It's a stark fact: The U.S. averages more than one melanoma skin cancer death per hour.
It's a false perception: A golden tan makes one look healthy, vigorous and youthful.
Both of those points are why it's critical to stay on top of skin lesions and other disorders. Then, if ever in doubt, make an appointment with a dermatologist such as Dr. Tanda Lane.
She co-founded Lane Dermatology & Dermatologic Surgery in Columbus six years ago with her husband, Dr. Joshua Lane. While Tanda primarily handles medical appointments and cosmetic treatments, Josh is the expert in surgery.
With the Columbus area situated in the Deep South, it's a busy practice and one that should only grow as an outdoors-loving population ages.
The Ledger-Enquirer talked recently with "Dr. Tanda," as one staffer referred to her, about her job, why she enjoys it, and her thoughts and advice for people suffering from skin problems and minimizing the damage that the sun can create.
Why did you decide to specialize in dermatology?
I like the visual nature of dermatology. I like that I can walk into a room and have a pretty good idea immediately what's going on with someone just from my visual exam. And I do like the procedural nature of derm; I actually did a year of general surgery prior to my derm residency and enjoyed it. I even got surgical intern of the year at the Medical College of Georgia.
But I just always found myself migrating back towards dermatology. I get a little bit of both. I can do the surgery, but I also do a lot of medical and cosmetic derm.
What percentage of your work is medical versus vanity-based cosmetic treatment?
Every dermatologist that you ask that question of is going to have a different answer. My husband is probably 98 percent surgical. I'm probably 30 percent surgical and the remainder would be split between medical and cosmetic.
Why do you enjoy your job?
I like the variety of it. On any given day, I see newborns and I see elderly patients. I think my oldest patient is 102. I see people that are coming in because they just want to maintain skin health or want to do Botox or fillers. And I have people that have autoimmune blistering conditions that require IV infusions.
So I enjoy that I'm challenged from the very difficult medical patient to a very challenging surgical patient, and then I can do the cosmetic patients as well. To me, it's a just blend.
I still get a lot of general medicine, because the skin sort of represents what's going on internally. We have diagnosed internal malignancies, leukemias, lymphomas and thyroid disorders from skin. And then the same day I'll have a 16-year-old who wants laser treatments because prom is coming up.
What types of laser treatments do you use?
We do photo facial lasers. We have pulsed-dye lasers for things like acne and rosacea. We can do dilated and broken blood vessels that cause redness on the face. We have hair-removal lasers. We have CO2 lasers, which is resurfacing and removal of wrinkles.
With our celebrity-driven culture, vanity treatments remain popular?
Even with the economic downturn, that's something that has been very stable. I haven't seen the demand for cosmetics decline at all. In fact, it probably has gone up a little bit as people are out looking for jobs and they want to look their best. I think it will continue to grow as the population shifts and the Baby Boomers get older and with everybody looking to maintain their youth.
Is treating age spots a common thing?
Certainly. That is a fairly common complaint from men and women. But age spot is not a specific medical term, so it may be different things. It may be a keratosis. It may be a lintego. How we would approach it would be different for every patient. There are bleaching procedures that we can do. We can do chemical peels. We can do laser treatments.
What's it like working with a fellow dermatologist who happens to be your husband?
We get that question a lot. The bottom line is it's wonderful to work together. I always tell people if I didn't like him I wouldn't have married him. (laughs)
But we're very different. We have different areas of expertise. We both did the derm residency. But then he went on and did a fellowship in Mohs micrographic surgery (removal of skin cancer and reconstruction). In fact, he's the only fellowship-trained Mohs surgeon in this region.
I certainly consider him to be the expert in skin cancer. And it's nice to have that expertise available without having to send patients out for consultations. I would say almost daily I approach him with (a question asking): What do I do? I've got a tumor that's a little bit outside of my comfort zone.
On the flip side, he consults me on some of his more difficult medical patients. I think it's just a great circumstance for both of us professionally.
What's a typical day like for you?
