Saving Your Skin - And Your Life
Robert Mansell and his wife, Wendy, and their children: Adam, 9, and Tegan, 5. The Mansells protect their kids’ skin with sunblock—and with clothing.
Fair-skinned, fair-haired Robert Mansell grew up in Australia, where sunshine is plentiful. He spent much of his youth outside, for as many hours as there was daylight. That’s what kids like him did in the ranching and farming community where he was raised. There was work to be done.
Clad in shorts, boots, and a hat, but often shirtless, Mansell didn’t ignore the idea of protecting his skin. He did coat his nose with a goopy white zinc-based sunblock. But even that heavy-duty barrier was no match for the 100-degree heat. And the moist sunblock would attract so much dust, Mansell’s skin would quickly become a cakey mess.
Finally, in 1988, Mansell’s work in information technology began to keep him more inside than out, so much so he didn’t think much about protecting his skin. Five years later, Mansell’s wife, Wendy, a keen-eyed daughter of a nurse, spotted something on her husband’s back that did not look right.
"I was a textbook case.” – Robert Mansell, treated for skin cancer at Stanford Hospital & Clinics
Mansell, who has lived in Half Moon Bay for the last several years, is now a regular patient at Stanford Hospital & Clinics Department of Dermatology. His doctor is Hayes Gladstone, MD, a specialist in one of the most effective treatments for basal cell carcinoma, the kind of skin cancer that has emerged many times on Mansell’s body in the last 15 years.
A technician prepares a five micron-thin frozen sample for Gladstone's microscopic examination.
Hayes Gladstone, MD,
determining the type of skin cancer he's seeing.
Preserving a delicate barrier
Think of the skin as delicate wrapping paper for the body and it is easy to see its vulnerability. At any given time, one out of every three people in the U.S. suffers from a skin disease. More than 3,000 varieties of skin disease have been identified, from common conditions like herpes simplex and contact dermatitis to the more uncommon, and very serious, melanoma and blistering diseases. Skin cancer is the second most diagnosed condition.
Stanford Hospital & Clinics dermatology department was an early adopter of innovative treatments for skin cancers, including an approach called a Mohs micrographic procedure. Named after its creator, the Mohs is a tissue-saving surgery, very precisely removing just cancerous skin and tissue. Previously, surgeons did not have the microscopic support now available to accurately chart a skin cancer’s depth and width. They had no choice but to take more skin and tissue. The scars could be quite disfiguring.
Gladstone, who has performed more than 20,000 Mohs procedures, also specializes in any reconstructive surgery needed afterwards to restore the skin in the affected area as naturally as possible.
What alarms dermatologists and dermatologic surgeons is the number of patients they see who come in with late-stage skin cancer — especially men, and especially on their backs.
Vigilance Rewarded
Wendy Mansell was particularly aware of skin cancer’s appearance. She’d been the one to notice a suspicious mole, later diagnosed as cancer, on her 18-year-old brother’s back. She also grew up in Australia, and, like her husband, wishes that Americans would take skin cancer a bit more seriously. The Australian government takes it so seriously that it passed legislation several years ago requiring schoolchildren without hats to stay inside at recess.
You just need to be aware, and you need to go to a doctor who knows the difference.”
– Wendy Mansell, Robert Mansell’s wife
Gladstone knows that Americans are more aware that sun can cause skin cancer, but he would be happier if people insisted their doctors start doing skin checks from an early age. “Sun damage starts at an early age,” he said. He recently treated a young woman who grew up in Southern California and now, at 21, has had her first skin cancer removed.
Hats are a must when the family goes outside, although a windy day can be a challenge for keeping them on.
Catching skin cancer early, and preventing its recurrence, is an important part of the clinical care at Stanford. Within the department are special clinics and services focused on different types of skin cancer, unusual skin diseases and scar reduction. The department is also a partner in a national awareness campaign focused on the most lethal type of skin cancer, melanoma. The message repeated by these dermatologists is simple. Most skin cancers are treatable with great success, if removed before they grow large or spread to other parts of the body. And doctors know that if one skin carcinoma has appeared, there’s a 50 percent chance of another emerging.
