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How to spot skin cancer from NYC Dermatologist, Dr. Sophie Greenberg

Jul 27, 2023

We are excited to welcome Dermatologist, Dr. Sophie Greenberg, to The Style That Binds Us podcast to talk all about skin cancer: how to spot it, prevent it, and more. Dr. Greenberg is a Princeton & Columbia-trained dermatologist. She practices both medical and cosmetic dermatology in Manhattan. We hope you enjoy this important and informative conversation. 

I had a spot that I wanted to investigate. This is where all of this came about because we wanted to raise awareness of how to spot skin cancer, what is skin cancer, etc. Thank you so much for being here.

Thank you so much for having me. I’m so happy that we met and that we’re able to do this together.

Same. Let’s start with a really important thing: What does skin cancer look like? Thank you for sending these two phenomenal & helpful articles (article 1 and article 2).

Excellent. Yes, the visuals are really helpful, but the bottom line is that skin cancer can present in so many different ways. Not only is it because there are different types of skin cancer, but each type may look different on different individuals based on their skin tone or which body part is involved.

One thing that’s key is it will look a lot different than any other non-cancerous growths and moles on your body. The less deadly cancers are called Basal cells and Squamous cells. These are more common and may even present as a sore that doesn’t heal over weeks to months, or a spot on the face that keeps bleeding every time a person is shaving.

It can be so frightening to have this spot. Then you’re wondering, “Is this cancerous? Is this a freckle?”, or you may not even know what to be concerned about.

It can be so hard to distinguish, even as a dermatologist, sometimes we have to do a biopsy to be a hundred percent sure, or a pathologist looks under the microscope to determine.

Is it true that people with more fair skin are more prone to skin cancer? Is that a myth?

That is true. Being more fair-skinned, especially people who have red hair or blue eyes has been shown to have a higher risk of skin cancer.

Should they come in once or twice a year to get a full body scan? Or is that something everybody should do?

I recommend everybody should go in at least once to get a full body skin check, and then talk to their dermatologist. If you have a higher risk, sometimes even more than once a year, generally once a year is recommended. But for some people, it might be even less frequent than that.

I’ve never even had one and I’m sixty, probably time for me to get one. Is there any way to tell the difference between skin cancer, a freckle, or a mole? Maybe you just answered that, whether it’s a wound that doesn’t seem to heal or if it looks different than the other spots on your body. I read somewhere that maybe they have an uneven edge, or is that all kinds like you said?

Exactly. All kinds of things. I usually go over with my patients what’s called the “ABCDE’s of Melanoma“, which is a guide for people to do at home. A stands for Asymmetry, a spot that’s different on both sides. B is a Border that’s irregular so you can’t tell clearly where the mole starts and where it stops. C is the color, a different color than your other moles, or has multiple colors within it like brown, black, pink, and gray. D, Diameter bigger than a pencil eraser, and E, Evolution or change over time.

I’ve had Keratosis. Sort of bumpy raised places on your body that you can get frozen off. I could see when they got one they might think that was skin cancer because they’re unusually feeling and looking.

Yes, the Seborrheic Keratosis tends to be raised a little scaly. They can be different colors. That’s one that usually the dermatologist can help you distinguish because they can be a little scary looking.

Does sunscreen prevent skin cancer? And if so, including that, what are some other ways that we can prevent skin cancer?

Multiple studies are showing that regular and appropriate use of sunscreen does prevent skin cancer, both the common ones like Basal cells and Melanoma. Now, it’s tough and not everybody uses it as it’s supposed to be, which is enough and frequently. It’s about half a teaspoon for your face and neck, and a shot glass amount if you’re putting it on your entire body with reapplications every two hours, or every hour when you’re swimming or sweating.

Our skin does remember past sun damage. Five sunburns or just one blistering sunburn in childhood doubles your chance of developing Melanoma later in life.

