Melanoma and Breast Cancer: Know Your Risks

An Interview with Dr. Anthony Rossi, MD, FAAD, FACMS

Anthony M. Rossi MD, FAAD, FACMS: Dr. Anthony Rossi is a board-certified dermatologist and dermatologic surgeon at Memorial Sloan Kettering Cancer Center as well as an Assistant Professor of Dermatology at Weill Cornell Medical College. The views of Dr. Rossi are his own and are not the views or opinions of Memorial Sloan Kettering or affiliated hospitals. Please discuss with your medical physician before starting any routines, supplements, or medicines.

Erin Hazelton is a freelance writer and women’s health advocate. Formerly a fashion and beauty writer, Erin’s career changed paths after being diagnosed with breast cancer in 2018. Since then, her main objective has been educating women about the nuances of breast cancer and encouraging resilience in the face of adversity.

May is Melanoma and Skin Cancer Awareness Month.  As we gear up for summer and some much needed vitamin D, we wanted to share some tips about how to safely enjoy the sun while protecting our extra delicate skin. 

Whether you are in the midst of breast cancer treatment or have already gone through it, taking care of your skin while outdoors is necessary… but so is getting some sunshine! There is nothing like a healthy dose of sun to boost the mood, we just need to be prepared. Recent studies have found that people diagnosed with breast cancer have a higher risk – potentially up to 2.5 times higher – of developing melanoma and other skin cancers. The increased susceptibility may be linked to DNA damage, genetic factors, age, and radiation therapy. This link also works in reverse: According to a 2018 Stanford study, if someone has had six or more basal cell carcinomas in a ten year period, they are three times more likely to develop other unrelated cancers, including breast cancer. 

We spoke to Dr. Anthony Rossi, Dermatologist and Mohs Surgeon at Memorial Sloan Kettering Cancer Center, to learn more about this link between breast cancer and the increased risk of secondary skin cancers such as melanoma and basal cell carcinoma… and how to best protect ourselves. 

What can you tell us about the link between breast cancer and melanoma?

There have been multiple studies looking and second primary cancers in persons who have breast cancer, and they have found an increase in melanomas of the skin when compared to the general population. The reason behind this is thought to be multifactorial with both environmental and genetic influences at play (mutations such as BRCA2, CDKN2A, CDK4 and BAP1 may also contribute to this association). Other variables, including age, gender, and use of radiotherapy and chemotherapy are potential risk factors for second primary cancers as well.

Does the melanoma just show up in the area where radiation was administered?

There is a risk of getting secondary skin cancers in the radiated field. But because of the genetic link, there is an increased chance of getting melanoma or basal cell carcinoma anywhere on the body. 

How can women protect their skin before, during, and after breast cancer treatment?

One of the best ways to protect the skin, always, is to use a broad spectrum sunscreen that shields against UVA and UVB rays. Certain chemos may make you photosensitive (more likely to burn) and radiated skin should not be exposed to sun immediately before starting, during, or after treatment. 

During radiation therapy the skin can desquamate or slough off akin to a bad sunburn. Avoiding sun and protecting the skin in between sessions is crucial. Using topical steroids for acute reactions (dermatitis) and thick emollients devoid of fragrances or allergens are all very helpful in protecting the skin barrier. If there is a severe reaction, your dermatologist can also apply special types of bandages that can help absorb and drainage from acutely radiated skin. 

Washing the area should be done with a gentle wash. (Neutrogena Hydro Boost Gel Cleanser is gentle and has hyaluronic acid in it, which is hydrating.)

Once skin has healed, it is important not to expose it to direct sun, using a mineral sunscreen of SPF 30 or above, and the use of a rashguard is also recommended. 

After radiation, people can experience a tightening sensation in the radiated area after sun exposure, even with sunscreen. Additionally, after treatment, especially if someone is on SERMs or aromatase inhibitors, their skin may feel extremely dry due to the lack of estrogen at work. Super hydrating emollients are worth it here. [At Stage we like shea butter, coconut oil, and creams with a base of sunflower or avocado oil.] 

Look for products without fragrances and without known irritants like SLS [sodium lauryl sulfate] and dyes, which irritate the skin. 

I developed Dr. Rossi Derm MD skincare with a proprietary peptide complex that targets TRPV1, which is the root cause of skin sensitivity and inflammatory aging in the skin; the receptor that causes skin cells to ‘heat up’ in response to irritants. I also took out the ingredients dermatologists dislike (formaldehyde releases, etc.) because many of these common ingredients can cause irritation and allergy.

