SPEAKER_01:0:00

Unfortunately, we have seen a absolutely appalling trend where young people are going out in the sun in order to then take photos and selfies.

SPEAKER_00:0:09

Goal and survival. I mean, basically I don't want what happened to that patient to happen to anyone.

SPEAKER_01:0:14

Today we're talking about skin cancer. Two out of three Australians diagnosed with skin cancer sometime in our lifetime. We first met Dr. John last year when the team and I went for our skin checks at his Sydney Clinic. What are Australians supposed to do about checking their spots?

SPEAKER_00:0:30

It's a good question. I think that there are a couple of things. Number one is the awareness that something might happen.

SPEAKER_01:0:35

In this episode, we talk about what people really need to know about skin checks and the small actions that can literally save your life. Let's get into it. Welcome, Dr. John, to Sunday Sessions. Thank you so much for being here.

SPEAKER_00:0:51

Thank you, Sam.

SPEAKER_01:0:52

We met you last year at our Check Your Spots annual campaign where everyone in the office realized that we hadn't had our spots checked in we don't even know how long. And we looked down and thought, gosh, we're doing this big campaign and none of us have had our spots checked. So we came to you. And I think I'm not sure if you were appalled or impressed that we came or that we hadn't been in so long. But what are Australians supposed to do about checking their spots?

SPEAKER_00:1:20

It's a good question. I think that there are a couple of things. Number one is the awareness that something might happen. So sometimes people think it's something that others get, but anybody can get it. You quite rightly said that it can be an issue for younger people. It can be an issue for older people. If we think about the overall incidence, the average age of diagnosis of skin cancer is 64, but it's also the greatest cause of cancer death at the age of 13 and continues up to being the number one cause of cancer death to the age of 44. So we kind of look at those numbers and go, hmm, okay, well, that's not what people kind of thought. So if we think if we have skin, skin has cells, and any one of those could become cancerous. It's more common with more UV exposure and with those who have a very significant family history, but it doesn't mean others can't get it. And if you're not looking, then you won't find.

SPEAKER_01:2:10

So you're saying that kids as young as 13 can get skin cancer?

SPEAKER_00:2:13

Aaron Ross Powell, it can happen. You can be born with melanoma. Okay, so it can occur if the mother actually has it, it can cross the placenta. So you can actually be born with it, or you could develop as a a a genetic mutation in the first few months of life. It's extremely rare, but it can occur. So I suppose if we think about it, it's something that if we kind of partition out certain periods of time in our lives where we can't get it, we we're not going to be necessarily correct. We might be correct on the balance of probabilities. But what if you're that one? What if it's your child is that one? What if you didn't check but you could have? How are you going to kind of reconcile that and think about that and go, well, God, if only I'd dot dot dot. And how difficult is it? It's not hard. And we'll go through. There are things about self-checking and things about professional checks. And it does depend upon the risk as to how frequently those need to be done.

SPEAKER_01:3:02

Aaron Powell I want to take you back. So you uh studied medicine and you did that to save lives, essentially. But what was the first case that you saw with skin cancer or melanoma that made you want to get into this line of work?

SPEAKER_00:3:15

Aaron Ross Powell Look, it's something I think about almost every day. There was uh a chap who was actually a director of a significant financial institution here in New South Wales. Young chap who was 42, and I was working at a major hospital in in the northern suburbs of Sydney, and he came in, he was wearing a singlet, he had a sports bag, and he'd just come off the squash courts. And you know, I I said, Well, what are you here for? And he said, for my pain relief. And I go, What do you mean? Uh, for my melanoma. And I thought, hang on. In the back of my mind, I'm thinking, if you need pain relief for melanoma, it's it's it's not necessarily a good outcome. It it's possibly a really bad one. I thought, well, he just seems completely it's almost like he's I've got a headache and have a panodol. And I thought, this is strange. So sure enough, a week or two later he was admit admitted to hospital with, you know, a deteriorating condition very, very rapidly. And a month after that, I was actually the doctor that certified his passing. And I remember that the decline that he went through was extraordinary. He went from someone who was literally playing squash to somebody he'd he'd lift up a cup of coffee and his arm would break because he actually had so many melanoma metastases in his arm bones that they couldn't hold up a cup of coffee. He had fifty, sixty, seventy fractures at the same time. So breathing for him was beyond agony. And you sit there and go, This is how can this happen? And then I remember also, sorry for getting emotional, but you can't not. Yeah. I remember th going outside after certifying his passing, and there was his wife and his two young kids around the age of ten, similar age to my own kids right now. And they all said, When's daddy coming home? And I I just decided then I don't want this to happen to anyone. So that's why I do what I do.