We get in at 7 and we're usually out of here by 5. It's nice office hours and a good lifestyle for a physician.
It just goes back to variety. In Columbus, at this location, from a medical standpoint I have seen leprosy. I've seen leishmania. I see skin cancer. And then I do cosmetics. So there's no risk of boredom. I come in and see what walks in the door that day. I never really know what to expect.
We do, believe it or not, cover hospital and emergency room calls. We get a couple of calls for skin rashes and drug rashes and things like that from the hospitals.
But I would say 90 percent of our time is just a clinic-based schedule. Josh goes to the (operating room) at The Medical Center and The Surgery Center in town. But I'm completely office-based.
I've heard there is no such thing as a good tan, correct?
I would agree with that. The only good tan is probably going to be one out of a bottle.
Do you preach that to people and warn them often?
I don't like to make decisions for people, and I don't appreciate it when people kind of force decisions on me. I think that my role is to educate. I just explain to them what it means.
A tan is your body's way of trying to protect itself. It represents that the skin is damaged, that there's DNA damage that has occurred. The body is trying to produce pigment to protect itself from the burn.
There's no way you can have that bronzed, beautiful look and not have free radical production and thickening of the skin and all of the things that women, particularly, don't want. So it's really a double-edged sword. Short term you may look better, but certainly long term it's going to age the skin dramatically.
Are people with darker skin safer than those with lighter skin?
That is the case. People with higher levels of melanin, which is pigment, do have some natural sun-protective factor. But we still see skin cancers in even the darkest Type 6 skin types, which would be the darkest African-American skin types. They get cancer as well. But certainly the rates are going to be highest in very fair Caucasian individuals, because they don't have that natural protection.
With children spending plenty of time in swimming pools this summer, what SPF (sun protection factor) should sunscreen have and how often should it be reapplied?
Intermittent burns in childhood is actually the highest risk long term for skin cancer. So it's extremely important that parents are protecting their kids from what's going to happen down the road. The minimum SPF I recommend is 30.
There also have been new changes with the FDA labeling that occurred just this year. (Manufacturers) can no longer make claims of waterproof. You're able to say it's water resistant or sweat resistant. That means it either lasts 40 minutes or it lasts 80 minutes. But that's the maximum. So every two hours minimum you need to be reapplying sunscreen.
What can teen-age girls and women in their 20s do now to protect their skin from aging prematurely?
For all people in general, to be honest, there are three things that are key -- sunscreen, antioxidants and a retinoid of some sort, like a Retin-A product. That's in addition to just true physical avoidance. Even with sunscreen on you don't want to go sit in the sun. You're still getting damage through that.
Retinoids and antioxidants are topical products?
Most of the retinoids are going to be in topical cream form. There are a lot of antioxidants that are topical as well. But you need to have a diet high in antioxidants as well. So blueberries and kale and pomegranates and resveratrol are all things that we talk to patients about supplementing their diet with for skin health. But I'm a fan of topical antioxidants. I think that's something that should go on the skin before sunscreen, for everybody.
Are skin lesions or cancers mostly found on the face, arms and hands, or can it be anywhere on the body?
You can get cancer anywhere. We have people who have had genital skin cancers. We see vaginal, penile, perianal skin cancers. It's certainly less common, but we do see cancer in, quote-unquote, areas where the sun doesn't shine, the bottom of the feet, under fingernails. So no place is really safe.
That's why full-body skin exams are important. We even look inside the mouth. You can get melanoma in the back of the eye. So we really try to screen thoroughly in everybody. But certainly the most common area is going to be the head and neck.
What should people look for when checking themselves or each other for skin problems?
The main thing I tell people is if the lesion is persistent, then check it out. That means if it's symptomatic, it's itching, it's burning, it's tender, it bleeds, and just won't heal. If you see a spot on the skin -- whether you think it's a pimple, a bug bite or a splinter -- and it's not healing, it needs to be looked at.
What would you do to treat common liver spots or age spots?
I would probably start with a bleaching procedure or a chemical peel and then we can do more of the pulsed-dye laser or IPL (intense pulsed light) laser or something like that.