Can you explain the difference between mineral sunscreen and chemical sunscreen and why mineral is better in your opinion? 

I love that sunscreen is basically a trending skincare product. As a dermatologist, that warms my heart! Mineral sunscreens, also called physical sunblocks, are trending. They contain Titanium Dioxide or Zinc Oxide and are less irritating or allergenic compared to the chemical sunscreens. The FDA also labeled the mineral ingredient sunscreens as GRASE: Generally Recognized As Safe and Effective. 

Chemical sunscreens can be more irritating and some ingredients used in chemical sunscreens have been identified as hormonal disruptors. 

Dr Rossi Derm MD Day Formula uses micronized titanium dioxide that goes on sheer but also contains niacinamide and triglyceride to moisturize.

Neutrogena’s Invisible Daily™ Defense Sunscreen and Mineral Ultra Sheer® Dry-Touch SPF 30 Sunscreen Lotions are also great oxybenzone-free, paraben-free and oil-free options that boost the skin’s natural moisture barrier.

As a reminder: Don’t forget the tops of your ears, behind your ears and the frontal scalp where your hairline begins. These areas tend to be missed and can burn easily. 

What’s the actual difference between SPF 30 and SPF 50?

SPF stands for Sun Protection Factor and is the ratio of equivalent exposure by UVB on protected skin compared to unprotected skin. An SPF of 30 means that the amount of UV exposure in 10 minutes without sunscreen is the equivalent of 10 minutes x 30 minutes with sunscreen. Your skin is protected from the damaging rays of the sun for a longer period that it would be naturally. An SPF of 50 means this protection lasts longer. This is also predicated on reapplying sunscreen every 2 hours… and applying a thick and even coat for proper sun protection.

You should always use a sunscreen with SPF 30 or above and get in the habit of using it every morning before going outside. Not only does sunscreen protect against skin cancer, but it also prevents photoaging from UV and hyperpigmentation from UV exposure. UVA even passes through clouds and window glass!   

Any issues with sunscreens being dangerous or cancerous?

Sunscreens are very safe to use and have been shown to prevent skin cancer and skin aging. However, there are certain ingredients you may want to avoid: sunscreens with parabens can be irritating and allergic for some people and some of the chemical filters such as oxybenzone and benzophenone-3 may cause a photo allergy for people who are allergic. 

There was a recent investigation about contaminants in sunscreen products and benzene was one component that was tested for, which is often found in sunscreen formulations. This issue was most likely due to contamination from the manufacturing rather than the sunscreen formulation itself. 

What is the shelf life of sunscreen?

Sunscreens usually have a two year expiration date. Always look for the date. Don’t use expired sunscreen! Additionally, you should store sunscreen in a cool place so the formulation doesn’t overheat and separate out of the solution. But if you are using a shot glass worth of product for your whole body, which is how much you are supposed to use, you should be done with a bottle well before the expiration date!

What happens when radiated skin gets too much sun? 

Radiated skin is very UV sensitive. There is even a phenomenon called “radiation recall” where the skin looks burned again after a patient takes certain medications. 

When radiated skin gets too much sun it can look “dyspigmented,” which is a mixture of hyper- and hypo-pigmentation. Also chronic radiation dermatitis can occur, which includes blood vessels and fibrosis. 

What the kinds of skin changes should we look out for? What does early melanoma/basal/skin pre-cancers typically look like?

Melanomas are usually brown to black (but sometimes even red or pink) patches or raised bumps. New spots or changing moles should be seen by your dermatologist. 

Basal cell carcinoma and squamous cell carcinoma, as well as Merkel cell carcinoma, are typically pink to red evenly pigmented papilla or patches. 

A rare skin cancer called Angiosarcoma can happen in radiated or lymphedematous areas, this one is purple in color. 

Does clothing protect us enough on a day-to-day basis, or should we be wearing sunscreen under our clothes? 

Clothing that contains SPF is made of a tight weave and can offer good sun protection. A regular white tee shirt doesn’t offer as much protection because the weave of the fabric is loose and lets UV through. The color of your clothes doesn’t reflect rays or effect its ability to protect your skin. 

Thank you, Dr. Rossi!

And now that you’re armed with this info, go out and enjoy your summer!

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You should always use a Sunscreen with SPF 30 or above and get in the habit of using it every morning before going outside. Not only does sunscreen protect against skin cancer, but it also prevents photoaging from UV and hyperpigmentation from UV exposure. UVA even passes through clouds and window glass!

- Dr. Anthony Rossi


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