SPEAKER_01:5:04

Wow. And so what is your advice? This person's forty-two, I'm forty-two. What what do we do?

SPEAKER_00:5:13

Good question. I suppose let's think about the preventative aspect. You asked, can it be prevented? There are two main causes. One is genetics, so that occurs from cell division, and new mutations can come in, which could predispose to cells continuing continually dividing. And there's not a lot you can do about that but be born to someone who doesn't have a family history. So you can't change that. Okay. But what the the other aspect, in Australia, about 80% of skin cats, it comes from mutations induced from UV. And you can get involved in preventing that. And it's not about not doing things, it's about how you do things outdoors. So it really comes down to the time of day and the time of year. What we want to do is to minimize the amount of time between 10 and 3 when we're outside in the warmer half of the year.

SPEAKER_01:6:04

When I came to see you, I had multiple spots and I did have to have one removed. And I remember you telling me that I had to have it removed on my back and just I was hysterically crying and it hadn't even been removed and it hadn't even been tested yet. But just the fear of thinking that of all those times that I was outside in the sun from 10 to 3, probably without sunscreen, because I didn't before Naked Sundays, I didn't even think about sunscreen and without protective clothing. And the first thing you said to me was, There is no more sun for you unless you are wearing long sleeves. And I guess we've grown up in a generation and in a country where no one wears long sleeves outside in the sun in Australia at the beach. And my daughter who's now nine is only allowed outside with a long-sleeved swimming costume. But how long is that gonna last? I mean, I'm sure by the time she's a teenager, she's gonna not be wanting to do that. Is that the solution? Are we just literally, especially someone like me who is prone to spots, are we just not allowed in the sun?

SPEAKER_00:7:10

No, you're not ideally, it's not like you're not allowed to. We think about it in terms of a numbers game. The more photons of UV that come in, the more potential mutations that you might have. I tend to liken it to something like a game of snooker. You've got the red balls in a little kind of triangle, you've got all the different colors all lined up the right way. Think of the cue ball as being a photon of UV. It comes in, knocks everything sideways. Some fall off the table, some go in the pockets, and they're all mixed up. Now, if and imagine that's the DNA of that particular skin cell. If this if the body can't repair the DNA, that cell will die. And we know that is peeling. And that's what peeling is, because the skin cells literally have so many mutations they can't survive. We're not worried about those cells so much. We're worried about the ones that have slightly less mutations but survived. Because now they still have those mutations, and they won't all be repaired adequately. So that's why the number of sunburns you have is a significant factor in the longer term outcomes. So because you've still got damaged cells which are around and we don't want those. So you kind of think, well, the less photons, how do we do that? Well, when is when when is there more UV around? Middle of a day, warmer part of the year. So we try and kind of decide to be out if we have the choice. Sometimes we don't. But if we do, earlier or later, is a better option. Before 10, after 3, if you can do it as much as possible. And if there's an option, the afternoon's a better plan. And the reason why is the UV's trending down massively. So number one, you wouldn't probably need to reapply your sunscreen. Let's say you went out at three. By five, there's almost no UV, I wouldn't worry. But the temperature of the day is higher. The temperature peak is at 3 p.m. We find the UV peak is at midday. So given the fact we can't feel UV and that wonderful sense of warmth and and and comfort that comes from being in the sun and doing things outdoors, that's actually heat. Peaks at 3 p.m. So we get more of the heat, the thing that we really like in the afternoon as well. So you sit there and go, well, it's almost a little bit, given the fact that there's less UV. It's like having low-calorie ice cream. You can have more of it, and it doesn't cause the problems that we would normally see. So a little bit of thought planning and so on is just really all it takes in terms of the bigger picture. Now, on one day, one weekend, a week or two, perhaps that's not really achievable. But if that becomes the habit as to how we use the outdoors, it's going to make a profound impact on the amount of UV we end up with. A hell of a lot less cue balls, a hell of a lot less damage to you to DNA.

