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0:16 One. 0:17 >> One. 0:18 >> In the name of God. 0:19 >> In the name of God, the Most Gracious, 0:20 the Most Merciful. Peace be upon you, 0:22 and God's mercy and blessings. My dear 0:24 brothers and sisters, may God have 0:25 mercy on you. Praise be to God, we are 0:28 blessed with the opportunity to be 0:31 together in this health space to 0:33 maintain our ties. Hopefully, this will 0:38 increase our motivation to move forward 0:41 more easily in addressing matters 0:44 related to our health, both soul and 0:47 body. Let us not forget to send prayers 0:52 and greetings to our leader and beloved 0:54 , Muhammad, the Messenger of God, may 0:56 God bless him and grant him peace. May 1:00 we one day be reunited with him at the 1:02 time we long for in the hereafter. Are 1:06 all the brothers and sisters healthy? 1:08 Praise be to God. Now, for this health 1:12 segment, we will discuss something 1:16 related to skin health. And our doctor 1:22 who will be joining us is Dr. Dr. Aida 1:25 Sofati Dahlan Umardani. She is a senior 1:29 specialist in dermatology, venereology, 1:33 and aesthetics. A graduate of the 1:36 Faculty of Medicine at the University 1:38 of Indonesia, from her bachelor's 1:39 degree up to her doctorate. Alright, 1:42 she is already there at the other end. 1:43 Let's greet her. Peace be upon you, and 1:45 God's mercy and blessings. Peace be 1:48 upon you, and God's mercy and blessings 1:51 , Miss. 1:52 >> Thank you, Doctor, for joining us so 1:54 you can provide us all with guidance. 1:58 So, what exactly is "Sakuri"? 2:02 >> Well, perhaps I also have a slight 2:05 revision. Sakuri was initially referred 2:10 to as "self-skin examination," but we 2:14 have since refined the term. We have 2:18 updated the term to be "independent 2:20 skin examination." 2:23 >> Why independent? Because by definition, 2:27 Sakuri is an independent skin 2:30 examination so that a person empowers 2:34 themselves to recognize and identify 2:38 any changes or new lesions on the skin 2:42 and then report them to a doctor. So, 2:48 besides checking it themselves, they 2:51 must also be able to recognize and 2:53 identify if there are any changes or 2:56 new lesions on the skin. Yes, then 3:00 report it to the doctor. So, Sakuri is 3:03 an independent skin examination used 3:05 for screening. 3:07 >> Screening towards skin cancer, perhaps. 3:11 It is not a skin examination for the 3:12 face, such as determining if it's 3:14 normal, oily, or dry skin—that's not 3:16 it. But it is more directed towards 3:20 skin cancer screening. 3:24 >> So 3:26 >> for those who previously imagined, "Oh, 3:29 is there something wrong with me?""Why 3:32 is my skin dry, or why is my skin too 3:35 oily, or wrinkled?" That isn't included 3:38 , right, Doctor? Right. Of course, 3:43 brothers and sisters would really like 3:46 to know exactly what should make us 3:48 concerned about whether we have skin 3:50 cancer or not. What are the signs, 3:54 since we have to do the independent 3:55 check before seeing a doctor, right, 3:57 Doctor? 3:58 >> Perhaps 4:00 >> your enlightenment will be very much 4:02 needed. So, brothers and sisters, 4:05 listen with all your heart, body, and 4:07 soul. Okay, go ahead, Doctor. 4:10 >> Right, thank you. So, as we know, 4:13 although perhaps skin cancer is not, uh 4:17 , what, not too common, especially 4:21 since we have, uh, pigmented skin types 4:25 . So, skin cancer is not very common in 4:27 Indonesia. But, but, if we happen to 4:31 get a type of skin cancer that's quite 4:34 aggressive, it can be really 4:36 troublesome, right? 4:39 >> Yeah. 4:40 >> So, actually, skin cancer is divided 4:42 into two. The first is, uh, melanoma, 4:45 and the second is non-melanoma skin 4:47 cancer. For Indonesians, there is more 4:50 non-melanoma skin cancer, especially 4:52 basal cell carcinoma. However, the one 4:56 that is feared is melanoma. Because, as 4:59 an example, melanoma skin cancer in 5:02 America or worldwide, the global data 5:06 in 2022 shows that the incidence of 5:09 melanoma ranks 17th. 5:12 >> Yeah. 5:13 >> Meanwhile, for regular, non-melanoma 5:15 skin cancer, it ranks fifth. But, 5:19 here's the "but". 5:21 >> Melanoma mortality is number 22 out of 5:23 all cancer data worldwide. 5:25 >> Yeah. 5:26 >> While non-melanoma skin cancer is also 5:29 number 22, it is much more common, 5:31 ranking fifth. But, perhaps, sorry to 5:34 say, it progresses slowly, very slowly, 5:36 until it reaches number 22. But for 5:39 melanoma, there are fewer cases, it 5:42 ranks 17th, but the mortality is also 5:46 number 22, like that. So actually, it's 5:50 actually fewer cases for melanoma, but 5:52 for non-melanoma skin cancer, it is 5:55 indeed, uh, ranked fifth worldwide. But 5:59 in Indonesia, in Indonesia, uh, skin 6:02 cancer is only 2.5%of all cancers. out 6:07 of all 6:08 >> only 2.5%in Indonesia. So, research 6:13 from 2013 to 2017 in 14 provinces and 6:16 26 cities in Indonesia shows skin 6:19 cancer is only 2.5%of all cancers, yes. 6:24 Now, in Indonesia, melanoma ranks 33rd 6:27 for men and 32nd for women. 