The Mansells have been quite vigilant about protecting their children’s skin from the time they were babies. Adam, 9, and Tegan, 5, are both very fair, like their parents. “They are both very good about hats and covering,” Wendy said. Once or twice, they’ve gone outside without protection on the kind of foggy day that’s part of life on the coast. “They got a little bit of a sunburn and they didn’t like it.”
She goes one step farther and sends them for annual checks to a pediatric dermatologist. “You just need to be aware, and you need to go to a doctor who knows the difference,” she said.
Special Feature
What you need to know about sunscreens
•
Use an SPF of at least 30, but be aware that number only reflects how well UVB rays are screened. There is no effective way to measure a sunscreen’s protection against UVA rays, equally as dangerous as UVB.
•
Look for sunblocks with titanium dioxide or zinc oxide. These substances act as actual barriers against the sun. Two ingredients are musts for a sunscreen to be effective against UVA rays: aveobenzone (also known as parsol 1789) and, to keep it from breaking down in the sun, Mexoryl.
How to protect your skin
• Apply sunscreen or sunblock 30 minutes before going out. Use enough: two tablespoons, a palm-full, for full body coverage. Reapply at least every two hours. If your scalp is not fully covered by hair, try a spray-on sunscreen.
•
Wear a hat that covers your ears and the back of your neck.
• What else you wear counts, too. Cover as much of your skin as you can. A tightly-woven fabric can protect skin better than inadequately-applied sunscreen. For extra protection, look for clothing rated for its UVA-protection.
•
Avoid the 10am-3pm sun, unless fully protected. Seek shade when available.
Free lecture
Hayes Gladstone, MD, and Susan Swetter, MD, will give a free talk about skin cancer, skin protection and skin rejuvenation at 6:30 pm, May 13, at the Frances C. Arrillaga Alumni Center, 326 Galvez St., near Campus Drive on the Stanford University campus. For more information, phone 650.725.0455.
Free screening
Stanford Hospital & Clinics hosts its annual free skin check clinic from 9 am to noon, May 16 at the new Stanford Medicine Outpatient Center, 450 Broadway, Redwood City. For more information call 650.723.6316.
We’re at a new frontier in skin medicine.” – Hayes Gladstone, MD, Director, Division of Dermatologic Surgery, Stanford Hospital & Clinics
One of the first things Stanford physicians did to check for cancers on Mansell was take a very close look at his face, after chemical peel. “I was a textbook case,” he said. “They could see very small but very numerous skin cancers.”
New ways to see
Gladstone is looking forward to the arrival at Stanford of a brand-new diagnostic tool, a confocal microscope. It uses a probe to send light through the skin. Cancer cells respond to that light differently and make it possible to map a cancer without an invasive biopsy. Other non-invasive treatments in development at Stanford include the use of non-toxic substances that would chemically deter skin cancer growth.
And, Stanford bioengineers are working with Stanford physicians to create computer software that could build a 3-D image of a skin cancer, again without the pain of surgery. “In an ideal world there will be no more cutting to treat skin cancer,” Gladstone said. “We might have to inject something or use a topical treatment, but we’re at a new frontier in skin medicine. We are definitely getting there.”
Robert Mansell still goes to the beach, bikes with his kids and enjoys outdoor life, but he does so with scrupulous care of his skin. Whenever the opportunity arises, he also does his best to be an advocate of skin protection and skin checks. He’s not always effective. “If they’re not doing it, with all the media coverage and the information that’s out there, they won’t listen to me. I just back off and shake my head.”
Wendy Mansell is eager to share what she has learned about sunscreens “They have a shelf-life, although the date isn’t stamped on the tube,” she said. "So I throw out the unused tubes every season and buy new. For what you’re playing with, and the odds of getting it, it’s not worth taking
the risk.”
Gladstone talks about sunscreen to patients who tell him, “I never go out in the sun.” His response? “We live in California, so it’s impossible not to.”
For more Stanford Hospital Health Notes Click Here.