SPEAKER_01:9:37

I would love to explain this to young people that it's really important that you try and stay out of the sun during these hours, or at least if you're in the sun, wear protective clothing, wear your sunscreen, and reapply. Unfortunately, we have seen a absolutely appalling trend where young people are going out in the sun between 10 and 3. I actually feel ill talking about this and getting burnt and getting tan lines in order to then take photos and selfies and put it up on social media as a trend. I have no idea who in the heck ever thought that that was attractive because that can cause death. Now, I just would love you to explain to the people that are listening. And a lot of my cohort and my circle have um children that are in this age bracket and they can't say to them enough, please stop burning your skin. There's nothing appealing about this. But can you explain to us how that can actually lead to and and I don't even want to say it can it can kill you. I want to be able to say, I went to your clinic and because I was in the sun and my back was in the sun and I got burnt, not for the looks, just because I had to get it cut out. There is nothing appealing about that massive scar on my back now. And this is what's gonna happen if these girls continue to do this. Please tell tell them, like what does this cause to your skin and what is the consequence?

SPEAKER_00:11:13

Aaron Ross Powell Well, look at me, I suppose thinking back to the snooker snook snooker analogy that they're going to get more cells that have more mutations, which are a few steps closer to losing control over cellular reproduction, which is basically what we call cancer. There's simply cells that keep dividing. It's not a difficult concept. The downside is it can be lethal.

SPEAKER_01:11:34

Aaron Ross Powell And it it can be just one freckle, right?

SPEAKER_00:11:36

Yes. Unless we're as wide as a sheet of paper, we've got pigment cells everywhere. And any one of those, whether it's in an existing, let's say, lesion or a freckle mole, whatever you want to call it, okay, or normal-looking skin, there are pigment cells everywhere. Any one of them could mutate and become an issue. And it may not be in a visible area, and this is one of the issues about checking. If you don't look, you won't find, because we can only really see 40 or 50 percent of our skin area at any given time. What about the rest of it? Who's looking at that?

SPEAKER_01:12:06

So let's talk about that. So how are we supposed are we supposed to check our skin? Are we supposed to come to you to check our skin? And what are we looking for? Aaron Powell Sure.

SPEAKER_00:12:14

Well basically it's all about let's look at the survival rates. Okay, we're looking for the highest level of survivability. And that comes with the earliest form of detection. So the earlier we get something in any area of medicine, any area of cancer, the greater the chance that we've got to have 100% survivability. And that's really the goal. So what we're looking for is roughly a monthly self-check for any adult. Okay. Children probably it it's a difficult for there to be a performer, but let's just focus on adult adults for the moment. So monthly on the first day of every month, possibly set a reminder on your phone. And you can do it simply, let's say you've finished your daily daily hygiene, you've just had a shower, you've got mirrors around, okay, you're you're probably not wearing terribly many clothes, so therefore you can actually look over the area that you can see. If you're lucky enough to have a partner on an ongoing basis, then they can perhaps look at the areas that you can't see and you can return the favor on them. And what you're looking for is something that just flags up. You gotta go, hmm, what's going on with that? And you know, it's something that's called we call a cognitive dissonance. So the brain just goes, is that new or was that there before? You may not even know, and it's not important to know. It's more the issue that is it still giving you the same reaction two to three weeks later? Because if it is, that's something that probably should be looked at at that time. Now, we all get bumps or scrapes or spider bites we didn't know we had, but they're over a two or three-week period going to start to settle or become really, really clear that, ah, that's fine, not an issue. They could even plateau out and not really change anymore. It's the things that are continuing to change. Because remember, I said cancer cells are cells that can't stop dividing. It's impossible by definition for them to settle. They can't stop. So we're looking for something that's changing uniquely for more than two to three weeks, anyway, anywhere, doesn't matter what it's doing. So it could be a change in color, size, shape, could be getting raised, itchy, bleeding, crusting, sore, you name it. It's doing something nothing else is doing, and it's continuing to do it for more than two to three weeks. It's actually a very simple thing. Next thing is in terms of professional checks over the age of 18, typically an annual review. The evidence shows between six months and two years is a reasonable interval. Six months is pretty frequent. Most people perhaps may not even see their relatives that frequently and they get a bit over it. And the problem there is after a few negative checks, they might not come back for a check for ten years because I'm I'm fine. And that's not a good issue. When it comes to every second year, again, people forget what year they came in. Whereas if it's you know, every year, number one, it's somewhere in the middle of that period. Number two, it's like, well, if something popped up the day after the check, a year is a lot less time for something to run than two. And it's also easy to remember. For example, if it's around Easter, well, it's around their birthday, it's around, you know, beginning or the end of the year. It's something that they can easily remember. And it's best when you walk out of that check, wherever you are, to book the next one. Because it's easier to be reminded than to remember.

