What Does Skin Cancer Look Like?

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Transcript

Host: Tessa Lackey:

Welcome to Prescribed Listening from the University of Toledo Medical Center. On this podcast, we interview our experts to get the answers you need and can trust. I'm your host, Tessa Lackey. Skin cancer is one of the most common cancers in the US and melanoma is one of the deadliest forms of it. So how can you prevent it and recognize it in yourself, and then when is it time to talk to a doctor? Let's ask the expert. Dr. Danae Hamouda joins us from UTMC's Department of Oncology and Hematology to discuss this and more. Dr. Hamouda, thank you for joining us. So just to get kind of a baseline as we get started here, what is skin cancer and what's the difference between some different kinds of skin cancer?

Guest: Dr. Danae Hamouda:

Yeah, so really good question. So skin cancer is a collection of abnormal cells that grow out of control or out of order. It's actually the most common diagnosis of cancer. One in five Americans will develop a skin cancer in their lifetime. And there are three main types of skin cancer. The vast majority are this first type or the second type, this basal cell carcinoma or squamous cell carcinoma. And together these represent over five and a half million new diagnoses of cancer per year.

Now these types of cancer are typically associated with sun exposure and occur in these sun exposed areas of our skin. And they can be locally aggressive. They can cause some disfiguration and some discomfort and require some significant surgery to remove sometimes. But thankfully often these don't acquire the ability to travel. So while they can be locally aggressive and cause a lot of symptoms, they thankfully don't move to other areas very often. So although we have a lot of diagnoses of these cancers, it's about 2000 people a year die of squamous or basal cell carcinoma.

And this is contrasted to melanoma. So this is the third most common type of cancer. And this represents about a hundred thousand diagnoses per year compared to the five and a half million of the squamous and basal cell carcinomas. But the deaths due to melanoma are significantly more. So that's about 8,000 per year.

Host: Tessa Lackey:

And is skin cancer something you can only get from the sun?

Guest: Dr. Danae Hamouda:

So skin cancer is traditionally associated with sunlight exposure. That's the vast majority of our risk factor is related to ultraviolet rays which the sun emits. So there are three types of ultraviolet rays that we talk about, UVA, UVB and UVC. Now UVC is mostly filtered out by the ozone layer. So really what we see skin damage from and skin cancers is from the UVA and UVB rays. And we see this especially penetrating through during the height of the sunlight, so hours of 10:00 AM to 4:00 PM but we also can get UV exposure from other areas.

And the second most common exposure is from tanning beds. And so these devices intentionally transmit UVA and UVB rays in order to tan the skin. And what happens when our skin tans? So these are our skin cells that are melanocytes that produce a pigment. And when our cells are exposed to this UV radiation, our body is trying to produce a protective mechanism to reduce that penetration of those light waves by making our skin darker.

So our first evidence of some skin damage or changes is when we have tanning, and that can then lead to some further exposure to ultraviolet light and then can cause more damage down the line. Now there's another form of ultraviolet radiation that we can see, which is UVC. Now I said kind of the ozone layer filters out a lot of it, but we use UVC's devices now pretty commonly as a disinfectant, especially after the era of Covid. So in businesses and in some personal use, people may be using these UVC devices. You may not see light from them and you may not have any symptoms from that. But just as a warning, if you do have one of these devices to make sure that you're following the precautions on the label. Because this is still a form of ultraviolet radiation that we're not typically exposed to otherwise.

Host: Tessa Lackey:

That's interesting. Okay. So kind of getting into the different A, B and C types of UV light, so A, what would be an example of A?

Guest: Dr. Danae Hamouda:

So UVA and UVB kind of go very close in the same wavelength. So they're able to get through the ozone and onto the level of the earth, and then it can get into the very outermost layer of our skin, and then its energy falls off. So it doesn't penetrate more deeply than that, but it does reach our layers in our skin, which then causes our tanning or skin damage and can lead to skin cancers.

Host: Tessa Lackey:

Okay. So A and B is mostly something you'd get if you're walking around outside or if you're on the beach or something like that?

Guest: Dr. Danae Hamouda:

Yeah.

Host: Tessa Lackey:

Okay.

Guest: Dr. Danae Hamouda:

And those are the rays that are mostly protected against when we use sunscreen. So they block the UVA and UVB.