Now, not all of us are reapplying sunscreen when we’re out and about or going to work. I see sunscreen as one step but also wearing a hat, covering up with UV (Ultraviolet) protective clothing, and even planning your activities not in the sun’s peak hours to early morning and late afternoon.

It’s so interesting because we’ve tried a couple of different sunscreens lately. On the box now they all say the same thing, which is exactly what you just said, is that a new requirement?

It might be and I see a lot of people putting just a little bit on their arm and calling it a day and then getting a severe burn and saying, “Put sunscreen on.” But you have to do it the right way, which can be messy and annoying when you’re trying to enjoy your summer.

Also, I’m so glad you said a little bit less than a teaspoon, for your neck.

Yes, half a teaspoon.

I thought it was like a tablespoon. I was thinking, “I can never do that.” Then I put on makeup and go about my work day. That’s so much to put on your face, so I’m thrilled to know that it’s more like a teaspoon.

When I came to you you said, “Were you exposed to a lot of sun when you were growing up?” That was sad to hear because now I’m thinking of all the damage that I did way long ago. Now it’s showing up, is that how it works?

Unfortunately, our skin does remember past sun damage. Five sunburns or just one blistering sunburn in childhood doubles your chance of developing Melanoma later in life. It’s thought that intense UV radiation when you’re a child changes the DNA in your cells. 

“Sunscreen is just one tool of many to protect your skin from the sun.”

But ongoing sun exposure, even when you’re an adult, whether you burn or not, is linked with other skin cancers like the Basal cells or Squamous cells that are more common and less deadly. It does help to continue protecting yourself from the sun. I always like to ask my patients and I include their sun exposure history in my chart because it helps me understand their risk of the different types of skin cancer alongside their family history.

That’s great. One thing to know about Delia, I don’t know what you thought when you looked at her skin, but even as a child, she put sunscreen all over her body. She’s only had a couple of burns.

I always get burned.

Sometimes on the back of your shoulders, maybe on the back of your legs, and things like that. 

Sometimes you try hard and then it just doesn’t work. I don’t know, sometimes you get burned anyway.

You have to enjoy your summer, but your skin is beautiful. I didn’t see a lot of sun damage, so I love hearing from your mom that you were careful about sunscreen.

She’s a good student, when someone tells her, she will do it. But then you have people my age who had no clue. Not only did we stay in the sun, we took a double album which young people probably don’t even know what that is. An album that opens up like a book lined with thin foil, put it under our chin. 

With no sunscreen, just like oil.

We didn’t know then, but now we know. There are lasers and things like that, that can help with some of that damage.

There are a few ways that can help. There’s a vitamin called Nicotinamide. That’s a form of Vitamin B₃ that has many studies consistently showing that it prevents Basal cell and Squamous cell Carcinoma

There are treatments for the precancerous lesions that are called Actinic Keratosis that can be frozen with liquid nitrogen, or using topical chemotherapy, or even like you said, more cosmetic procedures like Chemical peels or Fractionated Laser. Nicotinamide, the form of Vitamin B₃ is an oral supplement. If you have a diagnosis of precancerous lesions, freeze with Liquid nitrogen.

Do you think we should all be having this vitamin B₃?

It’s tough because there are so many great vitamins out there. If you are at higher risk, if you have a history of skin cancer, or if you know that you’ve had a lot of sun exposure and a lot of people in your family with skin cancer, it’s a very safe vitamin that doesn’t have side effects. It’s a great thing for those types of people to take.

Does it reverse the damage?

If you continue to take it, you get fewer skin cancers. But when it’s stopped, your risk goes back to where it was before you took it.

Any summer skin tips that you’d like to share?

As we talked about before, I’d like to emphasize that sunscreen is just one tool of many to protect your skin from the sun. I love the EPA’s SunWise UV Index app, which gives you an hourly forecast based on your zip code to help you plan when it’s safest to go on a run or have a picnic. 

