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0:21 One. 0:22 >> One. 0:23 >> In the name of God. 0:24 >> In the name of God, the Most Gracious, 0:25 the Most Merciful. 0:26 >> Peace be upon you, and God's mercy and 0:28 blessings. Brothers and sisters, may 0:30 God have mercy on you. Praise be to God 0:33 , we are blessed with the opportunity 0:37 to be together in this health space for 0:40 fellowship, which hopefully will 0:43 inspire and motivate us to take lighter 0:47 steps in addressing matters related to 0:50 our health, both soul and body. We must 0:56 not forget to offer prayers and 0:58 greetings to our beloved leader of the 1:00 ummah, Muhammad, the Messenger of God, 1:02 peace be upon him. May we eventually be 1:06 reunited with him at the moment we long 1:08 for in the hereafter. Are all the 1:12 brothers and sisters healthy? Praise be 1:14 to God. Now, for this health segment, 1:19 we will discuss something related to 1:24 skin. And our doctor who will be 1:28 joining us is Dr. Dr. Aida Sofati 1:31 Dahlan Umardani. She is a senior 1:35 specialist in dermatology, venereology, 1:38 and aesthetics. A graduate of the 1:42 Faculty of Medicine, University of 1:43 Indonesia, from her bachelor's to her 1:45 doctoral degree. Alright, she is 1:47 already there on the other end. Let's 1:49 greet her. Peace be upon you, and God's 1:51 mercy and blessings. And peace be upon 1:54 you, and God's mercy and blessings, 1:56 Miss. 1:57 >> Thank you, Doctor, for joining us so 2:00 you can enlighten us all. So, what 2:04 exactly is "Sakuri"? 2:08 >> Well, perhaps I have a slight revision. 2:12 "Sakuri" was originally referred to as 2:16 self-skin examination, but we have 2:19 since refined the term. We changed that 2:24 term to independent skin examination. 2:28 >> Why independent? Because by definition, 2:33 Sakuri is an independent skin 2:36 examination to empower individuals to 2:40 recognize and identify any changes or 2:44 new lesions on the skin, and then 2:47 report them to a doctor. Yes. So, 2:53 besides examining themselves, they must 2:56 also be able to recognize and identify 2:59 whether there are changes or new 3:01 lesions on the skin. Yes, and then 3:05 inform a doctor. So, that "Sakuri" is 3:08 an independent skin examination as a 3:10 screening tool. 3:12 >> Screening for skin cancer, perhaps. 3:16 It's not a skin examination for the 3:18 face, for example, like normal, oily, 3:20 or dry skin; it's not that. But it's 3:23 for skin cancer screening, leaning more 3:26 towards that. 3:29 >> So, 3:31 >> for those who were imagining, oh, 3:34 what's wrong with me? Why is my skin 3:38 dry, or why is my skin too oily or 3:41 wrinkly? That doesn't fall into this, 3:43 right, Doc? All right. Of course, 3:49 brothers and sisters want to know 3:51 exactly what makes us feel concerned 3:53 about whether we have skin cancer or 3:56 not. What are the signs like, since we 3:59 have to do the independent check before 4:01 going to the doctor, right, Doc? 4:04 >> Perhaps 4:05 >> your enlightenment will be very much 4:08 needed. So, brothers and sisters, 4:10 listen with all your soul, body, and 4:12 heart. Okay, proceed, Doc. 4:15 >> Very well, thank you. So, as we know, 4:19 even though skin cancer might not be, 4:22 well, that common, especially since we 4:26 have, well, colored skin types, right? 4:30 So, skin cancer is not very common in 4:33 Indonesia. But, but if we happen to get 4:36 a type of skin cancer that is quite 4:39 aggressive, it’s going to be a real 4:42 problem. 4:44 >> Yeah. 4:45 >> So actually, skin cancer is divided 4:47 into two. The first is melanoma and the 4:50 second is non-melanoma skin cancer. In 4:54 Indonesians, non-melanoma skin cancer 4:56 is more common, especially basal cell 4:58 carcinoma. However, the one that is 5:01 feared is melanoma. For example, in 5:06 America or worldwide, 2022 global data 5:10 shows that the incidence of melanoma 5:14 ranks 17th. 5:17 >> Yeah. 5:18 >> Meanwhile, regular skin cancer, the 5:20 non-melanoma type, ranks fifth. But, 5:24 here's the catch. 5:26 >> Melanoma mortality is number 22 out of 5:28 all cancer data worldwide. 5:31 >> Yeah. 5:31 >> Whereas non-melanoma skin cancer is 5:34 also number 22, but it's much more 5:36 common, ranked fifth. But perhaps, 5:39 sorry to say, it grows slowly and 5:41 eventually reaches number 22. But for 5:45 melanoma, it's less common, ranked 17th 5:49 , yet its mortality is also number 22. 5:54 So actually, it is less common for 5:56 melanoma, but for non-melanoma skin 5:59 cancer, it is indeed ranked fifth 6:01 worldwide. But in Indonesia, skin 6:06 cancer accounts for only 2.5%of all 6:10 cancers. out of all 6:13 >> only 2.5%in Indonesia. So, based on 6:18 research from 2013 to 2017 across 14 6:21 provinces and 26 cities in Indonesia, 6:24 skin cancer is only 2.5%of all cancers. 6:29 Now, in Indonesia, melanoma ranks 33rd 6:33 in men and 32nd in women. 6:36 >> Hmm. 6:37 >> Compare that to the global ranking of 6:38 17, right. Then non-melanoma skin 6:42 cancer in men is number 10 and in women 6:46 is number 12. So it is indeed low, but 6:50 we should still be concerned, right. 6:54 >> Yes. At Dr. Cipto Mangunkusumo Hospital 7:00 in Jakarta (RSCM), basal cell carcinoma 7:03 is more common at 66.9%, squamous cell 7:06 carcinoma at 27.4%, and melanoma is 7:09 only 5.7%out of 263 skin cancer cases 7:13 from 2014 to 2017. So actually, skin 7:18 cancer is quite rare compared to breast 7:21 cancer, cervical cancer, or lung cancer 7:23 . But, if we get it, it would be best 7:28 if we could prevent it, right. 