6:31 >> Hmm. 6:31 >> Compare that with earlier, if globally 6:33 it's 17th, right? Then non-melanoma 6:36 skin cancer for men in our country is 6:39 number 10 and for women number 12. So 6:42 it is indeed low, low, but we should 6:45 still be concerned, we should still be 6:47 worried, right? 6:49 >> Yes. At Dr. Cipto Mangunkusumo Hospital 6:54 in Jakarta (RSCM), there are more basal 6:58 cell carcinomas at 66.9%, squamous cell 7:01 carcinomas at 27.4%, and melanoma is 7:05 only 5.7%out of 263 skin cancer cases 7:08 from 2014 to 2017. So actually, skin 7:12 cancer is rare, not common compared to 7:15 breast cancer, cervical cancer, or lung 7:18 cancer. But, uh, if you get it, it's 7:22 best if we can prevent it, right? 7:27 >> Yes. Now, roughly that's it for the, uh 7:31 , 7:32 >> introduction 7:33 >> to the statistics, right? 7:35 >> Yes. Why? Why is this examination 7:39 necessary to be used? Because in 1985 7:43 in America, so many melanomas were 7:46 found and, as it happened, people died, 7:50 right? Many could not be saved. So, 7:54 finally, they initiated a self-skin 7:57 examination now, which is called a 8:00 self-skin examination. Self-skin 8:03 examination, which we translate into " 8:06 pemeriksaan kulit mandiri," was 8:09 introduced in 1985 to identify lesions 8:12 suspected of being melanoma. Because 8:15 the most feared skin lesion or skin 8:17 cancer is melanoma. Yeah. 8:21 >> at that time the examination used the 8:24 acronym ABCDE. 8:27 >> Okay. 8:29 >> Now, for ABCDE, A is asymmetric, B is 8:33 border or edge for us. 8:36 >> Yes, 8:37 >> C is color, D is diameter; diameter is 8:41 the same everywhere, right. Evolving is 8:45 , um, changes on the skin. But ABC is 8:49 used more for melanoma. Meanwhile, in 8:53 2014, in Australasia, Australia had the 8:58 most skin cancer worldwide. Why? 9:03 >> Yes. 9:04 >> Because the region is near the Equator 9:06 and there are many white people there. 9:10 >> Yes. 9:10 >> Yes. 9:11 >> Hm. So, they discovered what is called 9:15 the scan project. Scan is S-C-A-N. The 9:20 S is for a sore, right. Then C for 9:25 changing. Is there any change? Changing 9:28 . Everything is changing, right. Then A 9:31 for abnormal and N for new. 9:35 >> Yes. 9:36 >> So, is there a sore, like abrasions or 9:38 wounds like that. Changing is a change. 9:42 Abnormal is just not normal, right. New 9:46 is whether there is a new lesion. But 9:49 before we go to ABCDE and scan, perhaps 9:51 someone wants to ask what the 9:53 difference is. 9:55 >> Okay. 9:56 >> What is the difference between a benign 9:57 tumor and a malignant tumor? 9:59 >> Yes. Yes. Brothers and sisters, because 10:02 this is via Zoom, we can't take phone 10:04 calls. Okay, we will give an 10:08 opportunity because it is really 10:12 necessary to know how we understand the 10:16 emergence of, um, the disease called 10:20 cancer. Some people call cancer "kanker 10:23 tongkering"(a colloquial term). Okay, 10:25 here is a question from Ibu Dia. 10:28 Actually, I still don't know much, or 10:31 even know anything at all. Usually, the 10:35 clues are on our skin. Is there 10:38 anything we need to be suspicious of, 10:41 Doc? Thank you. 10:43 >> Thank you, Ibu Dia. Yes. 10:47 >> So, we don't know if there is anything 10:49 on our skin. We don't know, right. So, 10:52 earlier I already mentioned the acronym 10:54 . Um, ABCDE, perhaps. In English, let's 10:59 just use it in Indonesian, A B C D E, 11:01 right. Earlier, was there a skin lesion 11:04 . A skin lesion is a skin abnormality, 11:07 right. A skin abnormality that is, is 11:10 it asymmetrical in shape. Asymmetrical 11:14 is, um, not the same on the left and 11:18 right, right. Then, is the edge, is the 11:23 edge regular or not? 11:27 >> Hm. Then, what about the color? Now, 11:33 usually the color for a normal mole is 11:37 only, um, brown or black, right. Maybe 11:41 dark brown in the center, light brown 11:42 on the edges, just two colors at most. 11:46 But for skin abnormalities that point 11:47 toward cancer, it has colors, more than 11:50 one, more than two colors, like that. 11:52 It can 11:53 >> be in one mole. 11:54 >> In one mole. Yes. 11:56 >> Yes. 11:57 >> Yes. So, then, um, the diameter is 12:02 usually more than 6 mm, usually. There 12:08 are some smaller than 6 mm, but if the 12:11 diameter is 6 mm, we usually get a bit 12:15 suspicious that it's a malignant lesion 12:18 . Although there is also literature 12:23 that says less than 6 mm can be 12:26 detected as small-diameter melanoma. 12:30 That might still be early, perhaps. Hmm 12:32 , then there is D, right? A, B, C, D, 12:36 E. And E, what is E? E is evolving, or 12:39 the evolution of the lesion. Lesion 12:42 evolution includes size, shape, or 12:46 color. So, its evolution could be an 12:51 increase in size, a change in shape, or 12:54 the presence of other symptoms like 12:57 itching or tenderness, and perhaps the 13:01 surface could be abraded, bleeding, or 13:04 have a different color pattern. So, 13:10 just because you have one of the ABCDEs 13:12 , it doesn't mean it's definitely 13:14 melanoma or skin cancer; not 13:15 necessarily. It is just one sign, 13:19 A-B-C-D-E. Most people have many skin 13:24 lesions, but if looked at by a doctor 13:28 or an expert, they are usually benign. 