SPEAKER_01:15:07

What is your goal? I know you've told it to me before and it just struck me and it's stuck with me. But what is your goal by telling Australians and and really anyone who's listening to get their skin checked every year?

SPEAKER_00:15:20

The goal is survival. I mean, basically I don't want what happened to that patient to happen to anyone anywhere. That's kind of why I'm here, because there are people who will never be my patients, but hopefully this will make some difference to the outcome for them.

SPEAKER_01:15:36

You've told us a lot of information today uh about staying out of the sun and checking our spots ourselves and um and making sure you have that regular check every single year and some some people maybe every six months, like myself. Uh what's the one piece of advice that you hope that people will take away after watching this?

SPEAKER_00:15:56

Look, I'd say that going red or getting tanned are the result of sunburn. And that is something that will increase your risk over time. A single burn, uh single tan, perhaps not so much, but they all add up. So think carefully about whether or not it's worth the longer term cost for the short-term perceived gain. I that's the that's the important thing to bear in mind. You cannot get a burn, you cannot go red or cannot get tanned without sunburn. And the goal is to avoid that.

SPEAKER_01:16:29

When people think that that is attractive, that sunburn or those tan marks, can you tell us what you have seen could be from a freckle, could be from, as you say, a larger um mole that has changed over time, but what do you see as a consequence of you having to cut that out? Because I've seen it firsthand on my back. And I would like people to know what happens from that one or two burns and that tiny freckle.

SPEAKER_00:17:00

Well, the consequences are that they may need to undergo treatment. Okay, so they they have to be explained that there could be a risk if a certain amnesia was there, and that can be a shock to people in itself. So that's one thing. The other is for them to have to have the procedure, let's say it's going to be surgically removed, if that's the case, then then they have to have a needle with local anesthetic, it has to be then excised with the margin of normal skin, it then has to be sutured back up. The there's an aftercare process, they have to keep wounds dry and not exercise, things like that to minimize scarring. We then send it off. This is waiting period, which can be very difficult for some people to wait for the results to come back. So, well, what is it? Am I going to be okay? Those types of things. And these are all kind of things that you probably would rather not have a new routine day. Then sutures need to be removed, and then ultimately long-term, that that scar will be permanent. So that's something to think about. And if there is a significant diagnosis, then that may flow on to either subsequent treatment or subsequent potential increased risk there could be some problems down the track. Ultimately, that's the bottom line.

SPEAKER_01:18:00

So I don't want to say that you're downplaying it, but I have seen from skin cancers being cut out or melanomas cuts massive, like someone had a on the top of her head, she had staples all in her head. I've seen legs like cut, you know, this is ugly, awful stuff that you that is, you do not want to go near.