Host: Tessa Lackey:

And then C would be something, so you had said the light that people use to clean. I know for me, during the pandemic, I bought a little light cleaner thing for my phone or anything. Would that be an example too?

Guest: Dr. Danae Hamouda:

Yeah, yeah. And they usually say an ultraviolet sanitizer or disinfectant, so that would be one of those devices that you can have at home. And so it does a nice job of cleaning viruses and cells because the energy is able to penetrate through that well. But you can still have damage that you're unaware of. So make sure that you're using the precautions that are listed on the label to make sure that you're protecting your skin and your eyes as well.

Host: Tessa Lackey:

What are some signs and symptoms of skin cancer? Let's say someone's listening and they're like, "I noticed something on my arm," that someone's like, "Hey, you should go get that looked at," or what do you look for?

Guest: Dr. Danae Hamouda:

Yeah, so with those three different types of skin cancer, they present in three different ways. So for basal cell carcinomas, we might see a pearly looking or waxy looking bump on the skin. Another way that we might see something that we're concerned as being basal cell is if it's a flat lesion that looks kind of fleshy colored. Or if there's a bump on the skin that you notice it bleeds, it scabs, it heals, and then suddenly it's bleeding and scabbing and healing again. So those are all signs that you may want to talk to your doctor about and they can present as the basal cell carcinoma. These are typically in those highly sun exposed areas. So we often will see these on the face or on the ears or on the hands or on the shoulders. So the areas of sun exposure over your lifetime that see the most amount of sunlight.

For squamous cell carcinoma, which is another type of skin cancer, you can see a firm and reddish looking bump or nodule on the skin, or it can look flat, scaly, crusted, kind of flaky. And again, these are typically in those sun exposed areas. So if you notice those symptoms or signs on your skin, that's a good time to bring that up to your primary care physician or your other medical team.

Now for melanoma, these present in a different way, and these are usually where we kind of associate with this A, B, C, D, E acronym. And if we're looking at one of the moles that we have and kind of monitoring to see if there are any changes, these are the five things that make us a little bit more concerned and we'd want you to talk with your physician about. So A is for asymmetry. So if you notice on a mole that it looks a bit asymmetrical or not totally circular, maybe looks a little bit oblong, that can be a concerning feature. If the borders around the mole look irregular, that's another sign that could be a melanoma.

If the color within the mole looks different, so if it looks darker in one area and lighter in another, that can also be more concerning. If the size of the mole is larger, we would also like to monitor that. And the size that we're looking for is about a quarter of an inch or six millimeters. Or if you notice that your mole that you've been monitoring has changed or evolved over time, that's also a concerning feature. So if you notice any of these signs on any of the moles on your body, this is a good opportunity to say to your physician, "Hey, I've noticed this lesion on my skin. Would you mind having a look and letting me know what you think about this?"

Host: Tessa Lackey:

I know for me, maybe this is just the nature of mothers in general. For me, I have a mole on the back of my neck that I've had my entire life. And now and then she'll grab me and be like, "What's going on with that mole on the back of your neck? Is it really dark?" And then I'm like, "Mom." But in terms of the lesions and whatnot that you were talking about as well, it sounds like something that like a scab or a bruise almost. Would you compare it to that almost?

Guest: Dr. Danae Hamouda:

Yeah, so for a basal cell carcinoma, it can look very scab-like. And if it keeps bleeding and it doesn't heal and it comes back again, that could be a sign of a basal cell. So that could be something you'd want to talk to your doctor about to have a look at.

Host: Tessa Lackey:

So let's say you're someone who's very clumsy. So you had said it's in places that are normally pretty exposed to the sun, like if you whack your hand on something and you don't remember whacking your hand on something, I may be one of those people that tends to do that. But if you are one of those people and you don't remember whacking and you're like, oh, wait, should this be concerning or anything? Would it look? And I understand we're on a podcast and people are listening in terms, so just trying to visualize it a little bit too.

Guest: Dr. Danae Hamouda:

So you know, can watch it and see if it heals and resolves. And if that does that within two or three weeks, I think that's just a natural healing process after a bruise or an injury. But if it heals and then suddenly this scab comes back again in the same spot and it heals and it comes back again, that's a little unusual. So that would be a time then to bring it up to your doctor,

Host: Tessa Lackey:

But somewhere between three to four weeks as a normal bruise or anything, if it seems to heal-

Guest: Dr. Danae Hamouda:

Yeah, you'd expect that too.