You’ll often catch me in UV-protective clothing, like a long-sleeved shirt, from brands that test their fabric to ensure that they’re UV-protective because a regular t-shirt can have a rating of SPF 5 to 10. But these fabrics have a tighter sleeve that is still very lightweight and can protect up to 50 to 100.

Wow, that’s wonderful. I had no idea about that app. That’s great.

It’s a great app and it’s free from Apple.

It’s wonderful. Like you said, when people go for a run that’s one time that they’re probably not thinking, “Oh, I need to put on my sunscreen before I go for a run.” Some people do if it’s a cloudy day, which leads to the next question. Do you have any favorite UV-protective clothing brands?

I do. Three of my favorites are Solumbra, Solbari, and Cabana Life which is a brand that was founded by two women, one of whom is a melanoma survivor.

What’s the difference between wearing sunscreen on a sunny versus cloudy day, as well as in the winter versus the summer? Do we need to wear year-round every single day?

It’s a good question. Daily sunscreen on your face, your ears, your back, and some of the backs of your hands is recommended regardless of the weather. If you check the UV Index on that app, you’ll see a mighty high, even on a cloudy day.

The reason you might not burn is that UVB Rays are more related to sunburns. But on a cloudy day, there are still tons of UVA Rays that cause sun damage, including contributing to skin cancer and premature aging without even getting a sunburn.

Can you use the same product for both UVB and UVA?

As long as your sunscreen says “broad spectrum”, it’s good. The SPF rating is specifically for UVB rays, But the UVA rating if it says broad spectrum, it has UVA protection.

Will you talk to us about blue light from screens?

Blue light likely doesn’t contribute to skin cancer. It can contribute to pigmentation such as Melasma and the sunscreens that protect against blue light generally, which is a pigment that is in a lot of concealers or foundations.

Photo Courtesy: Cabana Life / Learn more about their fabrics here

Wear UV-protective clothing, like long-sleeved shirts from trusted brands that test their fabrics for sun protection.

As you said, we can’t run our lives completely around sun protection, but as much as possible we can try. But of course, we all need to enjoy the summer and sometimes you just want to go have that picnic with friends, or go for a run in the middle of the day. Just try not to make it a regular habit.

That’s good advice. Don’t get too stressed. I have one of those powder forms of sunscreen. Sometimes if you’re on a bus, on a train, or in a car, you’re in the passenger seat, you’re driving, all of a sudden you feel the sun on your face, and you’re like, “Oh no, it’s beating down on me.” Do you think that is a good plan that I’ve incorporated?

Yes, the powder which usually comes with a brush attached to make it easy, is really good for reapplying just not as your primary sunscreen.

It’s just hard to completely reverse. I feel like growing up, it was so much about you needing the sun, it’s that essential Vitamin D. Then also, a lot of the ideals of beauty are this tan skin. Now we have to completely reverse our thought process to say, “No, all you have to do is have a Vitamin D supplement, and you should stay out of the sun as much as possible.”

Exactly. Studies show that Vitamin D is the same whether you get it through the sun or orally. The American Academy of Dermatology recommends oral supplementation because we don’t want to add to more sun damage.

What about that thing that is Seasonal Affective Disorder (SAD)? Does the sun make you happier, or does a Vitamin D supplement do that?

Vitamin D supplements are good. There are lamps with bright white and blue light that can help boost mood. It doesn’t necessarily have to be from the sun, but a lot of us get a little bit more down in the winter when the daylight hours are short.

Do those lumps not cause problems?

They can have some blue light, which can contribute to Melasma. But they generally don’t have UV light.

Mom has this LED Face Mask (*Use code THESTYLE for 10% off) that she uses on her face, is that harmful?

Those are wonderful and we offer clinical grades in our practice. The red light helps with inflammation, including Acne or Dermatitis. It’s shown to increase Collagen so it can help with anti-aging. They do work and they can be helpful.

Now let’s talk about the self-exam for skin cancer detection. Because of course, I came in and thought you were going to do a biopsy. When you look online at the images, I have little freckles that look exactly like that.