13:33 But there is one lesion that is a bit 13:36 different. For example, if the others 13:39 are just light brown. Yes. And that one 13:44 alone is black. And then, 13:46 >> the shape is also different from the 13:48 others. Well, we call that the ugly 13:51 duckling. That is usually an additional 13:56 criterion as well. So, it's called the 14:00 ugly duckling sign. Ugly duckling. So 14:07 it is very different from the other 14:10 skin lesions. Now, this is also a 14:14 parameter. It could be a malignant 14:19 lesion. So, that is what we use; we use 14:25 an acronym. We usually use the acronym 14:29 A, B, C, D, E plus the "funny" thing 14:33 from the ugly duckling sign, they call 14:36 it "funny." Because the others are the 14:40 same, and this one is a bit different, 14:43 it’s called A, B, C, D, E plus F. So, 14:46 A, B, C, D, E, F. You remember that, 14:48 Mrs. Diah? It makes it easier, right? 14:53 Yes. 14:54 >> And if there is more time later, maybe 14:56 we can use slides. 14:58 >> Yes. 14:58 >> I wasn't told that I had to use slides. 15:02 >> Using slides makes it easier to explain 15:04 . 15:05 >> People can read, take notes, and take 15:07 screenshots. Can screenshots be saved 15:10 as well? 15:12 >> Right? I hope Mrs. Diah didn't mention 15:14 her age. But all right, the next one 15:16 has no name, 0811 something. If I may 15:21 ask, Ms. Nuning, what causes people to 15:24 be exposed to skin cancer? Is it 15:29 because of the wrong diet, or playing 15:32 outside too often, getting sunburned, 15:34 or something else? Thank you. Yes, 15:39 >> thank you, Ms. Nuning. So, actually, 15:42 the cause of all cancer usually comes 15:44 from within ourselves, genetic factors, 15:46 and from the outside. Especially for 15:50 skin cancer, there are definitely 15:52 genetic factors, of course, and from 15:54 the outside, which is what we can 15:56 usually control, that is the 15:57 environment. 15:59 >> He he. 16:00 >> From the outside, it is usually, first, 16:04 sunlight, then second, chemicals, and 16:07 it could also be viruses. Now, usually 16:12 with sunlight, since we are in the 16:15 equatorial region, the sun's path, our 16:18 exposure to sunlight is certainly 16:20 higher than those who are not outside 16:23 or further from the equator. However, 16:28 luckily for Indonesians, 16:30 >> he 16:32 >> our skin has pigments that are large, 16:36 but not as large as people of color, 16:41 those who are quite dark. We are brown, 16:47 aren't we? 16:48 >> Our skin has large and numerous 16:49 pigments, 16:51 >> but it is indeed not as much as those 16:52 with black skin. You know the very 16:55 black ones, you know what I mean. He 16:56 >> yeah. Now, but for Caucasian people, 17:00 white people, their pigments are small 17:05 >> and few. 17:06 >> Whereas those pigments are located 17:11 around the cell nucleus to protect the 17:14 DNA. 17:16 >> Protecting DNA means protecting our 17:18 genes, right? And they are in our body 17:23 and should not mutate, they should just 17:26 stay as they are, they shouldn't be 17:29 disturbed. So, that is why sunlight is 17:34 one of the causes. And there are also 17:40 viruses, for example, the HPV virus, 17:43 perhaps Human Papillomavirus, from 17:46 warts; warts can be benign or malignant 17:49 , right? 17:51 >> Then also from chemicals, and those are 17:55 what we can control from the 17:58 environment. Okay, yes. The next 18:04 question is from Mrs. Sri Sriani. Yes, 18:10 Doc. On my right breast, there is a 18:15 black mole-like spot that hardens, 18:18 dries up, and can be picked off. And 18:22 after that, a few months later, it 18:25 appears again. Is this something that 18:28 should be suspected? Or what is it? 18:30 Thank you, 18:32 >> Ma'am. You are very welcome. So, we 18:35 rely on the ABCDE rule. ABCDE stands 18:38 for A, Asymmetric. What is its shape? 18:41 Is it asymmetric or not? 18:43 >> Then B, the borders. Are the edges 18:45 regular or not? Then C, the color. What 18:48 was the color again? Black or brown? 18:51 Blackish, perhaps. Then, ABC, what is 18:56 the diameter? Usually, if it's more 19:00 than 6 mm, we should be suspicious, 6 19:02 mm or more. Then, 19:06 >> E. 19:07 >> E is evolving. Is there any change or 19:10 not? Yes, if it's just one, but looking 19:14 at your statement that it 19:18 >> dries up, can be peeled off, and then 19:21 after some time, 19:23 >> months later, it appears again. Uh-huh. 19:26 >> Yes. In my opinion, it might be 19:27 seborrheic keratosis. But for certainty 19:30 , it is better to have it examined by a 19:32 doctor. If I'm not mistaken, Dr. Sonar 19:35 will also be giving a talk on breast 19:37 health soon, what month was it? January 19:39 , perhaps. I also kind of forgot, yes. 19:42 But Dr. Sonar, Sonar Sony Panigoro 19:45 >> will also be presenting on breast 19:48 cancer later. But this case is a skin 19:51 lesion on the breast, not breast cancer 19:54 . Yes. Yes. 19:55 >> In my opinion, it might be, and I 19:57 emphasize "might," just a possibility. 