A silent threat in the sun, or how not to make friends with melanoma? Episode 9

Monika Rachtan
I invite you to listen to the podcast. Patient First. Good afternoon, I would like to welcome you very warmly to another episode of After the Patient First, in which we speak the language of patients to patients, but we talk to eminent experts in order to give you the best possible knowledge to respond to various health problems. And dear colleagues, I would like to introduce my guest today. With me is Professor Anna Czarnecka from the National Institute of Oncology in Warsaw, the Academy of Young Scientists of the Polish Academy of Sciences, but above all a specialist in the treatment of melanoma. Welcome. Good morning.

Anna Czarnecka
Good morning to you. Good morning to you.

Monika Rachtan
Thank you very much for accepting the invitation to join my programme. We are going to talk today about a summer topic, because it is summer, so timely because we are going to talk about tanning, what is tanning, what is not tanning. Is there a problem with this in our country?

Anna Czarnecka
Unfortunately, there is a problem with sunbathing, and in fact with the effects of sunbathing, because we are seeing an ever-increasing trend in the number of skin cancers, including melanoma. Perhaps this is partly due to the increased detection rate, which is the good news. On the other hand, we are currently experiencing the effects of sunbathing that took place a few, a dozen or a few decades ago, when it was still more in fashion. We knew less about skin cancer then, we did not have the Melanoma Academy

Monika Rachtan
We had solariums on every corner

Anna Czarnecka
Yes, and we also had a solarium that let under-18s out there. Well, and now I'm afraid we are reaping the harvest of that.

Monika Rachtan
Okay, Professor, I will still say at the beginning that this is a patient-directed podcast and I will try to speak the language of patients, so I will ask you for answers, ones that patients will understand. I hope there will be no stupid questions for you here, because some of them might be a bit controversial for an expert who treats melanoma, but on the other hand patients probably don't always know the answer to them, so I will try to represent them here with dignity. Right. So yes in the summer when it's warm we go in shorts and we don't just do it when we go to the seaside. Although maybe some people do, but mostly you see people on the street in shorts. And the sun shines in the summer too. And on holiday. I think we use or should use sunscreen, but that's what Poles probably only do on holiday, if they do it at all. And when they go to the greengrocers to buy apples, they don't take that sunscreen and put it on. Even though the sun is shining, it's 30 degrees, they have their arms, legs, head, face exposed.

Monika Rachtan
It is.

Anna Czarnecka
Unfortunately this is the case, but it is worth thinking about what the people of India, for example, who are still warm, look like. Imagine going to that greenhouse in spite of 30 or 40 degrees in long trousers and a shirt, which I also encourage. On the other hand, when we get up in the morning, we put sunscreen on our face. There are now a very large number of ordinary, moisturising creams that are not associated with typical photoprotection.

Monika Rachtan
Photoprotection or ?

Anna Czarnecka
That is, protection from damage. Induced to me by the sun of ordinary facial moisturising creams, in which we will have a filter that protects us from the sun. We need to look at having 50 SPF50 written on the packaging on our creams and buy such a moisturiser in.

Monika Rachtan
The drugstore simply.

Anna Czarnecka
Yes, or on the internet, whatever one prefers. On the other hand, there can be a drugstore, there can be the internet. There is no need to go to the chemist and a simple face cream. On the other hand, clothes for the greenhouse or the park willingly long, can be airy.

Monika Rachtan
OK, fine. And in that case, what does it mean to tan?

Anna Czarnecka
To tan visually means to turn red or brown. However, unfortunately, at the level of what happens in our organism, tanning is in fact our body's SOS response to the toxic effects of the sun, the sun's rays, in other words the UV rays. So de facto tanning is a symptom of skin damage.

Monika Rachtan
I understand. So yes, because I think in the minds of Poles it is so, that they are sunbathing again on these holidays lying on the beach, on a towel behind a screen, then they are sunbathing, and when they are in some other position, not lying down, that is, for example, walking or sitting on the terrace and reading a book, they are no longer sunbathing.

Anna Czarnecka
Unfortunately, this is also not true. Any change of skin colour. Whether on a walk or for work on the allotment, a walk can even be in the woods, because trees do not eliminate 100% of sun. It can be a walk on a cloudy day. All this, unfortunately, is sunbathing. It is not at all necessary to lie down flat on a towel or blanket to get a tan. Any kind of exposure to the sun, even obscured by clouds and even obscured by an umbrella, is enough.

Monika Rachtan
Which is to say. Because I think there are umbrellas like that sold in shops with a filter. Yes, I do associate something like that.

Anna Czarnecka
There are different umbrellas, there are umbrellas with a filter and you really have to look out for those. To the eye you can recognise them by the fact that they will be partly. Most likely they will be silver on the inside, like a kind of food protection film. As far as these umbrellas are concerned, yes, they do protect us more or less 99% percent from the sun. On the other hand, I was referring to a regular umbrella. There was once an interesting study 10 or so years ago. At a British university, researchers borrowed umbrellas from colleagues, with which they came to work. They then exposed them to the sun at around ten o'clock and, using a suitable apparatus, measured how much of this harmful radiation, i.e. UV radiation, passed through ordinary umbrellas. And the winner of the ranking was, of course, the umbrella with the filter. On the other hand, ordinary, so-called umbrellas, i.e. those we take when the weather is rather bad, i.e. it rains, let through up to a quarter of the radiation, i.e. they did not in fact protect. 25% of the radiation was passing through. The worst performing umbrellas in this ranking were those that were also very brightly coloured. Well they also perform badly in the next one, unfortunately. In another study, a similar study was done on the beach.