For self-exams, It’s good to make an appointment once a season to look over your skin. If you have some moles that your dermatologist wants to keep track of, you can take a picture with them. Sometimes I do that in the office with my patients on their cell phone so that they can compare. 

When you’re doing a self-exam, look at your face, neck, front of your body, and palms, don’t forget to check your feet. To look at your back, you can use a handheld mirror to look in a full-length mirror. Although even with that it can be difficult to see close up everything on your back, so if you have a friend or a partner, they can help you with the back and you can help them with theirs.

You said palms, you can get skin cancer on your palms?

Yes, skin cancer can develop even in areas that don’t get sun exposure. There is a type of melanoma called Acral Melanoma that’s on the palms, soles, and even genital area that is thought to be less sun-related and more of a genetic predisposition. That can be even more deadly and people who have darker skin types tend to be found a little bit later on because people aren’t necessarily checking and they can progress very rapidly.

So much danger lurking everywhere.

“The reason you might not burn is that UVB Rays are more related to sunburns. But on a cloudy day, there are still tons of UVA Rays that cause sun damage, including contributing to skin cancer and premature aging without even getting a sunburn.”

But we can’t get too worried.

Sometimes, patients tell me they were at the beach and under an umbrella, but sometimes clothing & umbrellas can be thin and cause a lot of UV damage. You can even find umbrellas that are made from high-quality UV protective fabrics if you’re frequently utilizing an umbrella.

That is a piece of wonderful advice, because, until this moment, I always thought when you were under an umbrella, you were safe. That is another way that we could be sabotaging ourselves that we didn’t even know.

That’s important. Does skin cancer have other symptoms we should be on the lookout for? For example, when I was researching this, people talked about it like an itch between their toes.

Generally, they’re not painful or itchy. I’ve had some patients say that an itch alerted them to skin cancer but it’s not a common symptom. The only thing is sometimes a spot might bleed or not heal, but that’s pretty much it for symptoms.

Does sunscreen expire?

Yes, and the expiration date should be written on the bottle. But it can also go bad if you leave it in a hot car or out in the sun for too long.

You could be slathering yourself with sunscreen and not know it wasn’t doing any good. Check the expiration date and make sure you don’t keep it near a window or out in the sun if you’re out at the beach. Will it last for one season?

Usually, one season, because it is out a lot when you’re taking it with you. If it starts to separate, like the oil or the water separate, it’s probably not good anymore.

Great tip. We talked about your favorite sun-protective clothing brands. Do you have any favorite sunscreens? Do you prefer minerals or chemicals? All these different options can be very overwhelming.

The best sunscreen for you is the one that you love and you are consistent with using. For me, I prefer mineral sunscreen. I find it to be a little bit less irritating and a little bit more effective. Two of my favorite brands are ISDIN which is from Spain, and a brand called TIZO, which specializes in mineral sunscreens that have both tinted and untinted versions. They have a mineral primer that has a nice matte finish that you can put underneath makeup and even out your skin tone.

Thank you! What are some things that as a dermatologist you would never do?

The number one thing is don’t go to a tanning bed. There’s enough UV to be dodged in real life. Why expose yourself to high levels of something that we know causes skin cancer?

How do you feel about spray tans?

Spray tans are totally fine, they’re safe. It doesn’t protect you against sunburn, but if you want that tan look, it’s safe.

Dr. Greenberg, what is next for you?

That’s a good question. For me, I plan to continue to help my patients in my practice and keep up to date on the latest research and technologies. I can keep my patients healthy, feeling good, and looking good.

Tell us about the latest research and technologies. What are you excited about?

One of the latest technologies and research that I’m excited about is understanding how our immune system helps our skin. When I went to the American Academy of Dermatology research meeting, there were a lot of new exciting products, and technologies, both in the cosmetic and medical dermatology realm related to our immune system, and our general health, including our state of underlying inflammation.

“Skip the tanning bed. There’s already plenty of UV out there; no need to expose yourself to something that’s proven to cause skin cancer.”