19:59 Especially since the progression is 20:01 slow, it doesn't change quickly, right? 20:03 >> He he. 20:04 >> But to be safe, it is better to 20:07 >> check with an expert. Yes. 20:09 >> Okay. Alright. Before we return to the 20:12 incoming WhatsApp messages, if there is 20:14 anything you would like to add, Doctor, 20:16 please go ahead. 20:17 >> Oh, right. Perhaps, as we saw earlier, 20:20 regarding the second question from the 20:23 lady, the lesion on her breast is 20:25 likely benign. Likely. 20:28 >> Now, the actual question is, what is 20:30 the difference between a benign tumor 20:31 and a malignant tumor? 20:33 >> Yes. Anything that is a lump is a tumor 20:37 , right? However, not all tumors are 20:41 cancer, and not all tumors are 20:44 malignant, right? So there are benign 20:47 tumors and malignant tumors. What is 20:48 the difference? The difference lies in 20:52 their growth; as you said earlier, 20:54 benign tumors usually grow slowly. Then 20:59 , the borders—my apologies, you 21:01 didn't mention this earlier—but they 21:03 usually have clear borders. Furthermore 21:06 , they do not damage the surrounding 21:08 tissue. But with malignant tumors or 21:11 cancer, they grow very quickly. They 21:14 grow very fast and have irregular edges 21:17 because they grow rapidly. Perhaps one 21:20 part has already spread here, while 21:21 another is still there. Like that, 21:23 right? So the edges are irregular. 21:26 Unlike benign tumors. Benign tumors 21:28 have regular edges and do not damage 21:30 surrounding healthy tissue. Malignant 21:32 ones damage surrounding healthy tissue; 21:35 that is a characteristic of their 21:37 growth. Then there is also the matter 21:39 of spreading. Benign tumors do not 21:41 spread, while malignant tumors do 21:43 spread, or what we call metastasis. Now 21:46 , you are already familiar with the 21:47 term metastasis, right? So, benign 21:51 tumors do not spread, but cancer or 21:53 malignant tumors can spread directly, 21:56 through the bloodstream, or through the 21:59 lymphatic system or lymph nodes. If a 22:05 benign tumor is removed, it rarely 22:08 comes back, but with cancer, the risk 22:12 of recurrence is usually quite high. It 22:18 can even grow in other parts of the 22:21 body. So, that is the difference 22:23 between malignant and benign tumors. 22:25 For the skin, it is the same. So if it 22:29 grows slowly and has regular edges—as 22:32 noted in the description earlier—it 22:36 is usually more likely to be benign. 22:41 But if it grows quickly and also bleeds 22:44 easily. And then, furthermore, the 22:49 edges are irregular. All of those are 22:54 likely malignant. Okay, let's move on 22:59 to this one. The question again has no 23:05 name, but it could be a mother since it 23:09 asks about heredity. If my mother 23:15 suffered from breast cancer, will it be 23:17 inherited even if the hereditary cancer 23:19 isn't breast cancer but skin cancer 23:21 like the one being discussed? Please 23:25 explain. Yes. Some cancers are 23:29 hereditary and some are not. So there 23:32 are those that are, uh, hereditary, and 23:34 there are sporadic ones. 23:36 >> Heh. 23:37 >> Now, breast cancer is one of the 23:39 cancers that is hereditary. However, I 23:46 don't know if, uh, skin 23:49 >> is inherited as skin cancer. But if it 23:52 involves breast cancer, it's best to 23:55 have all children or siblings tested, 23:59 uh, have their genetics checked to see 24:02 if they carry the gene that leads to 24:05 breast cancer. But it's not certain, 24:07 even if they have the gene, it's not 24:09 guaranteed, right? There must be other 24:11 mutations as well, right? 24:13 >> He he. 24:14 >> To cause cancer. So don't be too 24:16 worried. We must remain vigilant, but 24:19 don't live in constant fear, okay? So 24:23 the first step, if earlier it was whose 24:25 mother had breast cancer, right? 24:27 >> Yeah. Her mother. 24:28 >> Her mother, meaning if she has 24:30 daughters, all the daughters should 24:33 ideally have their genetics checked for 24:35 cancer. Breast cancer. 24:38 >> Is that test difficult, Doctor? Just go 24:40 to the hospital and 24:42 >> go to the hospital to get a blood test. 24:43 Yes, 24:45 >> for example, since I work at Dharmais 24:47 Cancer Hospital, perhaps Dharmais 24:49 Cancer Hospital or also RSCM could work 24:51 , or other hospitals, just ask for a 24:54 breast cancer screening panel. Okay, 24:57 next is from me, Damar Nur Avian from 25:02 Bogor. Doctor, may I ask, how does the 25:07 mechanism of skin cell regeneration 25:11 work at the molecular level, and why 25:14 does this process slow down as we age? 25:19 Thank you. Yes. Perhaps the one asking 25:22 is a molecular biologist. Perhaps 25:25 >> Mr. Damar. 25:27 >> Mr. Damar. So, you mean skin 25:30 regeneration. Perhaps what we know most 25:33 about skin regeneration is that the 25:36 skin layer we call, uh, the topmost 25:38 part of our body is called the 25:40 epidermis. Uh. 25:43 >> The epidermis consists of several 25:44 layers. The lowest layer is called the 25:48 basal cell layer. Uh, it's called basal 25:52 cells, not carcinoma, the cancer 25:54 disease is basal cell carcinoma, right. 