7:32 >> Yes. Now, that's just some initial 7:38 >> opening 7:38 >> statistics, the statistics. 7:41 >> Yes. Why? Why is this examination 7:45 necessary? Because in 1985 in America, 7:49 many cases of melanoma were found and 7:53 unfortunately, many resulted in death. 7:57 Many could not be saved. So finally, 8:00 they introduced a self-examination now, 8:03 which is called a self-skin examination 8:07 . The self-skin examination, which we 8:11 translate as self-skin examination, was 8:14 introduced in 1985 to identify lesions 8:18 suspected of being melanoma. Because 8:20 the most feared skin lesion or skin 8:23 cancer is melanoma. He 8:26 >> at that time, the examination used the 8:29 acronym A B C D E. 8:32 >> Okay. 8:34 >> Now, A B C D E, A stands for asymmetry, 8:38 B for border, or edge, right? 8:41 >> Yeah, 8:42 >> C is color, D is diameter, diameter is 8:46 the same everywhere, right. Evolving is 8:50 , um, changes in the skin. But ABC is 8:54 used more for melanoma. Meanwhile, in 8:59 2014, in Australasia, Australia had the 9:03 most skin cancer worldwide. Why? 9:08 >> Yeah. 9:09 >> Because the region is near the Equator 9:12 and there are many white people there. 9:15 >> Yes. 9:16 >> Yeah. 9:17 >> Hmm. So, they invented what is called 9:20 the scan project. Scan is S C A N. The 9:26 S is for a sore, right. Then C for 9:30 changing. Are there any changes? 9:33 Changing. Everything is also changing, 9:34 right. Then A for abnormal and N is for 9:40 new. 9:40 >> Yeah. 9:41 >> So, is there a sore, like abrasions or 9:44 wounds? Changing is a change. Abnormal 9:48 is, well, not normal, right. New is, 9:51 are there any new lesions? Now, before 9:55 we go to A B C D E and scan, maybe 9:57 someone wants to ask what the 9:58 difference is. 10:00 >> Okay. 10:01 >> What is the difference between a benign 10:02 tumor and a malignant tumor? 10:04 >> Yes. Yes. Brothers and sisters, because 10:07 this is via Zoom, you can't call, right 10:10 ? Okay, let's give an opportunity 10:15 because it is very important to know 10:19 how we understand the emergence of, um, 10:23 the disease called cancer. Some people 10:27 call cancer "cancer tongkering"(a 10:29 colloquial play on words). Okay, this 10:31 is a question from Ibu Dia. Actually, I 10:34 still don't know much, or even know 10:37 anything at all. Usually, the clues are 10:41 on our skin. Is there something we 10:44 should be suspicious of, Doc? Thank you 10:47 . 10:49 >> Thank you, Ibu Dia. Yeah. 10:52 >> So, we don't know if there is anything 10:54 on our skin. We don't know, right? So, 10:57 earlier, I already mentioned an acronym 10:59 , A B C D E, perhaps. Although it's in 11:04 English, let's just use it in 11:05 Indonesian, A B C D E, right. Earlier, 11:08 were there any skin lesions? A skin 11:10 lesion is a skin abnormality, right. A 11:13 skin abnormality that, is its shape 11:16 asymmetrical? Asymmetrical means, um, 11:21 not the same on the left and right, 11:24 right? Now, then, are the edges, are 11:29 the borders regular or not? 11:32 >> Hmm. Then, what about the color? Now, 11:38 usually, the color for a normal mole is 11:42 just, um, brown or black, right. At 11:46 most, it's dark brown in the middle and 11:48 light brown on the edges, just two at 11:49 most. But for skin abnormalities that 11:53 point to cancer, it has colors, more 11:55 than one, more than two, right? It 11:58 could be 11:58 >> in one mole. 12:00 >> In one mole. Yes. 12:01 >> Yeah. 12:02 >> Yes. Now, then, the diameter is usually 12:07 more than 6 mm, usually, right. There 12:13 are some smaller than 6 mm, but usually 12:16 if the diameter is 6 mm, we tend to be 12:20 a bit suspicious that it's a malignant 12:23 lesion. Although there is also 12:27 literature that states that some 12:30 smaller than 6 mm are detected as 12:32 small-diameter melanomas. That might 12:36 still be in the early stages. H. Then 12:38 that was D, right? A, B, C, D, E, and 12:41 E. What is E? E is evolving or lesion 12:45 evolution. Lesion evolution includes 12:49 size, shape, or color. So, the 12:53 evolution means, for example, the size 12:57 increases, the shape changes, then 13:00 there are other symptoms like itching 13:04 or tenderness, and the surface might be 13:08 scraped or bleeding, and the color 13:11 pattern is different. So, just because 13:15 of one ABCD doesn't mean it's already 13:18 melanoma or skin cancer; it doesn't 13:21 have to be. That is just one sign, 13:25 A-B-C-D-E. Most of us have many skin 13:30 lesions, but if seen by a doctor or an 13:34 expert, they are usually benign. But 13:38 there is one lesion that is a bit 13:41 different. For instance, if the others 13:45 are just light brown. Yes. Well, that 13:48 one is suddenly black. And then, 13:51 >> the shape is also different from the 13:53 others. Well, we call that the ugly 13:56 duckling sign. That is usually an 14:00 additional criterion as well. So it is 14:04 called the ugly duckling sign. The ugly 14:09 duckling. So it is very different from 14:14 the other skin lesions. Now, this is 14:18 also a parameter. It could be a 14:23 malignant lesion. So that is what we 14:29 use, we use an acronym. We usually use 14:34 the acronym ABCDE plus, funny, like I 14:36 said earlier. The one called the "ugly 14:40 duckling sign" is called "funny" 14:43 because the others are the same, but 14:47 this one is different, so it's called 14:50 A-B-C-D-E + F, so A-B-C-D-E-F. You 14:55 remember, Mrs. Diah, right? It makes it 14:57 easier, doesn't it? Yes. 14:59 >> And if there is more time, maybe we can 15:01 use slides. 