness and encouragement of patients of color to seek dermatological evaluations as we have been able to improve their early diagnosis.
Q. In what area is the biggest need for education among those with skin of color?
A. biggest area needed for the education for patients with skin of color is the importance of having a full body skin examination yearly to evaluate for the possibility of skin cancer. Most patients with skin of color may have the misconception that they cannot get skin cancer and therefore do not go in for skin evaluations. Another misconception commonly encountered in this population is the reluctance to use sunscreen or other photo protective measures.
Q. What are the biggest challenges in preventing skin cancers in patients with skin of color?
A. The biggest challenge is that patients with skin of color may not seek dermatological care, and therefore they are less likely to have a skin evaluation. This leads to a delay in the diagnosis and treatment of their skin cancers.
Q. Any other precautions you suggest to your patients?
A. The strongest precaution that I suggest to patients is using broad-spectrum sunscreen SPF 30+ or greater. I encourage them to reapply sunscreen every 2 to 3 hours for the maximum level of protection.
I also encourage patients to seek shade structures to avoid prolonged sun exposure. In addition, I encourage them to use wide brim hats, sunglasses, and UV protective clothing.
Perez MI. Hispanic Doesn’t Mean Immune to Skin Cancer. Skin Cancer Foundation. October 14, 2020. Accessed May 19, 2022. https://www.skincancer.org/blog/hispanic-doesnt-mean-immune-to-skin-cancer/
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