25:57 Now, the basal cells will, uh, later 26:00 regenerate into the layer of cells 26:03 above it, which is the squamous cells, 26:07 right. Now, usually skin cancer from 26:11 squamous cells is called squamous cell 26:13 carcinoma. Then it moves further up, uh 26:17 , becoming the next layers, the last 26:21 one being the corneum layer, yes, the 26:24 stratum corneum. That stratum corneum, 26:27 it, uh, will peel off by itself. That's 26:29 why even though it, uh, what, becomes, 26:34 uh, becomes many, it, uh, becomes 26:37 >> uh, peeled off, regenerating upward, 26:40 upward, upward, but it, uh, disappears. 26:44 In what form does it shed? In the form 26:47 of, for example, when we take a shower. 26:49 So that dead skin, actually, is just a 26:52 layer of skin that, uh, a layer of skin 26:54 that has come off. 26:57 >> Hm. In basal cell carcinoma, because 27:04 there is a, besides the genetic aspect, 27:08 it will mutate, and those mutations are 27:11 uncontrollable. However, basal cell 27:15 carcinoma is the most benign skin 27:17 cancer—no, not the most benign, the 27:19 mildest skin cancer. 27:20 >> Hm. Now, those basal cells and squamous 27:25 cells are what we call keratinocytes. 27:28 And in keratinocytes, uh, besides those 27:32 cells, there are others called 27:34 melanocytes. Those melanocytes are what 27:38 provide, uh, supply pigment to our skin 27:40 . Now, that is what can cause melanoma, 27:45 yes. So, uh, I think that's, uh, 27:48 probably the easiest way to explain it. 27:52 But if you are interested in molecular 27:55 biology, maybe in the next meeting I 27:57 will provide slides that focus more on 28:00 that part, okay? 28:02 >> Yes. Yes. 28:05 >> All right. This one again doesn't have 28:09 a name, maybe they don't communicate 28:13 with Rasil very often. What I want to 28:19 ask, Doc, is how do we prevent it? We 28:23 are often outside exposed to the sun, 28:26 especially since my job is outdoors, 28:28 not inside a building. What should be 28:32 done to prevent exposure to harmful 28:36 sunlight? The hours, uh, aren't very 28:39 early in the morning, right, Doc? What 28:41 time to what time? Thank you. 28:44 >> Right, thank you for the question. Yes, 28:48 we indeed know that sunlight at certain 28:55 hours will, uh, can cause skin cancer, 29:01 yes. But usually, it's at hours— 29:07 >> let's say, 9:00 or 10:00 until 2:00 or 29:09 3:00, with the peak being at 12:00. 29:12 >> Oh. So at 12:00, don't be in the middle 29:15 of the hot street without any cover, 29:18 right, Doc? From 10:00 to 2:00, it's 29:22 really, uh, the rays are too, uh, 29:25 somewhat painful. We know that what 29:28 usually causes skin cancer is, uh, 29:30 ultraviolet light, right? 29:32 >> There is ultraviolet A, ultraviolet B, 29:35 and ultraviolet C. Now, ultraviolet C 29:37 is the one that most, uh, causes skin 29:40 cancer. But thankfully, we, uh, have an 29:43 ozone layer in our atmosphere that 29:46 prevents ultraviolet C from reaching 29:49 the Earth. So, because of that, it can 29:52 be, you know. But don't forget that the 29:54 ozone layer can leak, too. It can leak, 29:56 for example, due to, uh, refrigerators 29:59 or the greenhouse effect, yes. And in 30:03 certain areas where the ozone layer is 30:05 already leaking, for example, in 30:07 Northern Europe, perhaps in areas like 30:10 Norway, Denmark, and so on, that's why 30:12 there's a lot of skin cancer there, 30:14 although, uh, yes, their skin is also 30:17 fair, too. So, that's the C, which, 30:21 actually, it shouldn't, but it can also 30:24 enter, uh, and reach the Earth. Now, 30:27 the next one that is most frequently 30:30 talked about is ultraviolet B. 30:32 Ultraviolet B can reach the earth and 30:35 can reach our skin. Because ultraviolet 30:38 B radiation reaches the epidermis. 30:40 >> Right. 30:42 >> If it's ultraviolet A, it reaches the 30:43 dermis. So, skin layers consist of the 30:46 epidermis, dermis, and subcutis. Now, 30:48 as I said earlier, the epidermis has 30:50 cells like basal cells and squamous 30:51 cells. Then, the sun—that ultraviolet 30:56 B—attacks there, up to the epidermis 30:59 layer. If it's ultraviolet A, it 31:01 reaches the dermis. In the dermis, 31:04 there is a lot of collagen and so on, 31:06 which causes skin aging. While 31:09 ultraviolet B is more likely to cause 31:13 skin cancer. But ultraviolet A can also 31:17 cause skin cancer, and current theories 31:19 say it can cause skin cancer. If it 31:22 used to be said that it only helped 31:23 ultraviolet B, now it turns out that 31:25 ultraviolet A is also said to cause 31:26 skin cancer. The main one is definitely 31:29 UV B. 31:30 >> And that is at 12:00 PM, that 31:33 ultraviolet B. The peak hours are when 31:36 the sun is right above us. But usually, 31:40 it starts from 10:00 AM until...What 31:42 time? No. But we also need sunlight, 31:47 right? For what? 31:50 >> Yes. 31:50 >> For our bones, for 31:51 >> vitamin D. 31:53 >> Vitamin D, right. Now, doctors usually 31:57 suggest basking in the sun at 9:00 AM. 32:02 It is already...enough for the 32:06 ultraviolet, right. The ultraviolet and 32:09 ultraviolet B are at 9:00 AM, but only 32:11 for 15 minutes. 