15:03 >> Yes. 15:03 >> I wasn't told I had to use slides. 15:07 >> Using slides makes it easier to explain 15:09 . 15:10 >> You can read, take notes, and take 15:12 screenshots. Can the screenshots be 15:15 saved? 15:17 >> Right? Hopefully, Mrs. Diah didn't 15:19 mention her age. But anyway, the next 15:21 one doesn't have a name, 0811 something 15:24 . If I may ask, Ms. Nuning, what causes 15:28 people to be exposed to skin cancer? Is 15:34 it because of something they ate, or 15:37 playing outside too much, getting 15:39 sunburned, or what? Thank you. Yes, 15:44 >> thank you, Ms. Nuning. Actually, the 15:47 cause of all cancers usually comes from 15:50 within, genetically, and from the 15:52 outside. Specifically for skin cancer, 15:56 there is definitely a genetic component 15:58 , but what we can usually control are 16:01 the external environmental factors. 16:04 >> He he. 16:05 >> From the outside, it is usually first, 16:09 sunlight, then second, chemicals, and 16:13 also viruses. Now, usually with 16:18 sunlight, since we are in the 16:21 equatorial region, in the sun's path, 16:24 our sun exposure is naturally higher 16:27 than those further from the equator. 16:32 However, fortunately for Indonesians 16:35 >> he 16:36 >> our skin has large pigments, though not 16:41 as large as those of people of color, 16:46 those who are quite dark; we are brown, 16:51 right? 16:53 >> Our skin has large and abundant pigment 16:55 . 16:56 >> But indeed, not as much as those with 16:58 very dark skin, you know what I mean, 17:01 right? He. 17:03 >> Now, for Caucasian people, white people 17:07 , their pigments are small and few. 17:12 >> Even though that pigment is located 17:16 around the cell nucleus to protect the 17:19 DNA. 17:21 >> Protecting that DNA is protecting our 17:24 genes, you see. Our body's genes should 17:29 not mutate, they must stay as they are, 17:32 and not be disturbed, right? So, that 17:38 is why sunlight is one of the causes. 17:44 Then there are also viruses, for 17:47 example, HPV, human papillomavirus, 17:50 from warts; warts can be benign or 17:53 malignant, right? 17:56 >> Then also from chemicals, and those are 18:00 what we can control from the 18:03 environment. Okay, yes. The next 18:09 question is from Mrs. Sri Sriani. Yes, 18:15 Doc. On my right breast, a black 18:19 mole-like spot appeared that then 18:22 hardened, dried up, and could be peeled 18:25 off. And after that, a few months later 18:29 , it appeared again. Is this something 18:32 I should be suspicious of? Or what is 18:35 it? Thank you, 18:37 >> Miss. You're welcome. So, we rely on 18:41 ABCDE, right? ABCDE, A is asymmetrical. 18:45 How is the shape? Is it asymmetrical or 18:47 not? 18:48 >> Then B is the border. Are the edges 18:50 regular or not? Then C is the color. 18:53 What was the color again? Black or 18:55 brown? Blackish, perhaps. Then ABC, D 19:00 is the diameter, how big is it? Usually 19:04 , if it's more than 6 mm, we should be 19:06 suspicious, 6 mm or more, right. Then 19:09 ee 19:11 >> E 19:12 >> E is evolving. Is there any change or 19:15 not? Well, if it were only one thing, 19:18 but looking at your statement that it 19:24 >> dries up, then can be peeled off, then 19:26 after some time 19:28 >> a few months later it appears again. He 19:31 >> yes. In my opinion, it might be 19:33 seborrheic keratosis. But for certainty 19:35 , it is better to have it examined by a 19:37 doctor. If I'm not mistaken, Dr. Sonar 19:40 will also be giving a talk on breast 19:42 health soon, what month was it? January 19:44 , perhaps. I also kind of forgot, yes. 19:47 But Dr. Sonar, Sonar Sony Panigoro 19:50 >> will also be presenting regarding 19:53 breast cancer later. But this is a skin 19:56 lesion on the breast, right, not breast 19:58 cancer. Yes. 20:00 >> In my opinion, it might be, and I 20:02 emphasize might, just a possibility. 20:05 Especially since the progression is 20:06 slow, right. The progression is slow 20:07 and doesn't change rapidly, right. 20:09 >> He he. 20:09 >> But to be safe, it's better to 20:12 >> check with an expert. Yes. 20:14 >> Okay. Alright. Before we return to the 20:18 incoming WhatsApp messages, if there is 20:19 anything you would like to add, Doc, 20:21 please go ahead. 20:22 >> Oh, right. Perhaps regarding the lady's 20:26 second question earlier, the lesion on 20:29 her breast is likely benign. Likely. 20:33 >> Now, the actual question is, what is 20:35 the difference between a benign tumor 20:37 and a malignant tumor? 20:38 >> Yes. Everything that forms a lump is a 20:42 tumor, right. However, not all tumors 20:46 are cancer, or not all tumors are 20:49 malignant, right. So there are benign 20:52 tumors and malignant tumors. What is 20:54 the difference? The difference is in 20:57 its growth; as you said earlier, benign 21:00 tumors usually grow slowly. Then, the 21:04 borders—apologies, you didn't mention 21:07 it earlier, but usually, the borders 21:09 are clear. Also, it does not damage 21:12 surrounding tissue. But for malignant 21:16 tumors or cancer, they grow very 21:18 quickly. Then, growing very quickly, 21:21 they have irregular edges because they 21:24 grow fast. Perhaps one part has 21:25 extended further, while another remains 21:27 here. Like that, yes. So the edges are 21:29 irregular, yes. Unlike a benign tumor. 