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The skin tells a story. Every freckle, mole, and mark represents years of exposure to the elements, genetics at work, and the body’s remarkable ability to protect itself.
Yet for all its resilience, our skin remains vulnerable to conditions that can significantly impact our health and quality of life. Understanding how to protect and care for this vital organ is just as important as caring for our internal biological landscape.
Dr. Brooke Eastham, a respected colleague I’ve known since medical school, brings over a decade of dermatological expertise to this conversation.
Insights From an Expert
Dr. Eastham has practiced medical dermatology at Nashville Skin since 2014, serving patients of all ages.
A board-certified fellow of the American Academy of Dermatology, her impressive credentials — like the Exemplary Service Award from the University of Tennessee Health Science Center in Memphis and a residency at Harvard Medical School — Dr. Eastham knew early that she wanted to specialize in dermatology.
“I think it’s fascinating how you can look at the skin, and that’s kind of your window into what’s going on internally,” she explains. “The more advanced medical derm was my big pull.” She was fascinated by the idea that something visible could give clues about deeper, systemic issues.
On the podcast, I wanted to talk with Dr. Eastham first about the biggest medical concern many people have regarding skin health: cancer.
The Foundation of Skin Cancer Prevention: Sun Protection
Beginning with skin cancer prevention, Dr. Eastham was quick to clarify that while she has her preferences, the best sunscreen is the one you’ll actually use. “You have to find one you’re going to wear,” she advises. Regardless of how perfect the ingredients are, they won’t do you any good if they stay in the bottle.
That said, Dr. Eastham personally recommends mineral-based sunscreens with zinc oxide or titanium dioxide: “I think zinc-based sunscreen is the best. It gives you protection right away,” as opposed to needing time for absorption. Instead, mineral-based formulations provide an immediate, physical barrier to ultraviolet (UV) rays and even visible light (which matters for conditions like melasma).
Modern lightweight, transparent zinc formulations make daily use easier (and more likely!), even under makeup.
As far as SPF, 30 has been the absolute minimum recommended for effective protection. However, Dr. Eastham shares that, in reality, most of us likely need to aim higher. The studies on SPF 30 effectiveness typically involve applying two tablespoons to the face. “When have you ever applied that much sunscreen?” she asks.
This application gap explains why many dermatologists, including Dr. Eastham, now recommend SPF 50 or higher for real-world protection.
For active outdoor enthusiasts, you’ll also need to reapply sunscreen every two hours for effective protection. While this frequency isn’t practical during a typical workday, it’s crucial for sun-heavy beach days, hikes, or prolonged outdoor activities.
Dr. Eastham notes that a common misconception about higher SPF sunscreens — and a reason some avoid wearing them — is that is that they prevent tanning entirely. But this isn’t true. Sunscreen aims to prevent burning but still allows a degree of tanning.
Understanding Skin Cancer in 3 Types
Next, our conversation turned to the three most common types of skin cancers. Dr. Eastham started with basal cell carcinoma: “By far, the most common type of skin cancer. The good news is that these are very slow-growing.”
Dr. Eastham says it’s not uncommon for a new patient to point out a spot that’s been slowly growing over months or years, sometimes developing bleeding or pain, that turns out to be this type of cancer. However, since basal cell carcinomas are typically non-aggressive and rarely spread beyond their original site, treatment is typically straightforward and comes with an excellent prognosis.
The next most common skin cancer is squamous cell carcinoma, which Dr. Eastham categorized into two types. “We have our basic squamous cells… they’re just on the skin. We’re not too worried about them.” Like basal cell carcinomas, basic squamous cell carcinomas typically remain localized and respond well to treatment.
But then there are the more dangerous head and neck squamous cell carcinomas. “They can, if not treated quickly, go to lymph nodes,” she says. “Sometimes a squamous cell can be more aggressive than a melanoma.”
Squamous cell carcinomas require a multi-specialty approach, including surgical oncology and sometimes radiation or immunotherapy. One of the most important factors for better outcomes with this type of cancer is proactive evaluation of any skin changes and timely diagnosis for early treatment.
Finally, melanoma, while least common, is most aggressive. It has the highest risk due to its potential for rapid spread, yet early detection has dramatically improved outcomes. “The good news is, right now, I feel like the majority of melanomas are caught early,” Dr. Eastham shares, attributing this development to increased awareness among patients, healthcare providers, and even professionals like hairdressers.
When caught early, many melanomas are “superficial” or “in situ,” meaning they remain isolated and can be treated with local excision. Deeper melanomas require more comprehensive evaluation and treatment, often involving surgical oncology teams and lymph node assessment.
A significant advancement in melanoma care involves genetic testing of the tumor itself through Castle testing. This analysis examines the genetic profile of a tumor to stratify risk levels for recurrence and spread, helping guide surveillance and treatment decisions even for relatively small melanomas.
Recognizing Warning Signs and Taking Action
Dr. Eastham shares that dermatologists often favor the “ugly duckling rule” for helping identify concerning skin developments. In other words, maybe you’ve always had a few moles, but one of them starts to change in appearance. It might get darker, grow larger, or develop irregular borders. Or perhaps you develop an entirely new skin growth or discoloration that doesn’t go away after several months.
None of these necessarily mean you’ve developed skin cancer, but they all warrant professional evaluation so that if it is cancer, you catch it early and treat it effectively.
Basal cell carcinomas can be particularly challenging to identify because they often masquerade as other common skin conditions. They might appear as a shiny pink patch, resembling irritated skin, or look like a persistent pimple or bug bite that never fully heals. The key warning sign here is persistence; any spot that doesn’t resolve within a reasonable timeframe deserves attention.
Squamous cell carcinomas often announce themselves more dramatically, developing rapidly and causing pain. Any skin lesion that appears quickly, grows noticeably, or causes unusual discomfort should get immediate evaluation.