32:13 >> Oh, I see. Yes. If it's 9:00 AM now, 32:16 it's very hot, right. 32:17 >> Yeah. 32:17 >> So, only 15 minutes. Don't do it at 32:19 10:00. Don't you dare. 10:00 AM. Maybe 32:22 if the sun is already out at 7:00 AM, 32:24 just go out at 7:00 AM, okay. Going out 32:26 at 7:00 AM is fine. But the UV isn't 32:27 there yet. 32:28 >> Not yet. Yeah. Okay. Alright. This is 32:31 from Mrs. Dari. Mrs. Dari in Sukabumi. 32:36 May I ask, Doctor. I am 65 years old. 32:40 Since I was little, there has been a 32:44 birthmark on my face that is dark brown 32:46 . As I get older, why is the color 32:51 getting darker and spreading? Please 32:54 explain, Doctor. Thank you. Yes. 32:57 >> Right. First, where is the birthmark on 33:00 the face? On the cheek, on the forehead 33:03 , or where? Then, what is the shape 33:06 like? Now, as it spreads, is it just 33:10 one that is getting wider or is it 33:12 shaped like spots? Increasing in number 33:15 and spreading is also different. So, if 33:19 it has been there since childhood until 33:22 the age of 65, it's usually fine. Well, 33:25 maybe it's fine, but now the color is 33:27 getting darker, right. 33:29 >> Yeah. 33:31 >> Well, it's best to maybe go to a doctor 33:33 to be 33:35 >> asked further. Okay. 33:37 >> Further. 33:38 >> If the color doesn't change, it's fine. 33:40 But any change should make us 33:42 suspicious. 33:43 >> Yeah. 33:44 >> Any change, right. Hopefully, there is 33:46 nothing wrong. But it still needs to be 33:48 checked, the birthmark. Birthmarks, 33:50 what does that word even mean, I mean, 33:53 what exactly is a birthmark? A dark 33:56 spot. 33:57 >> Uh-huh. That's what I imagined, I guess 33:59 . 34:00 >> Just one dark spot, right? It could be, 34:03 it could be a mole from when you were 34:05 small, from birth, perhaps. There are 34:10 many kinds, they come in various sizes, 34:13 and some sizes carry a higher risk for 34:15 cancer, so it's better to get checked 34:18 to be sure. Okay, we are still in the 34:26 health segment of Radio Silaturahim. We 34:30 still have about 20 minutes left, give 34:33 or take a little. Doc, by the way, Doc, 34:37 someone is asking about protecting our 34:39 skin from ultraviolet rays, are there 34:42 any topical creams sold for that? They 34:46 want to know, they're 22 years old. Oh, 34:49 a young adult. 34:51 >> Teenager. Have you ever heard of 34:54 sunscreen or sunblock? 34:56 >> Well, 34:57 >> certainly. Uh-huh. Oh, so that's for 34:59 ultraviolet protection? Yes. But 35:02 actually, that—the sunscreen—is 35:04 meant to protect you. But that is only 35:07 one way, you know. There are others, 35:09 like wearing a 35:10 >> hat, wearing a hat, a proper hat. 35:14 Uh-huh. A wide-brimmed hat. And then, 35:16 the most important thing, perhaps like 35:19 Ms. Nuning does. 35:21 >> What's that? 35:21 >> Wearing covered clothing 35:25 >> that automatically protects you from 35:27 sunlight, right? 35:29 >> Yes. Maybe apply sunscreen to the face. 35:33 >> Then cover up with a mask and wear 35:34 glasses. Oh, that's safe then. Yes. But 35:38 don't forget that skin cancer 35:41 >> isn't always caused by sun exposure, 35:43 you know. It can also be caused by 35:45 trauma. What kind of trauma? We can 35:47 imagine the hereditary part, right? But 35:48 what kind of trauma are we talking 35:50 about? 35:50 >> Trauma like, for example, on the soles 35:52 of the feet. Most melanoma cases in 35:55 Indonesians, and there is research from 35:58 Japan and Hong Kong, 36:00 >> turns out 36:02 >> it's because they don't wear footwear. 36:06 >> Oh, so going barefoot isn't good either 36:08 , huh? 36:09 >> Yes. Like farmers, for instance. So, 36:13 for colored skin—excuse me—the most 36:16 common type of melanoma is acral 36:18 lentiginous melanoma, and "acral" means 36:22 on the extremities, right? 36:24 >> Mm. 36:25 >> Usually on the feet. It turns out the 36:29 same happens in Hong Kong. Do they wear 36:31 footwear in Hong Kong or not? They do. 36:34 But perhaps, well, that's how it is. In 36:37 Japan too. So Japan, Hong Kong, 36:40 Indonesia. Three countries where people 36:42 often don't wear footwear. I don't know 36:47 for sure whether they don't wear 36:48 footwear or not. But 36:51 >> but if you're not wearing footwear 36:53 because you want to walk on gravel for 36:54 health benefits, that's just for a 36:56 short time. That should be fine, right? 36:58 Mm. 36:59 >> Yes, that's fine. Maybe there's a story 37:01 where, perhaps, there is 37:04 >> a family that really loves dancing, 37:06 loves doing things like that. And then 37:09 they—uh—learn to dance, maybe 37:12 somewhere. Yes. Yes. 37:16 >> What if, for example, you wear socks, 37:17 is it different? 