21:32 A benign tumor has regular edges and 21:34 does not damage healthy surrounding 21:36 tissue. While a malignant one damages 21:39 healthy surrounding tissue—that's 21:41 regarding its growth nature. Then there 21:43 is also the matter of spread. Benign 21:45 tumors do not spread, whereas malignant 21:47 tumors do, or what we call metastasis, 21:49 right. Now, you already know the term 21:53 metastasis, right. So, benign tumors 21:56 don't spread, but cancer or malignant 21:59 tumors can spread directly, through the 22:02 bloodstream, or through the lymph 22:05 system or lymph nodes, yes. If a benign 22:11 tumor is removed, it rarely recurs, but 22:15 for cancer, the risk of recurrence is 22:19 usually quite high, yes. It can even 22:24 grow in other parts of the body as well 22:27 . So that is the difference between 22:29 malignant and benign tumors. It's the 22:31 same for the skin, yes. So if it grows 22:35 slowly and has regular edges—as noted 22:38 in the description, regular edges 22:41 usually mean it's more likely benign. 22:45 But if it grows quickly and also bleeds 22:49 easily, yes. And then, furthermore, the 22:54 edges are irregular. Those are all 22:59 possibly malignant. Okay, let's move on 23:05 to this. Another question without a 23:10 name, but it could be from a mother as 23:14 it asks about heredity. If my mother 23:20 had breast cancer, will it be inherited 23:22 even if the resulting cancer isn't 23:24 breast cancer but skin cancer like what 23:27 we're discussing? Please explain. Yes. 23:33 Some cancers are hereditary, and some 23:35 are not. So there are those that are, 23:38 uh, inherited, there are hereditary 23:39 ones, and there are sporadic ones. 23:41 >> Yes. 23:43 >> Now, breast cancer is one of the 23:44 cancers that is inherited. However, I 23:51 don't know whether, uh, skin 23:54 >> is inherited as skin cancer. But for 23:58 breast cancer, it is best to have all 24:01 children or siblings checked, their 24:04 genetics examined to see if they carry 24:08 the genes that lead to breast cancer. 24:12 But it's not certain, even if they have 24:13 the gene, it's not necessarily certain, 24:15 right? There must be other mutations as 24:17 well, right? 24:18 >> He he. 24:19 >> To cause cancer, like that. So don't be 24:21 too worried. We must remain vigilant, 24:24 but we shouldn't live in constant fear, 24:26 right? So the first step, if it was 24:29 their mother who had breast cancer, 24:31 right? 24:32 >> Yes. Her mother. 24:33 >> Her mother, so if she is a daughter, 24:36 all daughters should ideally have their 24:39 genetics checked for breast cancer. 24:41 Breast. 24:43 >> Is that test difficult, Doc? Go to the 24:46 hospital and then 24:47 >> go to the hospital and get your blood 24:48 tested. Yes, 24:50 >> for example, since I work at Dharmais 24:52 Cancer Hospital, perhaps at Dharmais 24:54 Cancer Hospital, or it could also be at 24:57 RSCM, or other hospitals, just ask for 24:59 a breast cancer screening panel. Okay, 25:03 next is from me, Damar Nur Avian from 25:07 Bogor. Doc, may I ask, how does the 25:12 mechanism of skin cell regeneration 25:16 work at the molecular level, and why 25:19 does this process slow down as we age? 25:24 Thank you. Yes. Perhaps the person 25:27 asking is a molecular biologist. 25:29 Perhaps. 25:30 >> Mr. Damar. 25:32 >> Mr. Damar. So, you mean skin 25:35 regeneration, right? Maybe the skin 25:38 regeneration we are most familiar with 25:41 is the skin layer, we call, uh, the 25:43 outermost part of our body the 25:45 epidermis. 25:48 >> The epidermis consists of several 25:49 layers. The lowest layer is called the 25:53 basal cell layer. Uh, it's called basal 25:57 cell, not carcinoma, the cancer disease 25:59 is basal cell carcinoma, right. Now, 26:02 the basal cells will, uh, later, uh, 26:05 regenerate into, uh, the layer of cells 26:09 above them, which is the squamous cells 26:12 , right. Now, usually, skin cancer that 26:15 comes from squamous cells is called 26:18 squamous cell carcinoma. Then it goes 26:21 further up, uh, becoming the next 26:24 layers, and the last one is the corneum 26:28 layer, right, the stratum corneum. That 26:31 stratum corneum, it, uh, will peel off 26:33 by itself. That's why even though it, 26:35 uh, like, becomes, uh, becomes numerous 26:40 , like, becomes 26:43 >> uh, peels off, regenerates upward, 26:45 upward, upward, but it, uh, disappears, 26:48 like that. In what form does it 26:50 disappear? In the form of when we take 26:53 a shower, right. So that dead skin, 26:55 really, that dead skin is actually a 26:57 layer of skin that, uh, this skin layer 27:00 that has peeled off. 27:02 >> Hm. in basal cell carcinoma because 27:10 there is, there is what, besides the 27:13 genetics, it will mutate and that 27:15 mutation is uncontrollable. But basal 27:20 cell carcinoma is the most benign skin 27:22 cancer, not the most benign, the 27:24 mildest skin cancer. 