Host: Tessa Lackey:

Gotcha. Okay. So when it comes to trying to prevent skin cancer, we're getting ready to do an episode here on sunscreen. So if anyone's listening and has any questions about sunscreen, you can go back and listen to that episode as well. But talking about sunscreen and talking about what people should be paying attention to just for this episode as well, what would you recommend, especially as people head back to the lake and the weather warms up and everything as well?

Guest: Dr. Danae Hamouda:

Yeah, so May is melanoma awareness month. So the best thing that we can do to reduce our risk of skin cancers is to reduce our exposure to ultraviolet rays over time. And so that would be avoiding tanning beds and also to avoid sunlight during the peak hours or to have protection when you do go outside. So that includes wearing sunscreen and wearing sun protective clothing, wide brimmed hats and trying to offer additional protection to those areas of our skin that are most often exposed to sunlight.

Some other risk factors for skin cancer include if you have a more fair complexion, so blue-eyed, green-eyed or blonde or red hair have a higher chance of getting sunburns and have more sensitivity to the ultraviolet radiation. For melanoma, there's some additional risk factors that we've seen looking back to see what patients may have had in common. And some of these risk factors can include a history of blistering sunburns especially as a child or teen.

So it's really important as parents to make sure that we're providing our kids with sun protection with sun cream and trying to offer additional protection over those exposed areas of skin, especially in the summer months when we want to get outside and after a long winter, it's nice to be able to do that and important too, but to offer that protection, especially for the children. Having large or many moles can also be a risk factor. So if you know that you have those to make sure that you're monitoring them regularly. If you have yourself a personal history of melanoma or a family history of melanoma, that's another risk factor. So you would want to make sure you're doing all you can to prevent and avoiding ultraviolet radiation. And then Caucasians have a higher risk of melanoma.

Host: Tessa Lackey:

So you had mentioned something about eye color. I've never heard that before. So can you explain a little bit more about what your eye color would have to do with your exposure with the sun and everything?

Guest: Dr. Danae Hamouda:

So it has to do with the amount of melanocytes within our skin, which are there to help to protect us from the damage of the sunlight. So there's fewer pigmentation that happens in lighter skin or lighter eyes. So we just don't have as much protection against the ultraviolet damage that occurs.

Host: Tessa Lackey:

So for example, if you have blue eyes or something like that, typically you are going to have lighter skin and you're going to be more susceptible to sunburn or something like that.

Guest: Dr. Danae Hamouda:

Yeah. Typically they often will correlate together. But having that lighter skin, lighter eye color, yeah, they have less of this pigmentation, so less of melanocyte, less of that protection against ultraviolet radiation.

Host: Tessa Lackey:

Okay. So that's something that's good to know too. If you're on a boat with somebody or something and maybe you don't know them too well, and you know that if they have blue eyes or what was it, blue or green-

Guest: Dr. Danae Hamouda:

Blue or green.

Host: Tessa Lackey:

Blue or green, that they're most likely going to get burnt. My husband tends to flip between blue and green and he gets burnt really easy. So for people of color, do they really need to worry about skin cancer as much because they're not as fair skinned as someone whose Caucasian is?

Guest: Dr. Danae Hamouda:

So we do see a much higher incidence of skin cancer in the Caucasian population. It's in fact 30 times higher than for those persons of color. But there are some disparities and there are differences in presentation for melanoma for persons of color versus Caucasian. Persons of color and darker skin tones often are diagnosed with melanoma at a later stage. We had done a study looking at the incidents for lymph node positive disease with melanoma, and that would mean the melanoma had started in the skin and traveled to a lymph node. And that occurs in about 16% of Caucasians and it occurs in 22% of people of darker skin tones. So there is some higher stage for these patients that could be related to maybe difficult access to care or if it's not being noted more easily. So being aware of this disparity, I think we have some groundwork to do to try to improve that for persons of color.

Also, for persons of color, there is a higher risk of melanoma developing on non-sun exposed skin. These melanomas tend to be a little bit more aggressive so they behave differently than ones that are exposed and related to ultraviolet radiation. And these may present in somewhat unusual ways, such as on the palms of their hands or the soles of their feet or in between the toes or on the toenails or fingernails. So we do see that persons of color have a higher risk of those types of melanoma.

