Insights from Seminars
Educating the public about skin cancer and sun safety is a necessary, noble pursuit, and one of the specialty's true hallmarks. But is it a job for a superhero? Phoenix, Ariz., area-based dermatologist Ruskin R. Lines III thinks so and uses his costumed alter ego Captain Cutaneum to get the message across to local schoolchildren, teachers, and parents and has fun while delivering a serious message.
Dr. Lines, who is also a dermatopathologist, invented Captain Cutaneum as a fun way to get the sun-protection message out to elementary school-aged children"prepubescent children, who aren't blinded by the beauty of the tan." He then designed and commissioned his custom-made blue and yellow superhero suit (which takes 15 minutes to don) and began persuading school principals to let him make his in-class visits, which began in March.
The capeless, unmasked (though sunglasses-wearing) herowho wears a hat so large it could be a sombrero or a World War I doughboy helmethas visited four elementary schools in the Phoenix area and plans to visit more in the fall. "The kids are blown away when they see a full-grown man in a supersuit," Dr. Lines said. In his program, Captain Cutaneum explains the mechanics of sun damage with the use of clinical photographs and child-oriented props, advocates common sense sun-protective measures, answers questions from students and teachers, and sends everyone home with a free copy of Captain Cutaneum, the comic book written and illustrated by Dr. Lines himself, wherein the cancer crusader battles villains Lentigo and Squamous. The comic book contains Captain Cutaneum's Web address, so the students can share the sun-safety message with their families.
The students who show the most interest, he said, are fifth and sixth graders. Photos of melanoma, squamous cell carcinoma, and basal cell carcinoma are a part of Dr. Lines' presentations. Sometimes the kids are "a little bit shocked [at first] when I show actual photographs of skin cancers … [but] they're old enough to appreciate that this is real life … that this is something that could be the end result of excessive sun exposure, so [they] need to be careful." He noted that a common misperception is that without an actual sunburn, there is no sun damagea notion that he dispels in his visits.
The message also reaches the teachers, who often ask specific questions, such as how often to reapply sunscreen, which brands are preferred, and whether protective clothing is as effective as sunscreen. A few teachers have even asked him to look at moles they considered suspicious, Dr. Lines said, although all so far have been benign. Those same teachers have mentioned to him later that the Captain Cutaneum presentations helped them realize that they were getting too much sun, which prompted them to use sunscreen and hats.
But dermatologists don't need knee-high boots or their own comic book to get the sun-protection message across to patients. Taking the time to educate at-risk patientsand especially showing them photographs of skin cancerscan improve their sun-safety practices and get them to visit the dermatologist when they see a suspicious lesion, he said.
Photographs are instrumental when it comes to preventing sun overexposure in patients at high risk for skin cancer, he explained. "Recently I had a man in his 30s come in to see me with a melanoma in situ on his neck. He was a follow-up patient, and when I looked in my record of his previous visits, I saw that we had discussed melanoma because his skin type was at risk for melanoma cancer; he had fair skin and numerous moles, many with Clark's features. I saw in the chart that I had shown him melanoma photographs and discussed melanoma with him at length. So to have him come in years later with a melanoma in situ and to have that written in the chartsI felt good that he had had sufficient education to detect this skin cancer at an early, curable phase." Dr. Lines' Web site also includes photographs of melanoma, and basal cell and squamous cell carcinomas, which patients can refer to as a general reference, though not as a means of self-diagnosis.
Dr. Lines noted that both the incidence of skin cancers and deaths resulting from skin cancers are on the rise and that skin cancers in younger people have also been increasing, though there are as yet no effective measures of tracking these rates accurately. He added that Arizona and its neighboring states, which constitute the Sun Belt, are attracting new residents of all ages who are unaccustomed to the region's intense sunlight and often underestimate the need for protection. "It's not at all uncommon for a Phoenix dermatologist to have the majority of his or her patients come from other parts of the country."
He even uses music to convey his message. He's been singing and playing guitar with friends since high school, and the hard-rocking "Save Our Skins," written and performed by Dr. Lines, can be downloaded from his Web site, www.captaincutaneum.com
Dr. Lines plans to make the site more interactive by adding a game, along with information about ultraviolet radiation and photographs of benign lesions. Captain Cutaneum's online presence isn't just for children, he noted. "We're trying to educate the publicmake everybody a little bit smarter when it comes to protection from the sun. We want to take it to the next levelnot just telling people be cautious in the sun but actually educating them as to the results of chronic excessive sun exposure."
The comic book will also be expanded, with upcoming issues featuring more skin-cancer villains for Captain Cutaneum to vanquish. "My goal would be to have everyone in the Sun Belt appreciating not just that skin cancer exists but [knowing] the individual types of skin cancer and [recognizing] what each looks like and what each is capable of doing." The comic is expensive to produce, however; Dr. Lines has had 5,000 copies printed, at a cost of $2 per issue. He plans on charging for school visitsthough he adds that this would only help him break even. "I don't recommend that young dermatologists go out and buy a supersuit to build up their income," he said.
Have his presentations brought his practice any new patients? "I hope not!" he said with a laugh. "Our practice is bursting at the seams. We don't produce enough dermatologists in this country, so in Phoenix, as well as in many metropolitan areas, there are too few."
As for the long-term future of the terror of tumors, the conqueror of carcinomas? "Captain Cutaneum has staying power," Dr. Lines said. "Twenty years from now, I want adult patients to come in to me, saying, 'Weren't you that guy who visited my elementary school years ago?'"