27:26 >> Hm. Now, in basal cells, squamous cells 27:31 , we call them keratinocytes. And in 27:34 those keratinocytes, uh, uh, there are 27:36 other cells besides keratinocytes, 27:38 there are also cells called melanocytes 27:41 . Those melanocytes are what provide, 27:43 uh, supply pigment to our skin. Now, 27:47 that is what can cause melanoma, right. 27:51 Now, uh, I feel, uh, that's perhaps how 27:54 it's easier to explain. But if, for 27:58 example, you are interested in 28:00 molecular biology, maybe in the next 28:02 meeting I will provide slides, history, 28:04 focusing more on that part, okay. 28:07 >> Yes. Yes. 28:10 >> All right. Now, uh, this again has no 28:15 name, maybe they don't communicate with 28:19 Rasil too often. What I want to ask, 28:25 Doc, is how to prevent it? We are often 28:29 outside exposed to the sun, especially 28:32 since my job is outdoors, not inside a 28:34 building. What should be done to 28:38 prevent exposure to harmful sunlight? 28:43 The hours aren't, uh, very early in the 28:44 morning, are they, Doc? From what time 28:46 until what time? Thank you. 28:49 >> Right, thank you for the question. Yes, 28:54 indeed, uh, we know that sunlight at 28:58 certain hours will cause, will often, 29:03 uh, cause skin cancer, right. But 29:07 usually that is at the hour 29:12 >> yeah, let's say 9:00 AM, 10:00 AM until 29:14 2:00 PM or 3:00 PM, the peak is at 29:15 12:00 PM. 29:17 >> Oh. So at 12:00 PM, don't be in the 29:20 middle, uh, of the hot street without 29:23 any cover, right, Doc? From 10:00 AM to 29:26 3:00 PM, that's really, uh, the rays 29:30 are too, uh, a bit painful. We usually 29:33 get skin cancer from, uh, ultraviolet 29:36 rays, right. 29:37 >> There is ultraviolet A, ultraviolet B, 29:40 or ultraviolet C. Now, ultraviolet C is 29:43 the one that most, uh, causes skin 29:45 cancer. But thank God, we have, uh, in 29:48 our atmosphere, we have an ozone layer 29:51 that prevents ultraviolet C from 29:53 reaching the earth. Now, because of 29:56 that, it can be, you know. But don't 29:58 forget that the ozone layer can also 30:00 leak. It can leak, for example, because 30:03 of, uh, refrigerators, greenhouses, 30:05 right. And in areas like certain 30:09 regions where the ozone layer has 30:10 leaked, for example, in Northern Europe 30:12 , perhaps, areas like Norway, Denmark, 30:14 and everything. That's why there is a 30:18 lot of skin cancer there, even though, 30:20 uh, yeah, but they do have white skin 30:22 too, right. Now, that's, uh, the C, 30:26 which actually shouldn't, but can also 30:29 enter, uh, reach the earth. Now, the 30:33 next thing, which is the most talked 30:36 about, is ultraviolet B. Ultraviolet B 30:38 can reach the earth and can reach our 30:41 skin. Because ultraviolet B radiation 30:44 reaches the epidermis. 30:46 >> Yes. 30:47 >> While ultraviolet A reaches the dermis. 30:50 Now, the skin layers consist of the 30:51 epidermis, dermis, and subcutis. Now, 30:53 as I said before, the epidermis has 30:55 cells like basal cells and squamous 30:56 cells. Then, the sun—specifically 31:00 ultraviolet B—attacks there, up to 31:03 the epidermal layer. If it's 31:06 ultraviolet A, it reaches the dermis. 31:08 In the dermis, there is a lot of 31:10 collagen and so on, which causes skin 31:12 aging. Ultraviolet B is more likely to 31:17 cause skin cancer. But ultraviolet A 31:21 can also cause skin cancer, and current 31:24 theories say it can cause skin cancer. 31:27 In the past, it was said to only help 31:28 ultraviolet B, but now it turns out 31:30 it's said that ultraviolet A can also 31:31 cause skin cancer. The main one is UV B 31:34 , though. 31:36 >> And that is at 12:00 PM, that 31:38 ultraviolet B. The hours where it's at 31:40 its peak are when the sun is right 31:42 above us. But usually, it starts from 31:46 10:00 AM until. What time. No. But we 31:50 also need sunlight, for what, you ask? 31:55 >> Yes. 31:55 >> Our bones for. 31:57 >> Vitamin D. 31:58 >> Vitamin D, yes. Now, usually, skin 32:02 doctors suggest sunbathing at 9:00 AM. 32:08 It is already. Enough ultraviolet, 32:12 right? Ultraviolet and ultraviolet B at 32:15 9:00 AM, but only for 15 minutes. 32:18 >> Oh, I see. Yes. If it's 9:00 AM now, 32:21 it's very hot, right? 32:22 >> Yeah. 32:23 >> So, only 15 minutes. Don't do 10:00 AM. 32:25 Don't you dare. 10:00 AM. If maybe at 32:28 7:00 AM the sun is already out, go out 32:30 at 7:00 AM, okay? Going out at that 32:31 time is allowed. But the UV isn't there 32:33 yet. 32:33 >> Not yet. Yeah. Okay. Alright. This is 32:37 from Ms. Dari. Ms. Dari in Sukabumi. 32:41 I'd like to ask, Doctor. I am 65 years 32:44 old. Since I was little, I've had. A 32:48 birthmark or mole on my face that is 32:51 dark brown. As I get older, why is it 32:56 getting darker and widening? Please 32:59 explain, Doctor. Thank you. Yes. 33:02 >> Yeah. First, where is the mole on your 33:06 face? On your cheek, forehead, or where 33:09 ? Then, what does it look like? Now, as 33:14 it widens, is it just one thing that's 33:17 getting wider or is it spotty? Getting 33:20 more numerous and getting wider are 33:21 different things too. So, if it has 33:25 been there since childhood until you 33:27 are 65, it's probably fine. Yes, maybe 33:30 it's fine, but now it's getting darker 33:32 in color, right? 33:34 >> Yeah. 33:36 >> Well, it would be better if you went to 33:38 a doctor to be. 33:40 >> Asked further. Okay. 33:42 >> Further. 