SPEAKER_00:18:21

Look, I agree with you. I think that we could be uh we could be almost unwittingly deterring people for getting reviewed because they think that that might be the inevitable outcome. The reality is that if routine checks, self-checks, and professional checks are not done, then lesions can get to a more advanced stage. And that's when you start to get particularly large areas and large lesions and very deep and wide excisions and so on done because the risk is profoundly higher. That's where we start to get things like immunos and targeted therapies and all of those types of things, which can have massive impacts in themselves, because we're trying to make the most of what would be at that point a difficult situation. If we never got into the situation in the first place, we had less UV, we had routine self-checks, we had routine professional checks, the chance of that outcome occurring is profoundly less to the point where it's almost eliminated. So it I would gently put that to take that kind of proactive approach is one where that outcome is vanishingly rare.

SPEAKER_01:19:27

I've read somewhere that the government uh might be looking at making sunscreen topping up compulsory at schools. What do you think about that?

SPEAKER_00:19:34

Aaron Ross Powell, Jr. Fantastic. I mean, while most primary schools have uh guide advisories for their students, they need to have sunscreen on as as before they come to school and they have to wear their hats. And often they have longer sleeves when they do things like midday sports and things like that. It's not really enforced, but at least it's there as a policy. That seems to melt away in secondary school. And when you consider that sunscreen, look, if it's applied adequately, will probably maintain its effectiveness for about maybe two hours. Then it needs to be reapplied. And you consider most of the time a kid's going to be at school, they're probably indoors in class. And so they're only out for 15-20 minutes for recess and maybe a 45 minutes to an hour for lunch. But then the recess might still be under some level of protection from from the early application. The the re the lunch one will not. And the issue there is the UV's higher than. It's the highest in the day. Because it's typically around about 12 to 1. And you go, well, I've already said that that's the worst time to be out. And so to reapply would be a great idea. For kids to be educated as to how to reapply it would be good. The real young ones are going to find that challenging. I wonder if the teachers would be able to do that. That'd be great if they do. And if that becomes a policy, then there would have to be some process whereby teachers are trained and expected and given given the time in their day to be allowed to do it. No one expects more of them from the resources they already have. There need to be more resources. But at the same time, it'd be a wonderful thing. And to be honest, it was actually on my mind dropping my kids off to school today. They're in year five and year two. I was thinking, yeah, I put sunscreen on them, but I can't really get to school to reapply it. And wouldn't it be nice if they did have that policy? Now, the other thing is in secondary school, where I think what you were saying earlier in regards to a trend on social media where people will show their kind of their red tan lines from recent sunburn. Really what we're seeing here is uh there's more of a peer group. It's actually that people's psychological pain is the immediate psychological pain they have of being rejected or not being accepted is greater than the perceived long-term physical pain of having an issue that maybe they won't even get. So they'll definitely feel rejected today if their peer group doesn't accept them, but they may or may not get an issue in the future, physically, and they the mind tends to deny the reality and the impact of that. And that's the reason why you're seeing trends like that occur. The only good thing I would say is it's a trend, so it'll come. And it'll go. But it will be replaced by another trend at some stage, which also involves something like tanning or burning or some kind of activity outdoors, which is a high risk one. They're not all, but it will be a bit of a cycle.

unknown:22:14

Yeah.

SPEAKER_01:22:14

Do you think the government is doing enough? We've seen slip slop slap for 30 years, and now we're seeing there's nothing appealing about a tan. But do you think the government could do more? And I guess the schools would come into it as well. But I mean, w we're still seeing skin cancer rates increase despite all their work.

SPEAKER_00:22:34

True. A few drivers of that. One is the advancing age in the population. And I mentioned earlier that the average age of diagnosis is 64. So as as the population average goes higher and higher, you're going to see an increase there. But we are seeing three times the rate of increase than just what age would suggest. So you've got quite a good point that you're making there. It came from that concept where let's just shock them. And both of them were profoundly effective. So I think that the health department can put together campaigns that do imprint and imprint permanently in a positive way. So what the next step would be, how what the next program, look, I'm sure that they could come up with one. And I think it would be a great idea if they do, because prevention is the key. That's really the big, the big answer here. Treatment, yes, it's there. And my God, can we do a hell of a lot more now, especially with advanced melanoma than what we could do 20 years ago? We literally just said, get your affairs in order, you've got a few months. But now, 70% of people with advanced melanoma, we can do a profound amount for, roughly half we can cure. That's an incredible turnaround. Okay, but who wants to be there?