So I would recommend making sure if you're doing those skin exams to include your hands, your feet, and in between your toes and on the fingernails and toenails. If you notice an area of darkness on your soles or palms, I would recommend you talk with your physician about that. Or if you notice in your fingernails or toenails a dark line that stays there over a few weeks, to bring that to the attention of your physician too. Very uncommon for these types of melanoma to present, but we do see these at a higher frequency in persons of color.

Host: Tessa Lackey:

That's interesting. So especially if it's in places where it's harder to get that UV light that's there too. Is there any idea on why it would be there specifically?

Guest: Dr. Danae Hamouda:

So we don't really know the underlying reason for this. It may not be as much related to UV radiation, but other factors. So I think we still have some way to go to determining what those risk factors are and how to reduce that.

Host: Tessa Lackey:

Talking about different spots in between your toes and everything, it sounds like a place like if you're in the shower, having a mirror in the shower is a really, really good place to be like, okay, I'm going to do a quick skin check and just look around and look in between my toes for a second and just make sure that there's nothing new that's popped up.

Guest: Dr. Danae Hamouda:

That's a good time to do it, yeah, after you're showered or when you're in the shower to have a thorough evaluation once a month. Yep.

Host: Tessa Lackey:

Okay. Awesome. So with moles, what color range would you reference to say is quote unquote "safe" and on the other side of it might be time to have this looked at by a doctor.

Guest: Dr. Danae Hamouda:

So if it's really dark, that can be a feature, or if the color within the mole is different, it's not all the same color, if you have a little bit of irregularity or if it looks a bit waxy or pearly, those are things that we would want to take a look at and give some advice about.

Host: Tessa Lackey:

Okay. It sounds like a lot of this too is just paying, being aware of your skin and the different things that are on you on watching them over time and assessing from there.

Guest: Dr. Danae Hamouda:

Yeah, yeah. And so one of the other things that we can do is to kind of monitor our skin and to make sure that we don't have any changes that we notice, especially if you have one of these risk factors with a family history, fair complexion, history of those blistering sunburns, or having a lot of moles or having several large moles. So for those people who have some of those risk factors, I would recommend a monthly skin check. And you want to get familiar with your moles and how they look and notice if there's any changes over time. If you're by yourself, this might require some creativity and use of mirrors to be able to have a full skin assessment. It can be really hard to see your own back. So being able to get familiar with how to do that. Or if you have a trusted partner that's able to look over the skin, especially in areas that are more difficult to see, and to do that once a month. And if you notice any of those concerning signs that we talked about, to bring it up to your physician's attention,

Host: Tessa Lackey:

Or if you have a mother like mine who's like, let me see that one mole on the back of your neck.

Guest: Dr. Danae Hamouda:

Let me just watch that, although I've been watching for [inaudible 00:19:41].

Host: Tessa Lackey:

Exactly. So we talked a little bit about tanning beds as well too. So indoor tanning, tanning beds in general, the Skin Cancer Foundation also says that worldwide there are more skin cancer cases due to indoor tanning than there are lung cancer cases from smoking. So how do we get to where we are with tanning beds? I mean, from your experience and your knowledge. I know there are some people who in the past that I've heard at least said that long time ago, their doctor told them to soak up some vitamin D by going to sit in a tanning bed in the past. So I would say that now you would tell your patients avoid tanning beds. Would that be correct?

Guest: Dr. Danae Hamouda:

Correct. Yeah, yeah. It's amazing how science evolves over time and how our practices change and we look back and think, gosh, what were we thinking? So I'm sure that we'll do that eventually looking back at what we do today. But as we gain more knowledge, it evolves. That's the scientific method. So with tanning beds, I would avoid use, that would be our recommendation. And not just our recommendation, but the FDA also has a warning for tanning beds and tanning devices. And on it says this sunlamp product should not be used on persons under the age of 18 years. And there's a lot of rationale for that. So as you noted, skin cancer is so common and ultraviolet radiation is the largest culprit of that. And some of the data that we know, for instance, women who are less than the age of 30 years old are six times more likely to develop melanoma if they tan indoors than someone who didn't tan indoors. So it's a significant increased risk factor.