33:44 >> If the color doesn't change, then it's 33:45 fine. But we must be suspicious of 33:47 every change. 33:48 >> Yes, every change, right. Hopefully, 33:51 it's nothing to worry about. But it 33:53 should still be looked at, that mole. 33:55 What is a birthmark anyway, I mean, 33:57 what exactly is a birthmark? A black 34:01 spot. 34:02 >> Yeah. I think that's how I imagine it. 34:05 >> Just one black spot, right. It could be 34:08 , it could be a mole from when you were 34:10 little, from birth, perhaps. There are 34:14 various kinds of them, and they come in 34:15 different sizes too. And there are 34:19 sizes that have a high risk of cancer, 34:21 so it's better to get them checked for 34:24 clarity. Okay, still in the health 34:31 segment on Radio Silaturahim. We still 34:36 have about 20 minutes, give or take a 34:38 little. Doc, speaking of which, someone 34:43 is asking about protecting our skin 34:45 from ultraviolet rays, are there any 34:47 topical medicines sold for that? They 34:51 want to know, I'm still 22 years old. 34:53 Oh, a young adult. 34:56 >> A teenager. Have you ever heard of 34:59 sunscreen or sunblock? 35:01 >> Well, 35:02 >> definitely. Yeah. Oh, so that's used 35:04 for ultraviolet rays? Yes. But actually 35:07 , that's, well, it's a medicine, I mean 35:09 sunscreen to protect you. But that is 35:12 only one way, though. There are also 35:14 other ways, for instance, wearing 35:15 >> a hat, wearing a hat, a wide-brimmed 35:18 hat. Yeah. A wide hat. And then, the 35:22 most important thing is actually, 35:24 perhaps like Ms. Nuning. 35:26 >> What's that? 35:27 >> Wearing covered clothing 35:31 >> that automatically protects you from 35:32 sunlight, right. 35:34 >> Yes. 35:35 >> Maybe put on some sunscreen on the face 35:37 . 35:38 >> Then cover it with a mask and wear 35:40 glasses. Oh, that's safe. Yes. But 35:44 don't forget that skin cancer 35:47 >> isn't all caused by sun exposure, right 35:49 . Some are caused by trauma. What kind 35:51 of trauma? I can imagine the hereditary 35:53 part. But what kind of trauma are we 35:55 talking about? 35:55 >> Trauma, for example, on the soles of 35:57 the feet. Most melanomas in Indonesians 36:01 , and there is research on this in 36:03 Japan and Hong Kong, 36:06 >> it turns out 36:07 >> they are caused by not wearing footwear 36:10 . 36:11 >> Oh, so walking barefoot isn't good 36:13 either, huh. 36:14 >> Yes. Like farmers, for example. So, for 36:18 people of color, unfortunately, the 36:21 most common type of melanoma is acral 36:24 lentiginous melanoma, and acral means 36:27 on the extremities, right. 36:29 >> Yeah. 36:30 >> Usually on the feet. It turns out it's 36:34 the same in Hong Kong. Do they wear 36:36 footwear in Hong Kong? They do. But 36:40 well, perhaps that's just how it is. In 36:42 Japan too. So Japan, Hong Kong, 36:45 Indonesia. Are these three countries 36:47 where people often don't wear shoes? 36:51 I'm not sure if they don't wear 36:54 footwear or not. But 36:56 >> but not wearing footwear, if you want 36:58 to walk on gravel for health reasons, 37:00 just for a little while, that's fine, 37:02 right. Yeah. 37:04 >> Yes, that's fine. Maybe there's a story 37:07 , perhaps there's 37:09 >> a family that really loves dancing, or 37:12 something like that. And then, well, 37:15 they learn to dance, perhaps somewhere. 37:19 Yes. Yes. 37:21 >> That’s different if you’re wearing 37:22 socks, for example. 37:24 >> Can they still get pierced, right? Even 37:26 if you wear socks, you can, right? So 37:28 the footwear must still protect the 37:31 skin, protect the feet. 37:33 >> Hm. So socks are not enough. The thorns 37:37 can still pierce through. 37:38 >> Uh-huh. Okay. Okay. Alright. Moving on 37:41 to Ibu Suratmi. Assalamu'alaikum, 37:44 Doctor. I am 73 years old. Is it still 37:49 necessary to sunbathe? Thank you. 37:53 >> At 73, do you need to sunbathe for 37:55 vitamin D? 37:57 >> Still, yes. 37:57 >> Yes. Yes. But as mentioned earlier, 38:01 about 9:00 AM for 15 minutes. 38:04 >> And stop until the next day. Because 38:07 the limit is the morning time, right? 38:10 Or at what hour, or all day long? 38:13 >> Oh, throughout 10:00, 9:00, 10:00 until 38:19 noon, by noon the heat has already gone 38:22 down. 38:23 >> Right, there's no more ultraviolet left 38:25 , right? If it's noon, sunbathing feels 38:28 nice, it's not hot. But the ultraviolet 38:30 hasn't reached its peak output. 38:32 >> Yes, that's right. So it's a waste of 38:34 the heat, right? Okay. Regarding the 38:38 medicine being taken, Mr. Harjo. If I 38:41 take certain medications, does it have 38:44 any influence on the development of 38:47 skin cancer? There are certain 38:51 medicines that are taken routinely, 38:53 though not specified, right Mr. Arjo? 38:56 What is being taken? Perhaps usually 38:59 for those in their golden years, 39:01 whether it's because of, what's it 39:03 called? Gout or something like that. Is 39:07 there an effect on the skin? 39:10 >> Uh 39:12 >> certain medications, is that the 39:14 question, Mr. Ro? Uh-huh. 39:16 >> Yes. Uh-huh. But I will check that 39:19 again later. But so far, I haven't 39:23 found any specific medicine that causes 39:26 skin cancer. 39:28 >> I don't think so yet. 39:30 >> Uh-huh. But if there is such a question 39:31 , that's a good point, isn't it? We 39:34 have to look into whether it exists, 39:35 right? But 39:36 >> the effect, right? 