SPEAKER_01:23:55

Yeah.

SPEAKER_00:23:56

If we can prevent them all, 100% survival. That's that's where we want to be.

SPEAKER_01:24:01

100% survival rate. That's what got me when I first met you. I thought, wow, this man is incredible. I've never heard anyone really just say it like that. We want 100% of people. Well, I guess you don't want people getting skin cancer. So that's why we want a hundred percent survival rate.

SPEAKER_00:24:19

I'm happy to be out of a job.

SPEAKER_01:24:20

We've got some rapid fire questions. Five. Biggest skin cancer myth.

SPEAKER_00:24:27

The biggest one. That's a really good question. It is that the damage is done when people are younger. I've got two questions for people who think that. And it's not a rare perception. I think a really good proportion, maybe even more than half, of patients would would come in deep down thinking that. The qu two questions are, okay, now why is it that damage only causes problems when you're younger and not today? Is there a genetic answer? Or and there is actually no reason. Okay, so clearly an exposure, a damage, UV, it's going to cause as much damage today as it did then. So there is no reason, logically, why that is. And the next question is, well, what day did it cease to matter? Was it when you were 21? Was it your 30th birthday? Pick it pick a point in time where it ceased to matter.

SPEAKER_01:25:21

So you're saying the damage that was done when we're younger. Yep. Damage can still be done now.

SPEAKER_00:25:28

Well, it's it's cumulative. It's literally cumulative. And I would say that when we look at managing a patient's exposure patterns, which we've discussed is the biggest issue, then if they're able to adopt what I've suggested, minimizing time in the middle of a day wearing barrier clothing and sunscreen and reapplying it every two hours, then their risk kind of plateaus for two, three, four, five years and then falls off a cliff. And you can tell that from the number of lesions that are being removed, the number of lesions that we need to treat. And this is with people with the highest level, medium and low levels, same thing. It shows that what we do today is two to three times more important than what we did yesterday. So if we can think about it that way, we can actually drive the direction of our risk. We can drive it up by just doing whatever we've been doing, maybe, or we can drive it down by taking those simple steps to not go out. It's how we go out and when we go out, what steps we do to protect ourselves that will reduce long-term the outcome, uh the risk of out risk, this risk of a bad outcome. And you think about, well, that's enormously powerful to know that what would normally be an exponential rise in risk with age can actually be a decline. Wow. You can take control of the direction of your own risk.

SPEAKER_01:26:43

So you're saying it's not too late?

SPEAKER_00:26:45

Never too late.

SPEAKER_01:26:46

Never too late. Wow. What I do now after after meeting you is there's such a conscious uh thing that I do now where I don't walk out the house without three layers of sunscreen because I worry about walking to my car, getting a coffee, driving, or that incidental sun that you don't you don't even think about. And so whether it's raining or or or sunny, warm winter, snowing, whatever it is, I'm always thinking, but from that moment of walking to my car, that that sun damage right there.

SPEAKER_00:27:16

True. Fortunately, it's probably only a few minute minutes and so on. We everyone talks about vitamin D. We definitely need that in in an environment like Australia, we have so much that the amount of exposure we need, not just the hands and the face exposed in in in summer is around about five minutes a week. In winter, it's about 15 minutes a day. Okay, so and understand it's not as if if you have more exposure, you get more vitamin D. The body only creates as much as it needs. And if it's in deficit, well, it's in deficit. And there are many reasons why it could be lower. Okay, so it's not just UV. And we so overdosing with UV doesn't solve that problem necessarily. You get to the amount that you need and that's it.

SPEAKER_01:27:58

That is so interesting.

unknown:27:59

Okay.

SPEAKER_01:27:59

Five minutes a week in summer is how much sun you need.

SPEAKER_00:28:03

On average, yes.

SPEAKER_01:28:04

Wow.