Host: Tessa Lackey:

Do you think that comes with from people that are younger? For example, I know for me, when I was young, I'm 28, and I haven't done a ton of tanning bed stuff, but the only time I've ever done it was for prom and whatnot. My mom would look at me and say like, "You're really pale. We need to get you into a tanning bed before you put her on that strapless prom dress." So would you say that it comes from things like that, or do you think that or is it the beauty industry?

Guest: Dr. Danae Hamouda:

It's very culturally driven? Yeah, so it's interesting how it's shifted over time. So before World War II, it was very fashionable to have light colored skin and to avoid sunlight, to not have tanning. So that was very en vogue. And then after World War II, it's completely changed. So that had become much more fashionable to have darker skin, and one way to do that is through UV exposure. So over time, we've seen these correlations of increased skin cancer risks. Some of that is seen from one of these retrospective studies that I've done and been involved with recently. So we did see an increased incidence of skin cancers in the early eighties and an increased melanoma mortality rate over that timeframe, likely relating to that increased uptake of tanning and using tanning devices in the fifties and sixties. So thankfully, it's becoming a little less common, especially for people who are younger because the risk is higher. And there are other products that if your desired outcome is a darker skin tone to use sunless options and tanning creams.

Host: Tessa Lackey:

So with tanning creams, is there any kind of a risk for skin cancer based on whatever is in tanning cream or?

Guest: Dr. Danae Hamouda:

No, not that I'm aware of, no. No, it's a much preferred alternative.

Host: Tessa Lackey:

Okay. Well, that's good to know. Making a mental list as I get bathing suits and shorts back out here. So as we're touching on different studies that you've done, do you want to talk a little bit about the study that you recently did on melanoma?

Guest: Dr. Danae Hamouda:

Yeah, so this study I did with one of our hematology oncology fellows, and we did a retrospective analysis of an epidemiology database. So basically we looked back over time to see what the trends were for melanoma survival. And we did this kind of in three different sections. One from the 1978 to '88 timeframe, then we did in 1988 to 2013, and then we looked between 2013 and 2017. And why we separated them a little bit is some from the trends that have happened over time that we've seen in the sixties and seventies and the exposure that we've had to ultraviolet radiation. And then we've looked more in the current era as we've had new therapies arrive including immunotherapies, which have significantly improved our survival rates for patients with metastatic melanoma. So what we saw is in the early eighties, our melanoma mortality rate increased about one and a half percent each year over that 10 year time span.

That's probably due to some increased incidents, maybe not as much awareness of what to look for a melanoma later stage at presentation. Surgical procedures and approach may not have been optimal from what we do now. And then in the eighties, nineties and to early two thousands, the melanoma mortality rate had been the same, so neither improving or worsening over that timeframe. And then in the current era, since we've had approvals and utility of immunotherapeutics in the management for patients with metastatic melanoma, the melanoma mortality rate has decreased an astonishing 6% per year over that timeframe. So I think portions of that, it's from from early detection, having people aware of what to look for with melanoma and changes that they might notice on their skin, the surgical approach being more standardized, and then this wonderful advances in oncology to be able to offer this immunotherapy that can be significantly improving our patient's survival.

Host: Tessa Lackey:

It sounds like so we've really come a really long way from 1980s where you had started looking at this and moved into a place where things have been improving.

Guest: Dr. Danae Hamouda:

Yeah, it's really great to see things moving in a positive direction. We have a long way to go. We have a lot of work to continue to do. Not all of our patients do as well as we'd hope. So it's important to keep pushing forward and keep finding additional options for patients with cancer, especially with melanoma.

Host: Tessa Lackey:

So we've talked a lot about prevention and different things to avoid and things that are very related to causing skin cancer. On the little bit of the flip side of this, if someone finds out that they've been diagnosed with skin cancer, or maybe they're listening and they know they have a really high risk of skin cancer, so outside of making sure you're communicating with your doctor and paying attention to the A, B, C, D, Es of skin cancer and whatnot, what would you recommend to someone who just found out that they have skin cancer? Or how can somebody who has a family member or a friend, how can they support them?

Guest: Dr. Danae Hamouda:

Yeah, so I would say just being there, it's a scary diagnosis, but being there for your friend is important just to be present and offer support. When a person is diagnosed with melanoma, the first thing that we consider is to have the mole removed and to have the diagnosis. These surgeries are typically a little more in depth than some of the other skin cancers. So sometimes they require trip into the operating theater to ensure that they have done a good resection and removed any of the area of the skin that could be involved with melanoma, and that there's a good clean margin between cancer and normal tissue. And that would provide us with the amount of melanoma that's present or the stage, which then can lead to further workup or management.