Anna Czarnecka
There were these little cameras put in to measure how much of that UV goes into the camera. These cameras landed on a deckchair instead.

Monika Rachtan
Human.

Anna Czarnecka
So instead of a person and there they lay. And unfortunately it turns out that the umbrellas we have on the beach, again similar to those for the rain, let through about a quarter of the radiation, so we can sunbathe under them, unfortunately. The worst umbrellas are the ones that look the prettiest. I mean they are super tropical, they look like they are made of leaves, woven from grass. Because of how big the meshes are between these braided natural materials, some reeds and so on. They are the ones that let in more than 80% of radiation, so they actually serve to decorate the landscape, not to protect you from the sun. Also, you can also get a tan under an umbrella. And if you want to go actually with an umbrella, because let me remind you where the word umbrella comes from, please remember that an umbrella is for the sun. It is a de facto umbrella. It wasn't created as a gadget to protect from the rain, but precisely from the sun. So it's worth going for the kind you'd rather buy in a sports shop or a slightly more sophisticated place, which are either just so silver in the face, or will just have SPF 50 written on them again like creams do.

Anna Czarnecka
Not to make a cryptic statement, these types of umbrellas are also in well-known chain stores with a big red background in front of the logo.

Monika Rachtan
OK, I understand, I know what you mean. I think you do too, and we recommend that you get such umbrellas when you go to the Polish seaside, or somewhere else where the weather will be sunny.

Anna Czarnecka
Also cool for children are these little beach tents. Of course, they are also available for adults, only then we have a big piece with us. On the other hand, there are folding umbrellas. They also have a 50 filter in them. And if you are going with small children who want to sit on the beach and, I don't know, put together a sandcastle or throw blocks, it is worth buying such a tent for children instead of a screen with which to separate from the neighbours.

Monika Rachtan
That's what I thought too, that it's worth replacing our Polish gadget with one that really shields us from something. And now I'm going to ask again if we also sunbathe in winter.

Anna Czarnecka
Because it also burns terribly in winter? This is unfortunately due to the fact of such chemical, actually physical properties of radiation. Imagine the colour range from bright white. At the end is black, then the lighter the colour, so white wins. It will reflect the greatest amount of radiation back to us, and the darker, or black, will also absorb the least. Asphalt heats up, it absorbs, white reflects. It hits us in the face. Snow reflects roughly 90% of UV radiation. Take a look at Himalayan mountaineers, for example, the two hermit lords. They are in their famous photos wearing cool sunglasses, which also cover the sides, very thick sunglasses. Already professional for Himalayan climbers, the glasses they wear are so dark and filter so much that they are not allowed for drivers. So imagine how much filtering is required. So water. That's how we think to ourselves water burns, over water a person, can burn. Plain water, no foam. That is, a smooth, beautiful lake can reflect 10%. Snow reflects 90, water on the waves, that is, all surfers, kite and so on.

Anna Czarnecka
This foam because it too is white reflects more or less 25%. It is so a little bit, a little bit more than water let's call it blue green. Also being exposed to such sunny skiing, walking somewhere where there is snow tans me a lot.

Monika Rachtan
That's another thing I'll say, because you mentioned these drivers here. I recently saw a picture on the internet that showed the face of the very person who had the exposure and the sun was coming into the face of this driver. On one side you know as he was sitting in the car, it was a professional driver and the sun was coming in. And the part of his face that was just exposed was terribly wrinkled, but it was so very, very badly wrinkled. And the other side was. Nicer. Just no, it wasn't wrinkled at all, because the driver was in his seventies. But it was just less wrinkled, so we can imagine that in normal, normal situations, for example when we are driving a car, we are also affected by the sun's radiation. Exactly, because it also burns us through the car window. What is it like?

Anna Czarnecka
Yes, unfortunately the glass is such an illusory barrier. We may think that the heat will somehow bounce off it or that it will protect us. Unfortunately, it does not. Such quartz glass we have to deal with in a normal window pane, that is not, for example, in glasses with a UV filter, which we can buy and, in fact, should buy. Also the normal corrective ones can be bought with a UV filter, for example, my such.

Monika Rachtan
They are and I am about to ask why and for what?

Anna Czarnecka
Yes, while ordinary glass so that no UV passes through it. In short, it should be 4 inches thick at least, that is almost 10 centimetres. It's well known that we don't drive an armoured car, so our glass is so thin that it has no chance of winning against UV. It is so clever and passes between the particles of the glass so well that it falls straight onto our skin. And unfortunately melanoma is an occupational disease for drivers, and premature skin ageing also affects such sun-exposed occupational groups. Because please remember that melanoma is one unpleasant UV-related event. There are mainly UVBs. On the other hand, there is another type of radiation once considered so safe. And this is UV radiation, which penetrates deep into our skin down to the subcutaneous layer. And this is UVA, and also comes to us with the sun. Unfortunately, it is responsible for premature ageing of the skin, so this is bad news for ladies too. If we expose ourselves a lot to the sun, we will look beyond our age.