Fascinating, that gets back to the foods we eat, and our lifestyle.

Exactly. The foods we eat, how much stress we have, and how we manage our stress can all impact our skin. A lot of the new treatments and research are going in that direction both for beauty and overall health.

Oh, that’s good. Mom is obsessed with longevity

Well, the main thing is what you’re talking about, realizing that all of us are living in such a state of stress that we don’t even recognize that we’re all living on high alert. It gives you stomach issues and everything else. I have little posts around my apartment that say, “No stress allowed.” Because it affects everything, and now you’re telling us even our skin health?

Absolutely, and changing our mindset is extremely powerful.

We’ve been through such stressful times in the past couple of years, and these different things continue to happen. It’s hard to be calm unless you’re a Type B person, which we are not. Also, we’re entrepreneurs so we are always under stress. You go out into the world and you hear these things on the news, then you’re on high alert, “Be aware of your surroundings”, it’s not this calm environment walking around. 

I have one more question for you that is related to that. I recently had surgery and afterwards, a month later, I realized my skin was super dry. My hair was super dry, and my skin tone was less glowy. Things like the surgery, a major sort of trauma that your body goes through, does that affect your skin?

You also stopped taking your hormones. She had a Hysterectomy.

Absolutely. Even just the surgery, regardless of hormones, can have a huge impact on your skin. Sometimes they see hair loss three months after major stress on the body, kind of like we think about postpartum. Sometimes they see flares of underlying skin issues like Eczema, or Seborrheic Dermatitis (SD), which is the medical word for dandruff. All of these things can be impacted by a major stress on your body while it’s healing.

Skin cancer can develop even in areas that don’t get sun exposure.

That’s so fascinating. Because three months later, even for me, six weeks later, I thought, “Maybe this has something to do with that, but that was six weeks ago.” If it’s three months later, until someone comes to you, they might not have realized that you could still be affected by something.

Exactly. There can certainly be a delay. I usually try to ask questions about things that people might not think are relevant.

Well, this has just been full of very serious and exciting information.

I’m so glad.

Dr. Greenberg, thank you.

Thank you so much.

One more question, where can people find you?

You can find me in person in New York City at Tribeca Skin Center, or on Instagram @sophiegreenbergmd.

She has great educational content about all of this as well and you do it in such a fun way that people can understand. It’s not so scientific that people have no idea what you’re saying.

Thank you, I tried to keep it light and relevant.

And you also have a website?

I do, sophiegreenbergmd.com.

We encourage you to be very diligent about looking at your skin, using sunscreen, and staying in the shade. Thank you so much, everybody. We’ll see you next time.

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Important Links

Connect with Dr. Sophie Greenberg

Information on Skin Cancer

Cell Types and Skin Conditions Mentioned

Skin Health Essentials and Medical Treatments

Access Daily and Hourly UV Radiation Forecasts App


About the Guest

Sophie A. Greenberg, M.D., F.A.A.D., is a board-certified dermatologist in New York City. She is accepting new patients in her practice and accepts a variety of insurance plans. She graduated cum laude from Princeton University with a B.A. in the Department of Anthropology. As an undergraduate student, she volunteered as an emergency medical technician and created a peer mentorship program for students planning a career in the health professions.

She attended Columbia University College of Physicians and Surgeons where she graduated with an M.D. degree and completed a yearlong research fellowship investigating a novel, natural treatment for non-melanoma skin cancer, for which she was awarded the F. Lowenfish Prize in Dermatology. After graduating from medical school, Dr. Sophie Greenberg completed a medical internship at California Pacific Medical Center in her hometown of San Francisco, CA before returning to New York to complete a Dermatology Residency at Columbia University / New York Presbyterian Hospital.

Dr. Greenberg brings a holistic perspective to patient care, taking into consideration individual preferences, and cultural and lifestyle factors. In her leisure time, she enjoys painting, running, creative writing, and cooking.

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