For patients who have a history of melanoma or family history of melanoma, having all of those skin protective strategies we talked about before is important. But for these patients, many physicians would also recommend to have a screening of full body skin exam done by a physician at least once a year.

Host: Tessa Lackey:

I have some family members in general who I think I've heard them talk about this, and it's kind of an appointment that I think a lot of people might dread. I have family members that call it their naked appointment. And so can you explain and talk about this exam and just explain why it's really to your benefit, ultimately.

Guest: Dr. Danae Hamouda:

Yeah, it does feel really uncomfortable to kind of bear it all out there, but we've seen it all and we've done this all, so we would not want you to feel uncomfortable, and we would do everything we can to protect your modesty and your privacy. But it is important to have, especially if you have risk factors or a personal history, to have that full evaluation as this is how we detect earlier diagnoses for melanoma which has an improvement in the outcomes. It's intimidating to think about, but we'll do everything we can to make you feel at ease and protect your modesty. And it's important because it can be really impactful for your life.

Host: Tessa Lackey:

Typically, outside of having some kind of a risk factor, how old is the time that you should probably start doing these exams? Or does it really just depend on the person?

Guest: Dr. Danae Hamouda:

Yeah, I think it depends a bit on the family history and then your history, but just having that familiarity even from a young age that you notice, hey, okay, this is something new I hadn't seen before. I'm going to watch this and make sure it doesn't change. So I would say starting in your twenties would be a reasonable timeframe for patients who have any of these risk factors. And then if you do have these risk factors, talking with your physician, "Hey, do I need additional screening beyond just my monthly self exams? Would you recommend doing a full body skin exam?" And they can talk with you a little bit about those recommendations.

We've looked a lot at ways to offer screening for melanoma. And with doing a full body skin exam, you would think there's not a lot of risk to that. There's the modesty and the privacy and uncomfortability from a patient perspective, but it's not an invasive procedure associated with morbidity mortality. So we've wanted to use these full body skin exams to try to improve our outcomes. And there's been a lot of work done to try to see if doing these full body skin exams on an unselected population improves outcomes. And we just haven't been able to capture that and to see that we've had an improvement in outcomes.

So one of our major bodies which help to dictate the type of screening that's recommended for people in the United States is called the USPSTF, and they recently reevaluated our data for screening from melanoma for average risk persons. And average risk means they don't have those risk factors that we talked about. And they did not find that there's enough evidence to support full body skin exams by a clinician once a year for the average risk person. For those at average risk, I would still recommend to do familiarity and monthly skin exams. But if you have a higher risk, it's still a discussion with your physician or your clinician team to decide whether you could still benefit based off of your personal situation.

Host: Tessa Lackey:

So outside of having a professional and someone that knows what they're looking for, looking at your body at these appointments, what would you say is the difference between coming in for a skin check versus using a mirror and getting creative looking around at your body?

Guest: Dr. Danae Hamouda:

Yeah, so what's the likelihood of noticing and identifying those? So actually more than half of our diagnoses of skin cancer come from the patient saying, "Hey, I've noticed this abnormality. Would you look at this? Or, what do you think about this?" So there is some significant benefit for patients and people to be familiar with their skin and to see if there's any changes to bring it to attention, because that's the majority of how we come to diagnose these types of things.

Host: Tessa Lackey:

So essentially talk to your doctor always, period. But with being aware of your body and looking at everything and doing regular skin checks yourself can be super helpful. But also you should schedule a regular appointment anyway. But if you're not comfortable just yet, maybe just make sure you're continuing to do your own checks, right?

Guest: Dr. Danae Hamouda:

Yeah. Have your monthly checks, I would recommend I think for everybody. And then if you have a higher risk factor, family history, personal characteristics, ask your doctor what they think about a full body skin exam for you. And it may be different depending on your scenario. So having that conversation can be helpful. And if you notice any changes or any concerns or it's making you worry, just talk with your doctor about it. They can give you some advice. If it looks concerning, they can do further workup to be able to either provide reassurance or to diagnose and manage through, God forbid, if it would be a cancer.

Host: Tessa Lackey:

And your primary care doctor would be someone to show that first one to you. They wouldn't initially call someone from Eleanor N. Dana Cancer Center, for example.