Monika Rachtan
I think to myself about the fact that nowadays women who just use sunscreen on a daily basis I very often see the faces of 40 50 year old ladies who are actually in very good condition. And when I compare it to how it was 10 15 years ago, though, it seems to me that the ladies were getting their faces off quicker. And now that we use these sunscreens it's a bit better.

Anna Czarnecka
It is fortunate that we use creams with a filter. Apart from that, I think cosmetics manufacturers have simply seen the need for it and it is also becoming easier and easier to get ordinary base cosmetics or even foundation or powder also loose, which simply has filters in it. So I personally, if I'm choosing facial cosmetics or make-up, I look at whether they contain a filter. I don't particularly care if it is a well-known brand, although well-known brands and designer brands also offer cosmetics with filters. There is also a national brand, a well-known cosmetics manufacturer, which also offers a full range of cosmetics with such a filter, including, for example, lightly tinted creams to improve skin imperfections, so it is worth reaching for such products. Yes, there are actually a lot of them now.

Monika Rachtan
I am now reading more and more on the Internet that the best anti-wrinkle cream is one with a sunscreen, and I have read that term somewhere a few times already. That's right. And let's get back to our sunbathing. Tell me if we used to say that by the sea we don't get sunburn, only wind, that on a cloudy day I go for a walk because the wind will burn me. And immediately it's like there's no sun, there's a nice wind. So I don't think it's going to burn my skin.

Anna Czarnecka
Well, unfortunately the bad news is wind tanning is such a delusion that when we are comfortable in terms of temperature, because a nice cool breeze means we don't overheat, we take a nice walk, we don't notice the fact that we are tanning. The clouds only filter 10% UV.

Monika Rachtan
This is not much.

Anna Czarnecka
Very little of this is even, I think surprising to many people. A cloud is generally made up of water, and unfortunately these water molecules do not absorb this radiation. They smuggle us through it very well.

Monika Rachtan
OK, let me ask you one last thing, which you also mentioned, namely occupational illness. I have written down the occupations of builders, gardeners and beekeepers. It is true that these are the occupational groups that are particularly prone to developing melanoma, that is, sunbathing while working. This is also harmful.

Anna Czarnecka
Unfortunately, sunbathing while working is harmful and going to work for people who have such occupations is not free. This could of course be builders, but it could be farmers. Orchardists should take a barrel of sunscreen with them here, as well as using the sunscreen already, or using special clothing. And one more thing I have not mentioned. Nowadays there are already clothes available that have filters built into them. This. This in-built filter is that the fabric is simply woven accordingly. It is not a garment soaked in any chemicals or any compound that we have to be concerned about or somehow specially wash this garment. Yes, it is a garment where simply the weave of the fabric is arranged differently and arranged in such a way that this radiation will not reach the skin. And such. Such garments are more expensive than a regular t-shirt. However, they are easy to buy in popular sports chains. And shorts and T-shirts are in fact both for children and adults. Such people with such a profession should also buy them for work if they can afford the expense.

Anna Czarnecka
If they don't like the cream, it's also easier to put on clothes than to be constantly embarrassed. Men do. And such another occupational group it's easy to guess, are sailors too. The work is de facto outdoors, in a lot of it. Pilots, especially jet pilots, are an interesting occupational group that also suffers from melanoma. They are exposed, as we said, glass does not filter. Even a jet is not so armoured as to have 10 centimetres of glass thickness so that this protects the pilot. And these are also the people who are exposed and should also use sunscreen.

Monika Rachtan
Then I'll ask you about the eyes, because we've already started talking about them a bit. Is it possible to have melanoma of the eye?

Anna Czarnecka
Unfortunately, you can. It is a very dangerous disease. Melanoma can be of different parts of the eye. Of course, it can be on the eyelid, in which case it is a simple melanoma of the skin, but it can be deep within those structures that are responsible for vision or on the forehead. Then it can realistically be seen as a colour change. If the colour of the eye changes, some dark spot appears on the iris, then you definitely need to go to an ophthalmologist. And unfortunately, it is a disease for which we have very few medicines at the moment and it can mainly be treated topically. It is also very worthwhile to protect the eyes. If one uses glasses on a daily basis as I do, it is worth investing in glasses that are with a filter. If one chooses to wear sunglasses on holiday then choose too. Well from a decent, so to speak, supplier the ones that have a filter. And it is also worth remembering that they should not be very narrow glasses. I know that small narrow ankle glasses are very fashionable, trendy and emphasise the character. On the other hand, unfortunately it is worth protecting a large surface, as the radiation also passes through sideways. Take note, for example

Anna Czarnecka
for glasses for people who ski or for the aforementioned Himalayan climbers. Yes, they have the sides covered as well, so that this elimination of this radiation is also really on each side. Because the radiation is something so fine that it slips through every crevice. It is also very worth investing in sunglasses with a filter. I also recently bought myself contact lenses with a filter for my holidays.

Monika Rachtan
Does such a thing exist?

Anna Czarnecka
There are, It has appeared, already with a built-in filter, also such less costly suppliers than some large western concerns. Also the smaller, less expensive ones. Manufacturers have already released this version with a filter, also at a pretty decent price. I have fit in with my holiday purchase.

Monika Rachtan
So this is a product that most of us can afford and actually protect our health and sometimes our lives. Because it seems like a small change, like the little dot you mentioned, and here it turns out that melanoma is a cancer that can kill. And let me ask you something else, how long do you have to tan to have melanoma?