39:37 >> Yes. Is there an effect on the skin, 39:40 especially skin cancer? 39:42 >> Yes. For example, if the skin, excuse 39:44 me, for example, chemotherapy makes the 39:46 skin dark, there are indeed certain 39:47 medicines that can cause the skin to 39:49 darken. But something that causes skin 39:52 cancer, wow. I'll read up on it later, 39:56 perhaps. 39:57 >> Yes. 39:57 >> For the next meeting, this is also a 40:00 good question, Ms. Nuning. 40:02 >> Because you're curious, right? That's 40:04 true as well. 40:06 >> Yes. Why only 15 minutes left, Ms. 40:08 Nuning? Perhaps I 40:10 >> can give a closing idea because there 40:12 are a lot of "thumbs up" here, Doc. 40:15 Thank you for the information. 40:16 >> The Sakuri examination, the Sakuri 40:19 technique, is indeed better explained 40:21 using slides. But maybe for now, in a 40:24 >> passing manner, that's fine, next time 40:26 we'll use slides. Okay, 40:28 >> yes. For example, at home, we surely 40:31 have a mirror that is as tall as we are 40:33 , right? Whether it's a small wardrobe 40:35 mirror or 40:35 >> a special mirror, right? You have one, 40:37 right? 40:38 >> A full-length mirror, uh 40:39 >> a mirror that is as tall as our body, 40:41 right. Yeah. 40:42 >> A full-length mirror. Then don't forget 40:45 the small mirror we usually use 40:48 >> just for our face. Putting on lipstick. 40:51 >> Putting on lipstick, but it can reflect 40:54 backwards to see our back. Okay, we 40:57 can't see our back, right. So, we use 41:00 that small mirror to see our body, our 41:03 back facing the small 41:05 >> mirror, and the small mirror is used to 41:07 see it. Then don't forget, if the 41:11 lights are off or there is no light, 41:13 there must be enough lighting, right, 41:16 >> to be able to see. Yeah. 41:18 >> Yes. Then don't forget we also have to 41:21 check our head. Skin is from head to 41:24 toe, 41:25 >> but our head has hair. 41:27 >> So, what do we use? 41:29 >> Well, what is it? We use a hair dryer. 41:35 A hair dryer isn't just for drying hair 41:37 . Use a hair dryer so the hair parts, 41:39 allowing us to see 41:41 >> Yeah. 41:41 >> if there is something there, 41:45 >> some lines or such. So don't just do a 41:47 middle part, okay. 41:48 >> Middle part. Then 41:50 >> the side, the edge, all of that. In the 41:53 end, we divide it into about six parts, 41:55 those sections. Then don't forget there 41:58 are also two small stools. Small stools 42:03 to see what? To see, so we can sit and 42:06 check our feet. We can check our feet 42:08 too, right. It's hard to look at our 42:10 feet while standing, right. That way it 42:12 can be 42:14 >> So those are the tools. 42:17 >> Lift your feet onto the stool in front 42:19 so it's clearly visible, right, Doc. 42:21 Yeah. 42:22 >> Down to the soles of the feet, don't 42:24 forget, as already mentioned, many 42:25 Indonesians 42:26 >> until the mirror or tilted, oh not just 42:29 that, yes, yeah. 42:32 >> That is the use of the small mirror, 42:33 but we can also see even if it's tilted 42:35 , but sometimes the other side is a bit 42:37 hard to see without the help of a 42:39 mirror, bending down. 42:43 >> So what is really needed is a lamp, the 42:47 lighting must be sufficient, then a 42:49 full-length mirror, a large mirror, a 42:52 small mirror, then a hair dryer, and 42:55 don't forget two small chairs, yeah, 42:58 small chairs. Now, initially we face, I 43:03 apologize, naturally the clothes are 43:05 taken off. So in a closed room, in a 43:09 closed room that is locked, we take off 43:11 all our clothes. 43:13 >> We won't see anything, Doc, if there's 43:15 no light. 43:16 >> But the light must be bright. 43:18 >> It must be on. Yes. It's on, and the 43:20 door is locked, right. Don't let anyone 43:23 see. Then we look in the mirror at our 43:28 front, our front body, all the way down 43:31 to our feet to check there's nothing 43:35 there. We turn left. Eh, turn. Turn 43:38 left. We see our right side, what's 43:41 there, right. After that, turn again to 43:45 the right. See our left side, what's 43:48 there. If you turn to the right, the 43:51 one facing the mirror is the left side, 43:52 right. 43:53 >> He he. 43:53 >> We check everything, from top to bottom 43:56 , okay. And then, lastly, we must face 44:01 away from the mirror with the help of a 44:05 >> small mirror. 44:07 >> Small, right. After everything is 44:12 checked with the small mirror. Then 44:16 next, we also examine the hands; 44:19 earlier we already checked the body, 44:22 right. 44:23 >> Yes. 44:23 >> We only looked at the body earlier, not 44:27 the hands yet. Ah, the hands are what 44:29 we must look at properly. Hands and 44:33 arms, that's using the full-length 44:36 mirror. But there is. But later for the 44:40 legs and feet, including the soles, we 44:42 sit on that small stool and put the 44:45 other leg on the other small stool. 44:49 Then we check using a small mirror, 44:51 including the soles of the feet, 44:53 between the toes, and so on. Well, 44:57 that's roughly it. Next time, if 44:59 there's another opportunity, we'll 45:01 provide the slides. 45:03 >> Alright. Uh, Doc. Earlier it was easy 45:06 to move around to check everything, but 45:08 if it's already difficult for me, can 45:10 someone else or my child check it for 45:13 me, Doc? Yes, that's a possibility. 