37:19 >> Can it still get pierced? If you wear 37:21 socks, can it? So, the footwear must 37:24 still be something that protects the 37:26 skin, protects the feet. 37:27 >> Hm. So, wearing socks isn't enough. The 37:31 thorn can pierce through those too. 37:33 >> Yeah. Okay. Okay. Alright. Moving on to 37:36 Ibu Suratmi. Assalamualaikum, doctor. I 37:40 am 73 years old. Is it still necessary 37:44 to sunbathe? Thank you. 37:48 >> At 73, you do need to sunbathe for 37:50 vitamin D. 37:51 >> Still, yes. 37:52 >> Yes. Yes. But as mentioned earlier, 37:55 around 9:00 AM for 15 minutes. 37:58 >> And stop until the next day. Because if 38:02 it was the afternoon limit, right? Or 38:05 at what time, or all day long. 38:08 >> Oh, all day from 9:00 to 10:00. 10:00 38:14 to whenever, by then the heat has 38:16 already gone down. 38:18 >> Yeah, there's no more ultraviolet light 38:20 left, right. If it's later, sunbathing 38:22 is nice because it's not hot. But the 38:24 ultraviolet rays aren't at their 38:26 maximum yet. 38:27 >> Yes, that's right. So you're wasting 38:29 your time while it's hot. Okay. 38:31 Regarding the medication being taken, 38:34 Mr. Harjo. If I take certain 38:37 medications, does it have any effect on 38:40 the emergence of this skin cancer issue 38:43 ? There are certain medications one 38:46 might take regularly, but it wasn't 38:49 specified, Mr. Arjo. What is being 38:51 taken? Maybe those usually taken by the 38:55 elderly, whether it's for, what's it 38:58 called? Gout or something like that. 39:02 Does that have an effect on the skin? 39:05 >> Uh. 39:07 >> Are certain medications, for example, 39:08 the question is like that, right, Mr. 39:10 Ro? Yeah. 39:11 >> Yes. Yeah. But I will look into it 39:14 further later. But so far, I haven't 39:18 found any specific medication that 39:20 causes skin cancer, you know. 39:23 >> I don't think so. 39:24 >> Yeah. But if there's a question like 39:26 that, it's actually good. We have to 39:29 research if such a thing exists. But 39:31 >> the effect, right? 39:32 >> Yes. Does it have an effect on the skin 39:35 , especially skin cancer? 39:37 >> Yes. If, for example, the skin—pardon 39:39 me—if chemotherapy makes the skin 39:41 turn black, there are medicines that 39:42 can cause the skin to turn dark, that 39:44 exists. But what causes skin cancer, 39:47 wow. I'll read about it first, perhaps 39:51 later. 39:52 >> Yes. 39:52 >> For the next meeting, this is also a 39:55 good question, Ms. Nuning. 39:57 >> Because you want to know, right? That's 39:59 true too. 40:00 >> Yes. Why only 15 minutes left, Ms. 40:03 Nuning? Perhaps I 40:04 >> can give a closing idea because there 40:07 are a lot of thumbs-up here, Doc. Thank 40:10 you for the information. 40:11 >> The Sakuri examination, the Sakuri 40:13 technique is indeed better if we use 40:16 slides to explain it. But maybe just in 40:18 this way, in a 40:19 >> passing way for now, we can use slides 40:21 next time. Okay. 40:23 >> Yes. For example, we at home surely 40:25 have a mirror that is as tall as our 40:27 body, right? Whether it's a wardrobe 40:29 mirror, or 40:30 >> a special mirror, right? There is one, 40:32 right? 40:32 >> A mirror as tall as e 40:34 >> a mirror that is as tall as our body, 40:36 right. Yeah. 40:37 >> A mirror as tall as us. Then don't 40:40 forget the small mirror we usually use 40:43 >> just for our face. Applying lipstick. 40:46 >> Applying lipstick, but it can reflect 40:49 backwards to see our back. Okay, we 40:52 can't see our back, right. So, we use 40:54 that small mirror to look at the body, 40:57 so our back faces the small 41:00 >> mirror, and the small mirror is to see 41:02 it. Then don't forget to also consider 41:06 what if the lights are off or there are 41:07 no lights, it means there must be 41:09 sufficient lighting, right 41:11 >> to be able to see. Yeah. 41:13 >> Yes. Then don't forget we also have to 41:16 check our head, right. Skin is from 41:19 head to toe, 41:20 >> but the head has hair. 41:22 >> So, what do we use? 41:24 >> Well, what is it? We use a hair dryer. 41:30 A hair dryer isn't just for drying hair 41:31 . Use a hair dryer so the hair parts, 41:34 allowing us to see 41:36 >> Yeah. 41:36 >> whether there is something there, 41:39 >> like a line. So don't just part it in 41:42 the middle, right. 41:43 >> Middle part. Then 41:45 >> the side, next to it, that's it. 41:47 Finally, we divide it into about six 41:49 parts, right, those sections. Then 41:52 don't forget there should also be two 41:54 small stools. Small stools to see what? 41:59 To see, so we can sit and look at our 42:02 feet. We can look at our feet too, 42:04 right. It's hard to see our feet when 42:05 we're standing, right. That way it can 42:07 reach 42:09 >> So those are the tools. 42:11 >> Lift the feet as high as the stool in 42:14 front so it's clearly visible, right, 42:16 Doc. He 42:17 >> down to the soles of the feet, don't 42:18 forget, as already mentioned, many 42:20 Indonesians 42:22 >> up to the mirror or tilted, oh not just 42:24 I, yeah heeh, that is the use of the 42:26 small mirror, but we can also see, even 42:28 if it's tilted, but the other side is 42:30 sometimes quite difficult to see if we 42:32 don't use the help of a mirror, bending 42:34 over. 42:39 >> So what is really needed is a lamp, 42:41 sufficient lighting, then a mirror that 42:44 is as tall as our body, a large mirror, 42:47 a small mirror, then a hair dryer, and 42:50 don't forget two small chairs, yeah, 42:53 small chairs. Now, initially we face, 42:57 um, sorry, of course, the clothes are 43:00 taken off, right. So in a closed room, 43:03 right, in a closed room, locked, we 43:05 take off all our clothes. 