Anna Czarnecka
Well, unfortunately there is no safe dose of sunbathing. When it comes to summers we don't talk about the length of tanning. Maybe I can start with a simple piece of information about how long a day you can tan to make it safe, to make it safe. People with a complexion like let's say ours. Blonde. Well unfortunately they can tan for about 10, 15 minutes a day tops. At an exposure level of 18% of the body. What does that mean? It's the magic 18% of body. It means there are short shorts, but short shorts, basically exposing the knees and shins, not the whole thigh, and short sleeves, meaning no straps. And that's a safe dose of tanning for people with a photo Celtic type, i.e. its a very even lighter complexion than ours. Red hair. is the safe dose, the daily dose is about 5 minutes. This is not much, very little, but it is the amount of time in the sun that protects us completely. The vitamin D that is often said to be needed in the sun for this D to appear is that these 5 to 15 minutes are absolutely sufficient to cover our entire requirement. However, melanoma in terms of how much you need to sunbathe unfortunately often appears in young people who tan or have been tanning.

Anna Czarnecka
Because on the whole, children themselves often do not decide. In childhood, that is, from the burns of pre-schoolers on the beach to the 18 30 range. This is the time when melanoma can develop as a result of sun damage and burns in childhood. The second group of melanomas we have are melanoma and elderly people who have simply accumulated a succession of repeated burns throughout their lives. And this then already appears in people of retirement age and beyond as well. Sunbathing should be kept as short as possible.

Monika Rachtan
You said that this radiation accumulates in the human body. So it's like I got sunburned today, but I've already smeared on buttermilk and it's all going to come off. And this. Because what I was thinking, but maybe more so our viewers often think that it's already erased, like that red will come off and the skin will come off. It's been, it's gone, and it's cumulative, which means it saves each subsequent burn for each subsequent burn afterwards.

Anna Czarnecka
Unfortunately, UV has the bad property that it damages what controls our cells, i.e. the DNA, and one damage to a given does not cause any cancer. If UV hits four to five genes that are important for melanoma formation, for example, five very unlucky burns can already cause melanoma. Of course, humans have 30,000 genes. The risk of radiation hitting precisely the gene that is important for melanoma is lower, because it must fall on selected groups of genes out of these 30 000 or so. So the risk is not high. But calculate for yourself that a burn is any reddening of the skin.

Monika Rachtan
Well, that's a lot of those burns over a lifetime.

Anna Czarnecka
Very much so. Therefore, even though we have 30,000 genes, and out of these we have to hit, i.e. V has to hit 5 out of 30, with all the redness of a lifetime, this risk increases more and more for us. And unfortunately. Well, you could say that the body remembers every such damage, if we accumulate these mutations there, and they're not reversible in the sense of once they're there, then unfortunately it could be that they won't be repaired by our body's own strength. So such pre-melanoma lesions live there peacefully, waiting for a new one, for a new burn, smiling at the sun, waiting when the cells, when they will be able to divide so well as this melanoma.

Monika Rachtan
And I collect questions from patient groups on Facebook that don't ask the experts themselves then different things fall out. Sometimes better, sometimes worse, but it shows that patients don't have this knowledge. And what you said that I read something like that was a topic about the harm of tanning. One old lady wrote that she had been tanning for 60 years, but she realised her, her mistake, and that now she is 67 and she doesn't tan anymore. She also wrote that smoking cigarettes eliminates the risk of melanoma after 20 years, so she has probably already eliminated the risk of melanoma after 7 years and that she is generally safe.

Anna Czarnecka
Well, unfortunately this lady is in the risk group. If she has been tanning for 60 years, or even if she has been tanning for 20 years, she is in that group of patients who should see a doctor every year to have their skin examined. I would say that we cordially invite this patient to the Skin Cancer Prevention Centre, because once a year someone should examine her and she is in this vulnerable group. 60 years of sunbathing is like 60 years.

Monika Rachtan
I'm the one who will ask more about this group and this risk. That is, who should I see once a year, let myself be seen by a doctor, and who should I see in general? Well, because is it such an ordinary doctor who can see me, or should it be a specialist?

Anna Czarnecka
Any doctor armed with a dermatoscope can do this. The PCP theoretically has such a tool, but I think that a more appropriate place would be either a dermatologist, a surgical oncologist or the just-mentioned Skin Cancer Prevention Centre, because not in every area of the country are such clinics readily available. There is also such a grassroots, community-based project linked to the sarcoma Foundation. There's a health van that goes around the country and there's such a mobile skin lesion clinic and, given our latitude, pretty much everyone should come along. If any of you have never been to such an examination before in your life, you are welcome to do so. Yes.

Monika Rachtan
And please tell me if it's a dermatoscopy examination, because that sounds again to patients, maybe a bit scary, Gastroscopy comes to mind, nobody likes it. Does it hurt?

Anna Czarnecka
No, This is putting a magnifying glass to the skin. It's about melanoma and they're very small. I mean the kind of tiny melanoma that you should already know you have, it's 1 millimetre long, it's obviously a lesion that such a micro dot can be seen with the naked eye. However, those features that tell you whether it is a melanoma, whether it is an ordinary birthmark, a mole or any other skin lesion can only be seen under magnification and translated is actually a magnifying glass. It doesn't hurt. Maybe it's a bit cold?