Guest: Dr. Danae Hamouda:

Your primary care doctor would be able to help manage through. Sometimes they'll refer to a dermatologist or to a skin surgeon, but they would be a good first point of contact.

Host: Tessa Lackey:

Okay. So what have you been working on lately?

Guest: Dr. Danae Hamouda:

Well, I have been seeing patients. I recently became Chief of our hematology oncology division, so I'm still-

Host: Tessa Lackey:

Congratulations.

Guest: Dr. Danae Hamouda:

... Getting my feet wet with that and getting used to that administrative role. So I'm spending a lot of time with that. We do a lot of retrospective analyses, so I work with the students and residents and fellows to produce some of that research. So there's always some of that going on. And I'm involved with some early phase clinical trials, which is a really exciting field and really encouraging to be involved with that in oncology. So much has changed in cancer care just in the past 10 years since I've been a physician. So it's a really, really fun to be a part of the research that we hope will then translate into standard of care and improved outcomes for our patients.

Host: Tessa Lackey:

That's awesome. So is there anything, with what you're working on right now? Obviously you would be in early stages. But is there anything that maybe you're just really excited about that you might want to talk about in general?

Guest: Dr. Danae Hamouda:

Well, I think overall, as a cancer community, we have this cancer moonshot goal of reducing cancer related mortality by 50% in the next 25 years. So I am really excited by that investment to have such a big goal that we're all working towards. So I'm really excited by that. I think it's going to require a lot of involvement with our basic scientists and ensuring that our disparities are no longer existing. But it's really, really encouraging to have the support and investments to be able to try to reach this really lofty goal of reducing cancer related mortality by 50% in the next 25 years. So I'm really excited.

Host: Tessa Lackey:

What a cool thing to wake up to in the morning. Be like, "Oh, I'm just going to reduce cancer today. It's going to be a good day." That's awesome. Well, good for you. That's amazing. So this is one of my favorite questions that we ask every single person that comes in here. What is the most common question that you get from patients and what is your answer?

Guest: Dr. Danae Hamouda:

Oh, gosh. Yeah. I often hear patients ask when will there be a cure for cancer? And that's really tough. We've come a long way with what we have to offer for patients. We're getting to know more about the importance of prevention and risk reduction, and we have been able to improve our cure rates for patients with many types of cancer. But we have such a long way to go. And it's really difficult to know how one person might do with a treatment that we have when we're looking at the individual versus looking at a big paper involving thousands of people.

So I'm hopeful that we'll become a little bit more precise in what we can offer for our patients and to choose the right treatments for the right patients at the right time so that we would be able to offer a cure for the person in front of us, and hopefully someday that will be all of our patients, but at least becoming more aware of an individual's circumstances and finding the right treatments and really personalizing those, which I hope will lead to a more broad cure for patients. So a long way to go. And I don't know. That's a tough thing to answer.

Host: Tessa Lackey:

Oh my gosh, yes. Well, and yeah, I'm sure it's a question that you get a lot too with just the nature of the industry and everything too. I know that we've talked in terms of where medicine is and where we've been before with, I mean, we've talked to a lot of providers and about what we thought was a good thing in the past may not be a good thing now. But that's why we do things like all the research that you've done and continuing to just preventative tips and working to figure it out.

Guest: Dr. Danae Hamouda:

Yeah, yeah. It's important to keep coming back with new ideas and looking to see how it's translated over time and then trying to make a difference and impact in areas that we think we can do so.

Host: Tessa Lackey:

Yeah, absolutely. Dr. Hamouda, how can people schedule an appointment with you?

Guest: Dr. Danae Hamouda:

Yeah, so I'm at the University of Toledo Medical Center's Eleanor N. Dana Cancer Center. My office number is 419-383-6644.

Host: Tessa Lackey:

Wrapping everything up as if someone suspects that they have something on their body that may not look right, or they may have some kind of a question about talking to your primary care doctor first, and then your primary care doctor will guide you through from there and then maybe eventually giving you a call. Right?

Guest: Dr. Danae Hamouda:

Yes, yes.

Host: Tessa Lackey:

Okay. Awesome. Awesome. Well, that is all for this episode of Prescribed Listening. Tune in next time and subscribe for more on Apple Podcasts and Spotify.