Do we have more skin cancers here in the Southeast?
We do. Most of the data on skin cancer is on melanoma, because 75 percent of skin-cancer deaths are from melanoma diagnoses. And I know that Georgia has a 13-percent higher rate than the national average ... I'm sure Muscogee and Harris counties are high on the list because we're a water-based community and live a very outdoor lifestyle. We certainly see a tremendous amount of skin cancer in this region.
What skills are needed to be a good dermatologist and what advice do you have for someone considering your profession?
I would say it's a long road to get through the training. After college, it's four years of med school and four years of residency. So you have to be willing to put in the work. And you have to have concern for people with all degrees of problems.
Again, going back to the variety that we see in dermatology, we may have someone with an autoimmune blistering condition, or lupus that requires hospitalization. And then, at the same time, we may have a 27-year-old with acne or sunspots that she wants to get clear before a wedding.
So you have to really care about what your patients care about.
And you need to stay up to date on new treatments, technology and statistics?
Right. We're both clinical assistant professors at Emory. So we have mandatory continuing education requirements just through that. It's a lot of work to keep up with it, but I think patients deserve that. So we do make efforts to be current.
I almost forgot. How did you land in Columbus?
I'm from Atlanta and Josh is from Macon. It goes back to the procedural Mohs fellowship that he did. We knew we wanted to be in Georgia. So we looked at regions that have a need for fellowship-trained Mohs surgeons, and there were none in Columbus.
That put it on the map for us, so we drove down and visited and liked the community and how family-friendly it is. So we just picked it with no ties here. We've been glad we did.
Dr. Tanda Lane
Hometown: Grew up in Smyrna, Tenn. Her family moved to Atlanta when she was 12 and currently lives in Gwinnett County
Current residence: Columbus
Education: Graduate of South Gwinnett High School; bachelors of science degree, University of Georgia; post baccalaureate work, Georgia State University; medical school, Medical College of Georgia; general surgery internship, Medical College of Georgia; dermatology residency, Emory University
Previous jobs: Actuarial analyst
Family: Husband, Dr. Joshua Lane (also a dermatologist), and children Alexa Kate, 3, and Maxwell Archer, 10 months; and family pets, Olive and Leonard Lane, described as two crazy dogs
Leisure time: She says there is no relaxation in her life with a 3-year-old and 10-month-old, but she is very committed to working out. That includes pilates, lifting weights and frequently being seen around her neighborhood with the kids in a jogging stroller.
Also, since early adulthood, she has been interested in the biographical history of Abraham Lincoln and history of the American Civil War in general. She says her house is a veritable library on these subjects! She and Josh also have recently started a garden, which is rapidly becoming an obsession
Of note: Because of her daughters medical struggles, she and Josh are very active in childrens charities that benefit St. Jude Childrens research hospital and the American Partnership for Eosinophilic Disorders
For more information: www.lanederm.com and 706-322-1717
ABOUT MELANOMA SKIN CANCER
Cancer of the skin is by far the most common of all cancers. Melanoma accounts for less than 5 percent of skin cancer cases, but causes a large majority of skin cancer deaths.
The American Cancer Society's estimates for melanoma in the United States for 2013:
About 76,690 new melanomas will be diagnosed this year (about 45,060 in men and 31,630 in women). The rates of melanoma have been rising for at least 30 years.
About 9,480 people are expected to die of melanoma this year (about 6,280 men and 3,200 women).
Melanoma is more than 20 times more common in whites than in African Americans. Overall, the lifetime risk of getting melanoma is about 2 percent -- (1 in 50) for whites, 0.1 percent (1 in 1,000) for blacks, and 0.5 percent (1 in 200) for Hispanics.
Unlike many other common cancers, melanoma occurs in both younger and older people. Rates continue to increase with age and are highest among those in their 80s. But melanoma is not uncommon even among those younger than 30. In fact, it is one of the more common cancers in young adults (especially young women).
* Source: American Cancer Society