For melanomas, warning signs include changes in existing moles or the appearance of new, unusual spots. Pain, bleeding, or changes in color, size, or texture are all concerning developments that merit a visit to your doctor.
Regular skin checks with a dermatologist play a crucial role in early cancer detection, though we don’t have an officially established universal screening age. For most patients, Dr. Eastham recommends an initial skin check around age 35 to get a reasonable baseline. However, those with extensive moles, a family history of skin cancer, or significant sun exposure would benefit from starting earlier.
In her practice, Dr. Eastham even screens patients in their teens and 20s who have a family history of melanoma or abnormal moles. Even if she never finds anything concerning, the routine checks provide an opportunity to reinforce preventive practices to help higher-risk individuals take as proactive an approach as possible against cancer.
A final note on skin checks, whether from your dermatologist or with your primary care physician: Don’t forget your back! Dr. Eastham shares that she insists on checking patients’ backs, even if they come in for something else, because too often she’s discovered a cancerous spot the patient could never have seen themselves.
Beyond Cancer: Managing Common Skin Conditions
Next, we moved on from cancer to discussing common skin conditions.
Rosacea: Triggers and Treatments
Rosacea affects millions of adults, typically developing in middle age, though it can appear at any point in life. This inflammatory condition presents redness, broken capillaries, and sometimes pustules on the central face. “Sometimes it’s just redness, sometimes it’s both,” Dr. Eastham explains.
The condition involves both inflammatory and vascular components. The inflammatory aspect creates the characteristic small bumps, while the vascular component causes the hallmark flushing and persistent redness. Triggers like alcohol, stress, temperature extremes, spicy foods, and caffeine cause blood to rush to the facial surface, creating an uncomfortable burning sensation along with visible redness.
Treatment approaches target both components of the condition. For the inflammatory aspect, sulfur-based cleansers and topical medications like Soolantra (topical ivermectin) can provide significant relief. Soolantra also addresses Demodex mites, which can contribute to underlying inflammation, often putting rosacea into extended remission periods.
The vascular component requires different management strategies. While topical medications like Rhofade temporarily constrict blood vessels, they wear off and can cause rebound flushing. Broadband light therapy, pulse dye laser, and intense pulsed light treatments provide more lasting results, often significantly reducing visible blood vessels and decreasing flushing intensity over multiple treatments.
Eczema: More Than Dry Skin
Eczema, or atopic dermatitis, isn’t just for kids. It occurs across all age groups, though adults don’t typically see a rash only in the creases or arms and legs. Instead, they often experience diffuse, red, scaly rashes on the trunk and extremities, or circular patches that resemble fungal infections.
The hallmark symptom of eczema is intense itching, which can severely disrupt quality of life and sleep patterns. Fundamentally, the condition involves a compromised skin barrier. “Our skin cells should be a tight brick wall,” Dr. Eastham says. “When we have eczema, they’re loose… all of our water and moisture seeps out.”
Treatment starts with barrier repair. Dr. Eastham suggests regular use of ceramide-rich moisturizing creams from brands like CeraVe, Cetaphil, and Eucerin, which help restore the skin’s protective function and potentially prevent flares.
For flares, Dr. Eastham starts with topical steroids. “Never in excess,” she adds, acknowledging concerns about overuse. Newer non-steroid medications like Eucrisa and Opzelura can provide effective alternatives for patients requiring long-term management.
For severe cases that don’t respond well to topical treatments, injectable biologic medications like Dupixent, Adbry, Rinvoq, and Ebglyss can offer remarkable improvement in quality of life. “They are very safe,” Dr. Eastham notes.
The Biologic Revolution in Dermatology
The emergence of biologic medications has transformed treatment options for several chronic skin conditions. These targeted therapies work by blocking specific inflammatory pathways rather than broadly suppressing the immune system.
For psoriasis, biologics are particularly important when joints become involved. Psoriatic arthritis requires systemic treatment, and many biologic medications can effectively treat both skin and joint symptoms simultaneously. This dual benefit makes biologics a helpful option for patients experiencing both aspects of the disease.
Hidradenitis suppurativa is another condition where biologics have proved game-changing. This painful inflammatory condition affects areas where skin touches skin — underarms, breasts, groin, buttocks — creating abscesses and sinus tracts that can severely impact quality of life. Three FDA-approved biologics (Humira, Cosentyx, and Bimzelx), which have significant overlap with psoriasis treatment, now provide an alternative to our old reliance on long-term antibiotics.
The decision to move to biologic therapy typically comes when topical treatments prove insufficient and your condition significantly impacts daily life, work performance, or sleep quality. These medications represent a shift toward more targeted, effective therapies with fewer systemic side effects than traditional immunosuppressive approaches.
Final Thoughts: Your Skin Care, Your Future
The field of dermatology continues to rapidly evolve, with new diagnostic tools and treatment options emerging regularly. Still, while tools like AI show some usefulness for self-screening, clinical exams are indispensable for accurate diagnosis and appropriate treatment.
My conversation with Dr. Eastham reinforced a key principle we live by at Brentwood MD: early action matters. Whether you’re trying to prevent skin cancer or manage a chronic condition, the earlier you intervene, the better the outcome.
If you’ve been putting off that skin check or wondering whether your rash or new mole is worth a closer look, let this be your nudge. As Dr. Eastham reminded me, “If something doesn’t go away, get it checked. It’s always better to be safe.”
Dr. Wright joined Brentwood MD in 2022 as the model allows him to spend more time connecting with patients and build a foundation of exceptional care. He is a Nashville native and completed his family medicine residency at the University of Tennessee Health Science Center, where he also served as Chief Resident. He believes that your health deserves a prominent position on your priority list, and would be honored to serve you and your family.