SPEAKER_00:28:05

So you don't need much. So to kind of pursue it because it's medicinal. Well, on a medical level, if we had someone with vitamin D deficiency, number one, we would investigate why. And we wouldn't just assume it's a vitamin vi it's a it's a UV-related issue. We'd have to investigate why. But we would actually supplement. We'd use tablets, patches, or injections and so on. That's what we'd use. We would never recommend someone goes in the sun, which is think about it, we've got something which is non-lethal in in and of itself, which is vitamin D deficiency and and bone uh, I should we say weakened bone strength that's not inherently lethal in itself. But skin cancer is. So why would we say treat something that's non-lethal with something that potentially is? It doesn't make any sense. It's it it's insane. I mean, here in medicine we're meant to be weighing risks, and that would be the wrong direction to push someone to.

SPEAKER_01:28:53

Question two. What is the most forgotten place that people actually need to check for their spots?

SPEAKER_00:28:57

Look, I would imagine underneath the underwear, people would assume areas which are not exposed much, or often or at all, really, are not at risk. But you can have genetics comprise about 20% of the risk here in Australia. In Europe, it's actually it's two-thirds. Because the reason why is they haven't got as much UV, so they've got less UV-related ones. It's exactly the same proportion as skin cancer per head of population in Europe versus here, um that are genetically related. But genetic ones can occur anywhere. And it's not re with any regard to exposure. Therefore, it can occur in areas which are exposed or not.

SPEAKER_01:29:35

So my dad had has what has a a a bad uh melanoma uh under his foot.

SPEAKER_00:29:41

There you go.

SPEAKER_01:29:43

You would never think to look there.

SPEAKER_00:29:44

Well, that's what happened to Bob Marley. And that's why Bob Marley is no longer with us, because he had a melanoma underneath his toenail. And yeah, I mean, who would have thought?

SPEAKER_01:29:58

One skin change that you can never ignore. Is is it is it bleeding, is it a change, is it a raised scab? What is it?

SPEAKER_00:30:05

I'd I'd zoom out on that and say something that grabs your attention that doesn't seem to make sense. Okay. It's something that you go, huh? That kind of thing, but don't ignore it. Watch it. And then two or three weeks later, if you're still going, that what the what what is this? So unique change. So if we start to narrow it down, we start to miss. And given that it's such a very simple algorithm, something that's changing uniquely for more than two to three weeks, and captures every single skin cancer, you wonder why you'd narrow that down.

SPEAKER_01:30:38

What's the most alarming thing that you might hear from a patient?

SPEAKER_00:30:43

Wow. Well, the thing that i it hits every time I hear it, and surprising how frequently I hear it is Doc, I'm just gonna do what I do in the sun and I'll let you clean up the mess. So they're at least working in a better survival uh environment where if something is there, it has the opportunity for a relatively early. Because they're coming to you. That's right. And those individuals are surprisingly good with the regularity of their checks. Okay. So they kind of go, look, I'm outsourcing, okay, my my protection. And it's better than not actually having checks at all. Okay, but they're the individuals who they might be running a surf club or they might, for example, be an ocean swimmer. They might, for example, be someone and it's not that this is necessarily professional, it's actually voluntary. And their lives have voluntary, profound amounts of you. They might absolutely love the fact that they're tanned and go, Doc, well, I might be the color of mahogany wood, but at least I've got you. Okay, so in that way, it's a lot better than somebody who just completely closes off. But it is a shock every time I hear it.

SPEAKER_01:31:54

Yeah. What is the one thing that everyone listening now should do this week, even today?

SPEAKER_00:32:03

Look at how you can arrange your outdoor time to uh minimize time in the sum between 10 and 3. If you only do one thing, that would be it. It will give you more dividends and provide a greater survival advantage than any other single thing you can do.

SPEAKER_01:32:21

Dr. John, thank you so much. We're so inspired by you. I love your mission. I think it's so important, especially in Australia, but around the world as well. And we really appreciate your time.

SPEAKER_00:32:32

Well, thank you and congratulate and congrats congratulating you and your team in protecting everyone as well.

SPEAKER_01:32:38

Thank you.

SPEAKER_00:32:38

Well done.

SPEAKER_01:32:39

Thank you.