45:16 >> Yes. The idea is for it to be 45:18 self-examination, but if 45:21 >> it's already difficult, then please ask 45:22 for help. 45:23 >> Ask for help. Your child or a family 45:28 member, perhaps. 45:30 >> Yes, a child is a family member. 45:32 >> Yes, a child is a family member. Ms. 45:36 Nuning. 45:37 >> Okay. If earlier, um 45:42 >> those who are asking are mostly just 45:43 giving a thumbs up. Does skin 45:46 examination have to be routine or not? 45:50 If you have to go to a doctor, can you 45:51 use BPJS or not? 45:54 >> Oh, so speaking about BPJS. 45:59 >> At a public hospital, can we see a 46:01 dermatologist? Is that allowed? If you 46:05 want to be checked by a dermatologist, 46:07 please go ahead. It can be at a public 46:10 hospital, yes. Public hospital. 46:12 >> Yeah. 46:12 >> Of course, you can use BPJS. If you go 46:16 to a public hospital, you can use BPJS, 46:18 right. 46:18 >> But you need this, you need what? 46:21 >> A referral letter to have your skin 46:23 examined. 46:24 >> A referral from the community health 46:25 center (Puskesmas). The general 46:26 practitioner at the health center can 46:28 examine you themselves if they are able 46:29 . But once they are in doubt, they will 46:31 send you to the hospital. 46:33 >> Now, the doubt usually arises because 46:35 of the signs the doctor mentioned 46:36 earlier. 46:38 >> Whether those are suspicious black 46:40 spots like moles, even though a fly 46:43 doesn't deposit something on our skin. 46:48 >> When does it, when does it deposit, the 46:51 fly? 46:52 >> Yes. 46:53 >> Yes. It deposits. 46:54 >> This might be the last question, Doc. 46:57 Why are there more cases in Australia 46:59 compared to us? Is the sunlight there 47:02 different from the one in Indonesia? 47:05 Ooh. What a great question. Yes. 47:10 Perhaps it was said in the beginning 47:12 that Australia is located near the 47:15 Equator. 47:16 >> Hm. 47:16 >> Yes. God is indeed good, isn't He? So, 47:20 what are the indigenous people of 47:22 Australia called? Aborigines, right. 47:25 Aborigines have the same skin color as 47:27 us. 47:28 >> Brown. 47:28 >> Yes, brown. So, in Indonesia and 47:32 Australia, the native inhabitants were 47:35 actually created in such a way by God. 47:40 >> So even though they are near the 47:41 Equator, they are protected because 47:43 their pigments are large and abundant. 47:47 But Australia is now inhabited by many 47:51 people who originate from 47:56 >> countries or people with fair skin, 47:58 Caucasians, right? 48:00 >> Yes. 48:01 >> Whose skin, their skin pigments are 48:04 small and sparse. Now, even though 48:09 those pigments are located around the 48:11 cell nucleus to protect the DNA from 48:14 sunlight, so the DNA cannot mutate and 48:17 so on. However, because they aren't 48:20 protected due to the sparse and small 48:23 pigments, that can change 48:25 >> their DNA into 48:27 >> DNA that causes cancer, skin cancer. 48:31 That is the story of Australia. 48:35 >> Yes. Sometimes, whatever happens later 48:39 in our journey is also God's will, 48:41 right, Doctor? 48:43 >> It is God's will. That's absolutely 48:45 right. Yes, it is definitely His will. 48:48 >> But, roughly, we...roughly... 48:50 >> for the most part, God has opened the 48:52 doors of knowledge for us, right? 48:54 >> He he. 48:55 >> Now, 48:57 >> what? 48:57 >> Self-awareness. Do not sunbathe during 49:01 the hot hours when there is a lot of 49:03 ultraviolet light. And pay attention to 49:06 everything the doctor mentioned earlier 49:08 . Okay, perhaps you can give a closing 49:14 idea, a closing statement for our 49:16 discussion regarding Sakuri. Please, 49:21 Doctor. 49:22 >> Thank you. So, Ms. Nuning, it is 49:25 important for us to be able to examine 49:29 our skin independently to prevent skin 49:32 cancer on our bodies. Now, the Sakuri 49:36 examination is easy, isn't it? We can 49:39 examine ourselves in a private room 49:42 with equipment such as a large mirror, 49:46 a small mirror, then a hair dryer, and 49:49 so on. The point is so that we can 49:53 recognize by ourselves or identify any 49:59 skin abnormalities we have, so we can 50:05 refer it or notify a doctor if there 50:08 are any changes or if there are any new 50:11 skin abnormalities. Now, there was a 50:15 question earlier, how often? Maybe 50:18 every 6 months, or at least once a year 50:21 , or if you detect any new changes. I 50:26 think with Sakuri, a self-skin 50:28 examination, everyone can empower 50:30 themselves to recognize and identify 50:32 any changes or new lesions on the skin 50:35 and then inform a doctor. That is all, 50:39 perhaps, Ms. Nuning. Uh. 50:41 >> Yes, thank you very much, Dr. Aida 50:44 Sofiati Dahlan Humardani, a senior 50:47 specialist in dermatology, venereology, 50:50 and aesthetics who has been with us for 50:53 one hour. So remember, don't forget to 50:57 check our skin, starting from the soles 50:59 of our feet; check our entire skin 51:01 surface with a mirror. And one more 51:05 thing, don't play around with the 51:07 stinging sun, Doctor. Thank you very 51:10 much. Hopefully, next time we can 51:12 discuss other things related to what 51:15 our brothers and sisters really want to 51:17 know. Thank you. Billahi taufik wal 51:21 hidayah. Wasalamualaikum warahmatullah 51:23 wabarakatuh. 