Monika Rachtan
And please tell me, let's go back to those sunscreens. If I apply the cream. In order for it to be effective, do I just apply one layer at 8 o'clock in the morning and then forget about the cream. Or if I apply it thicker will it last me longer? What does it look like? How do you apply these sunscreens correctly?

Anna Czarnecka
Unfortunately, applying once is not enough. First and foremost, if you are moving around outdoors, not sitting in an office away from the glass, then you should be lubricating yourself roughly every two to four hours, but this should not be taken rigidly. Even a waterproof cream is not towel-proof. Therefore, if we are bathing and have even painted ourselves and the children with waterproof cream, we re-lubricate when we come out and wipe ourselves off. If we're just lying down and don't have any contact with water, then it's up to lubrication. And I would honestly advise under three and a half hours here. I will still quote such one interesting data apropos of these beach umbrellas. Again, there was a study with these nice cameras that measured UV, but unfortunately there was also an experiment. An observation actually related to people reporting how it is with these umbrella burns? Well, so the observations were made for three and a half hours and one group of people chose of their own accord to just sit under the umbrella. And the other group said they were going to spread themselves with creams. These people were free to choose and it was not imposed in any way.

Anna Czarnecka
They reported their success or lack of success in protecting their skin. And after three and a half hours of sitting under an umbrella without sunscreen, 78% of the people who chose this way of beachcombing were burnt. In contrast, only 25% of those who chose to apply sunscreen or sunscreen. So let's remember that this cream also needs to be repeated for three, three and a half hours, including in this study, so such an optimal time is more or less three hours, and if we did not choose, we do not sweat very terribly and we did not swim, because even a little bit of this cream also runs off. We just see when it goes into the water, a person sees one. So that's what oozes out of us that needs to be lubricated. And now. And another important thing how much of this cream should we put on ourselves?

Monika Rachtan
That's right.

Anna Czarnecka
Well, it's easy to find this in Google graphics if one wants to search. But generally on our body we should spread between a fifty and a hundred all over. Imagine that instead of pouring a hundred drinks, the volume of that fifty to a hundred is spread all over the body, whether it is tall, short, a child and so on. On the other hand, also imagine how many of these fifty hundred we have to take with us on holiday for one sunscreen, such a barrel here. That's enough for us for one day.

Monika Rachtan
Yes, for one person a family.

Anna Czarnecka
So you can easily find how many fingertips should fit on your hand. And, for example, a whole, whole pad of cream like this should be smeared on the face, another pad on the neck, one each on the forearm and shoulder as well. This is actually a considerable amount.

Monika Rachtan
It is true. I think we are completely unaware of how we should use these sunscreens. I think most people, however, apply thinly and once and forget.

Anna Czarnecka
Ladies and gentlemen, instead of a hundred drinks a hundred creams.

Monika Rachtan
What I would also like to ask is whether, if I follow these recommendations, i.e. lie down in the sun, take sunscreen 50, apply the sunscreen, then repeat this even after three hours, I can lie like this all day with impunity.

Anna Czarnecka
And no, and it is not worth it. Please remember that there is no such thing as a total blocker, that is to say, part of the radiation. Nonetheless, what is written will pass. This value with the sunscreen is a multiplication of the amount of time we can stay in the sun so that we don't get a burn, that is, the appearance of that red colouring of the skin. If we can stay 20 minutes without applying any cream and after 20 minutes of sun exposure, we have to know about ourselves. This is how the colouring appears. After a sunscreen of ten, for example, this will increase by 10 times. On the other hand, this does not mean that no radiation will pass through to us. Even a 50+ filter filters out only 98% rays, and one unfortunate ray. So out of that two per cent, there is still quite a lot there. It can contribute to the development of skin diseases and to ageing, so in general, recall what ladies and aristocrats looked like in old literature or in films styled after old eras. They were pale, white ladies who hid under an umbrella and were therefore considered a symbol of health. And this is true in the transmission of old period literature.

Monika Rachtan
I wonder what their umbrellas were made of if ours are so ineffective.

Anna Czarnecka
Well, I guess you'd have to ask the historians. On the other hand, thick, woven dark fabric, and these umbrellas were often decorated with such pretty flowers, and floral patterns protect better than such a thin umbrella. As for those experiments with measurements under the umbrella, I will tell you again that they were carried out in such a way that we know that it is all about the radiation that falls from above and not the lateral one. This can be separated in scientific experiments, so we know exactly about the umbrella.

Monika Rachtan
I'll ask you about your scalp. Does it also get tanned? We have hair, does my scalp get tanned?

Anna Czarnecka
Of course he's getting a tan. I can even see the parting. It was beautifully scalded. The scalp unfortunately tans, the hair does not cover our skin 100%. We know ourselves that there are fine gaps between them. And what can we do about this? First of all, it is worth buying a hat again from this well-known outlet chain with a red background. You can buy very nice coloured hats that have a filter built into them. There are some in sports shops. Well, if that cut doesn't suit someone. Although I personally have three of these hats, each one is in a different cut and they are very fancy and I think the ladies will find something for themselves. Are there any cowboy hats for the men? Yes? And please remember that a hat is better than a baseball cap like that, because also the ear that will be sticking out of the baseball cap here on this shore is a very vulnerable place for melanoma and then we have patients like that who have that, unfortunately, the tip of the ear like bulldogs used to have. I have had very few such patients whose ear we have had to remove because of melanoma. So please remember that if you are lubricating yourself for the beach, you also lubricate your ears and the tip of them, because it is on.

Anna Czarnecka
About it.

Monika Rachtan
I wouldn't.

Anna Czarnecka
She thought. There's very delicate, sensitive skin on top, so a brimmed hat or any hat out there is better. What's not to call it than a baseball cap? Of course, a baseball hat is better than nothing. The ideal is a Mexican hat, but that will be difficult. And the same goes for children. If we're buying children a cap, not just with a visor, but preferably with a brim. If we're planning on swimming or if the children are running around on the beach, there are also caps that have a kind of collar at the back, a kind of tongue collar that hangs down over the neck. It is worth getting these too, because the neck rarely gets sunburned at the back, and these hats are more likely to be bought in travel shops or online shopping services. However, for children on the beach as much as possible. For water sports as much as possible. All boats, kayaks, yachts and so on. If someone really doesn't want to wear a hat because they think it's extremely unfacial for them, there are special sprays, not greasy for the hair, for the scalp, which are also with a 50 filter These are also more difficult to find either in these outlet chains or on the internet.

Anna Czarnecka
On the other hand, if you type in the English name of a hair spray just with a factor 50, there are some. If any lady wants to have nice pictures without a hat on a tropical beach, I encourage her to buy something like this. They are designed to give your hair a natural look, too, so you can buy one.

Monika Rachtan
But they also eat thorough every three hours.

Anna Czarnecka
Yes, of course.

Monika Rachtan
This is important information.

Anna Czarnecka
It's pulling the hats off just for the photo.

Monika Rachtan
And please tell me, is there such a thing? I mean, you have already said that there are some people who have this exposure to melanoma that is greater firstly because of this skin type, secondly because of their occupation, for example. There is something else that predisposes us to getting the disease.

Anna Czarnecka
Well, there are rare genetic syndromes, but that's usually what we know about, because it manifests itself in children, well, one such characteristic. Which you might not think of, because it's not actually such a severe disease. These are people who have a lot of nevi, which are light brown discolourations on the skin. In short, there is a very, very important gene in melanoma. It's called braw and in these nevi, which are light brown, it's already damaged. And it is the first of these five. So if we tan our moles, then unfortunately one first step is behind that mole already so it's easier for it to become melanoma. So people with multiple nevi, who are simply born with such a skin event, should also be very careful. An interesting factor in the late detection of melanoma not the development of melanoma, because this is not worth confusing are numerous tattoos on the skin, because with dark pigment it is simply difficult to notice that something has appeared, as if a pigment. It does not cause it, it is not toxic, it does not damage genes etc.

Anna Czarnecka
That's not the point. The point is that its impossible to see. You might not notice that underneath our super tiger or Japanese cherry and whatever else we've wooed to emphasise our personality. Something bad is starting to happen. So black in black you can't see.

Monika Rachtan
That is true. I would ask, are the people who, well, are at higher risk of getting melanoma? Can they do something more than the person not at risk? Can they do something to protect themselves more?

Anna Czarnecka
Just like everyone else. No sunbathing.

Monika Rachtan
Well, OK. So I'm going to ask you again, are there any other skin cancers that are caused by the sun? Because we talk to you a lot about melanoma, but I don't think that's the only cancer?

Anna Czarnecka
It is not the only cancer. We have several more serious skin cancers. There is one that is so characteristic of the elderly. Basal cell carcinomas are those, looking at it, protruding, spherical, with such a pearly after flash. Lesions that are rather typical of older people. That is, you have to pay attention if you see something like this in your grandmother, which nicely, but de facto unhealthily shines on the skin. These are the types of tumours that develop, fortunately late in life, and are associated with the fact that during life a lot of these mutations have accumulated, i.e. there has been a lot of gene damage, and it develops from cells other than melanoma, not from these coloured, colourless skin cells. The second group of skin cancers that are not, are not melanoma. These are purely cellular cancers. These, on the other hand, are those cancers that are initially such an ulceration on the skin. We see that there is a crack in the skin that does not want to heal. It can bleed when we don't even touch it, just by itself. They just burst these vessels and it doesn't go away.

Anna Czarnecka
Yes, it doesn't disappear one month, the next, then you also have to think about the fact that it could be, that it could be cancer. Well, and finally, in our climatic zone, it's less often associated with UV radiation, but in these more southern areas, renal cell carcinoma is a very serious diagnosis these days, because it's a fast-growing disease. These are, in turn, relatively to all other skin cancers, fast-growing nodules that are often completely painless at first. But this one, this one grows so large in diameter that it is easy to see this as a high growth rate. So that we have at least three more dangerous skin cancers 3 skin cancers in total. Because please remember that melanoma is not a cancer by medical definition, it is a neoplasm. And the point is that the cells from which it arises in the embryonic development of the human being, a little bit from other parts come.

Monika Rachtan
I understand.

Anna Czarnecka
Which is not to say that it is not a malignant tumour.

Monika Rachtan
It also seems to me to be an important thing for younger people that I buy my parents a UV filter cream for their face and for their body on every possible holiday, because older people, for example, are not at all aware that these skin cancers exist, and the concept of sunbathing that we are talking about today is very much associated with lying in the proverbial sun. It is very often the case that I see in my elderly relatives the changes you mentioned, that is, the shiny ones, and I send them to a surgeon to have them checked. If something needs to be cut out, I cut it out. But this sun cream my dad carries in the car, my mum carries it in her handbag on a nugget, I've attached it to my dad so he has it and he tells him to apply it because I know how dangerous it is and I think it's good for younger people to take care of the older ones .

Anna Czarnecka
for sure. Well I try to do the same, with my dad not really accepting creams. Therefore for people who don't like the greasy feeling of the skin what I understand. Please remember that now the cosmetic industry also offers sprays where there is a filter. You have to look to see if it is one that is not an emulsion, so that you are not fooled by the shape of the bottle, but that it is a spray. And there are also those that are non-oily. It covers the skin with a matte layer and men or people who want to maintain a matte skin tone can also use them. Cosmetics with a filter. They are handy, by the way. I highly recommend that you carry these sprays in your handbag when you go on a trip, as it is easier to apply the spray yourself and spray yourself somewhere than it is to cream yourself. It's also easier if you're going on an intense trek or running. If I'm running by myself somewhere in the woods or in a park then I can spray myself on the backs of stupid passers-by. Could you please lubricate my back here? This could be misconstrued. Therefore, a spray also from Polish manufacturers, one in a good price range, available in drugstores, solves this problem for me.

Anna Czarnecka
Yes, I can get on. On jogging alone to splash also in such hard-to-reach places with such delicate areas. I also wanted to encourage you to give the top of your foot a go. If we are in sandals, the part between the straps also tans and moles appear there too. I must admit that I myself have already had a birthmark removed just on the dorsal top of this layer of the foot, i.e. the top. Not on the underside. To put it briefly and also between the straps in sandals, you have to be something or lubricated before you put it there. And this is the part that we rarely remember. We also rarely remember about those ears, which is all those kind of protruding places. Yes. And let's also remember under the knee, on that same bend, that's a very common place for burns. And also when we lubricate the leg like this, it goes so easily on the calf, it goes great on the thigh. On the other hand, above this slightly sunken area between the thigh and the calf, not everyone always lubricates. This is a great place for burns, there too.

Monika Rachtan
I have two thoughts for myself: I have a lot of catching up to do when it comes to the straps of my sandals, because even when I am walking around town with my daughter in a pram, because I have a small child, I have noticed that my feet get sunburnt there, and I have recently thought that the spray you mentioned is a lifesaver in the summer season, because it also has a filter and it cools down, so it is nice. I also need to start spraying my feet with this spray, because that's where something like that can occur. And my second thought is that I hope that greater awareness has been emerging among Poles at the Polish seaside recently. And those caps with collars and children, and those ladies in hats. There is a bit of a fashion trend for hats, but ladies in hats. There are more and more people like that, and it's very uplifting. But we would like everyone to comply.

Anna Czarnecka
I mean, I am happy to know that children are supposed to be dressed in the right clothes that come with a filter in these sports nets. They are readily available at the moment, because I think at the time of our childhood, without giving away our number, the attitude was that a child could wear nothing at all or just their underpants. To run around on the beach in a healthy way is so great, it's not great at all, and let's remember that most melanomas are numerically related to these childhood burns. So if we let our children run around in the garden, play ball, play tennis, whatever they choose, and the youngest ones just to run on the beach, let's put these clothes on them. They are really cute already, colourful, with superheroes appropriate to their age. It's also worth remembering that some pushchairs already have a canopy for the youngest.

Monika Rachtan
With the filter it's true, I've seen those too. Today we talk a lot about melanoma, we scare a bit about melanoma. So I'll conclude by asking whether melanoma is a death sentence or whether it can be treated, though?

Anna Czarnecka
Early detected melanoma can be treated. And what do I mean? Early? Early? This is the tiny little dot. I'm talking about one millimetre thick melanomas. In terms of thickness, not size by width, just how deep I penetrate the skin, that's what we measure. Is it threatening or is it dangerous. Well, one that only penetrates one millimetre, then after 10 years 92 98 patients are alive. I say after 10 years, because longer measurements are unlikely to be taken. Right? And this is such a cut-off point. If unfortunately the melanoma is already thicker. Thicker means 3 millimetres.

Monika Rachtan
So not much.

Anna Czarnecka
Although still not much. But it is a lot of time. It's not a matter of weeks, but more like months and years. This from a small mini metre strip to. A fat 3 mm mask. Well, that's already reduced significantly to seventy-something per cent, especially if something has occurred in a lymph node. But still, if we even have patients who are diagnosed with melanoma at the spreading stage, i.e. they have developed metastases in distant organs, with the therapies available today, treatment can be carried out for many years in these patients. Of course, this is not the case for everyone. Every patient is different. However, there is already a therapy on the market which, in such patients with metastases, allows more than half of them to live after five years. This is a lot. Melanoma used to be a sentence, that is, most patients died within the first six months of diagnosis, that is, of metastasis. Today, more than half have a chance of surviving for five years. This is a major therapeutic success story. When it comes to modern drugs. Of course, for someone in their 30s and 40s, 5 years may not be such a success in terms of overall life expectancy, whereas older patients have a chance that their melanoma will progress slowly enough with the drugs that they will die of natural causes from a heart attack or any other disease.

Anna Czarnecka
This is most often how I refer to a heart attack or stroke, because these are the main killers of our society, so to speak. Cardiovascular and vascular diseases are winning out over cancer. So there is still a chance that there will be another culprit and not melanoma.

Monika Rachtan
My last question. I'm looking at your nails and I'm wondering if not wearing a hybrid is also melanoma prevention? Because I don't wear either. Precisely for this reason among others.

Anna Czarnecka
Yes, please remember that this is the camera you put the handle in. If you are doing a hybrid, it has UV. Well it is said that these are UV lamps and it is UVC, which we have not talked about here. Nevertheless, also this UV damages the DNA. Such led lamps or whatever they call us are not like the lamps in a solarium. It does not change the fact that it is UV. And there was a paper last year where scientists put healthy epidermal cells in such a lamp and checked what happened to them, such cells on a dish. And unfortunately, after genetic examination, what happened in these cells was changes in the genes, in the genome, in the genes of these 30 000, because they examined everything. These cells were analogous to those that occur in Melanoma. Of course, a cell on a dish is not a cell on a finger and we know that. However, we do have second evidence which tells us this, and these are simply statistical reports, that these are reports from the United States, because the techniques there were available earlier, that after 10 years of regular clawing, in short, there is a 3% increase in the risk, statistically calculated, of developing melanoma within the fingers, the so-called actual one mainly under the nail.

Anna Czarnecka
Well 3% is not a lot, but I would rather not have the three per cent.

Monika Rachtan
Well that's what I think too. And on the other hand, I also think to myself that the moment we put these hybrids on, we're not in control of what's going on underneath that nail. Stylists should probably be watching, but I don't know if they're all watching their nails. But we're watching something on our phone, watching, watching. Newspaper. While the stylist is giving us that nail make-up, we're not looking, we're not inspecting And how will we know it's like a tattoo?

Anna Czarnecka
Would I say so professionally, a well-trained nail stylist should really look at what's going on under the nail and that's the place I use. There are nicely trained girls working there who, if they notice on my leg, point it out to me. Oh she's glowing like that, I don't like it. Yes, but not every stylist will do that. It wasn't melanoma and it wasn't cancer. They did pay attention. There is another problem. We should also look at ourselves. Yes. But if we have beautiful nails all the time-dark red, juicy pink-you just don't see it.

Monika Rachtan
Of course it does.

Anna Czarnecka
Also, I highly encourage you to take care of yourself and boost your mood with some cheerful colours. I do it myself. But it's worth doing it in salons with well-trained staff who have a lot of certifications on the wall, with staff who care about hygiene. Because let's remember that in a beauty salon, melanoma is not the only risk you can carry from a UV lamp, but well-sterilised tools are safe, whereas unsterilised, poorly sterilised or unkempt tools are. Unfortunately, they carry the risk of transmitting diseases such as hepatitis yes or what is popularly known as hepatitis vaccine yes, among others. Whatever you want to call it, it's also the sort of thing that damages the surface of the skin. And all these manicures, where however this epidermal layer can be damaged, carry the risk of completely different diseases. And this is something to bear in mind. Not to say that the equipment should be good. We also know not to come out with foot fungus, so this is a very broad topic, so I encourage you to have beautiful nails, but sensibly, sensibly rather Vinylux not being so, which is not put in these all lamps.

Anna Czarnecka
When you look at them it's bad too, because apropos of that UV you shouldn't look at them because that melanoma of the eye meaning both putting your hand in and looking at that hand are both bad.

Monika Rachtan
I'm going to ask you now, because I've already asked all the questions except the special one we talked about before the programme. But I would like to ask you what you would like our viewers to remember from our conversation today, the three most important things.

Anna Czarnecka
The three most important things to make them remember that good cream, good glasses and a cool hat are sexy and worth putting on every day. Oh, those are the three things cream, glasses, hat.

Monika Rachtan
Great message. It's now that last question that we talked about, because my podcast partner is the Institute for Patient Rights and Health Education and the Institute talks a lot about the humanisation of medicine. What is the humanisation of medicine for you?

Anna Czarnecka
A nice word from the dictionary of foreign words. To me humanisation means that there is such a nice message of our hospital. The patient at the centre of attention. It means that we pay attention to the patient's comfort, to their quality of life. We used to only look in such old, especially 19th century medicine. We used to look at the effectiveness of the treatment. Well, they were measured by such typical, hard parameters and improvement Yes, some X-ray. I think that nowadays there are such well-known quality of life scales and it is worth remembering them too. And it is worth remembering that, as far as humanisation in the treatment of the patient is concerned, apart from people like me, that is the chemotherapist or the surgeon who removes this melanoma, a psychologist or a psycho-oncologist is also important.

Monika Rachtan
They are the standard.

Anna Czarnecka
In centres that operate in line with what the national oncology strategy envisages. Yes. I can't say that this is certainly the case in every hospital, but it should be and.

Monika Rachtan
We are striving for this.

Anna Czarnecka
We strive for this in our centre. It is standard in our departments, within the country, also in many hospitals in the Warsaw area, and smaller centres do not always have the capacity that there is to employ someone. It's just like that. There are still relatively few of these real psycho-oncologists with the right certificates.

Monika Rachtan
Professor, thank you very much for our conversation today. I think the patients have taken a lot from it. The prescription today is a hatful of cream.

Anna Czarnecka
And glasses.

Monika Rachtan
Glasses actually glasses too. We are sending you all on a shopping spree before the holidays. We hope that you will be equipped. They will rest safe and healthy this year. Thank you very much.

Anna Czarnecka
Thank you. Any excuse to shop is a good one. Best regards to all the ladies. Thank you, thank you.