43:08 >> We won't see anything, Doc, if there 43:09 are no lights. 43:11 >> But the lights must be bright. 43:13 >> Must be on. Yes. Turn it on, the door 43:16 is locked, right. Don't let anyone see. 43:19 Then we look in front of the mirror at 43:23 the front part of our body, continue 43:26 down to the feet, having checked there 43:29 is nothing. We turn left. Uh, turn. 43:32 Turn left. We look at our right side, 43:35 see what's there, right. After that, 43:38 turn again to the right. Look at our 43:42 left side, see what's there. If you 43:45 turn to the right, the one in the 43:46 mirror is the left side, right. 43:47 >> He he. 43:48 >> We check everything, from top to bottom 43:51 , okay. And then, lastly, we must face 43:56 away from the mirror with the help of a 44:00 >> small mirror. 44:02 >> Small, right. After everything is 44:07 checked with the small mirror. Then 44:11 next, we also examine the hands; 44:14 earlier we already checked the body, 44:16 right. 44:18 >> Yes. 44:19 >> We only looked at the body earlier, not 44:21 the hands yet. Ah, the hands are what 44:24 we must look at properly. Hands and 44:28 arms, that's using the full-length 44:30 mirror. But there is. But later for the 44:34 legs and feet, including the soles, we 44:37 sit on that small stool and put the 44:40 other leg on the other small stool. 44:44 Then we check using a small mirror, 44:46 including the soles of the feet, 44:48 between the toes, and so on. Well, 44:52 that's roughly it. Next time, if 44:54 there's another opportunity, we'll 44:56 provide the slides. 44:58 >> Alright. Uh, Doc. Earlier it was easy 45:01 to move around to check everything, but 45:03 if it's already difficult for me, can 45:05 someone else or my child check it for 45:07 me, Doc? Yes, that's a possibility. 45:11 >> Yes. The idea is for it to be 45:13 self-examination, but if 45:16 >> it's already difficult, then please ask 45:17 for help. 45:18 >> Ask for help. Your child or a family 45:22 member, perhaps. 45:25 >> Yes, a child is a family member. 45:27 >> Yes, a child is a family member. Ms. 45:31 Nuning. 45:32 >> Okay. If earlier, um 45:37 >> those who are asking are mostly just 45:38 giving a thumbs up. Does skin 45:41 examination have to be routine or not? 45:44 If you have to go to a doctor, can you 45:47 use BPJS or not? 45:49 >> Oh, so speaking about BPJS. 45:53 >> At a public hospital, can we see a 45:56 dermatologist? Is that allowed? If you 46:00 want to be checked by a dermatologist, 46:02 please go ahead. It can be at a public 46:05 hospital, yes. Public hospital. 46:06 >> Yeah. 46:07 >> Of course, you can use BPJS. If you go 46:11 to a public hospital, you can use BPJS, 46:13 right. 46:13 >> But you need this, you need what? 46:16 >> A referral letter to have your skin 46:17 examined. 46:19 >> A referral from the community health 46:19 center (Puskesmas). The general 46:21 practitioner at the health center can 46:23 examine you themselves if they are able 46:24 . But once they are in doubt, they will 46:26 send you to the hospital. 46:28 >> Now, the doubt usually arises because 46:30 of the signs the doctor mentioned 46:31 earlier. 46:32 >> Whether those are suspicious black 46:35 spots like moles, even though a fly 46:38 doesn't deposit something on our skin. 46:42 >> When does it, when does it deposit, the 46:45 fly? 46:47 >> Yes. 46:48 >> Yes. It deposits. 46:49 >> This might be the last question, Doc. 46:51 Why are there more cases in Australia 46:54 compared to us? Is the sunlight there 46:57 different from the one in Indonesia? 47:00 Ooh. What a great question. Yes. 47:04 Perhaps it was said in the beginning 47:07 that Australia is located near the 47:10 Equator. 47:11 >> Hm. 47:11 >> Yes. God is indeed good, isn't He? So, 47:15 what are the indigenous people of 47:16 Australia called? Aborigines, right. 47:20 Aborigines have the same skin color as 47:22 us. 47:22 >> Brown. 47:23 >> Yes, brown. So, in Indonesia and 47:26 Australia, the native inhabitants were 47:29 actually created in such a way by God. 47:34 Even though they are near the Equator, 47:36 they are protected because their 47:38 pigments are large and abundant. But 47:42 Australia is now occupied, there are 47:46 many people living there who come from 47:50 >> countries or people with fair skin, 47:53 Caucasians, right? 47:55 >> Yes. 47:56 >> Whose skin, their skin pigments are 47:59 small and few. Yet, those pigments 48:04 surround the cell nucleus, protecting 48:07 the DNA from sunlight so that the DNA 48:10 doesn't mutate and so on. However, 48:14 because they aren't protected due to 48:16 having few and small pigments, this can 48:18 change 48:20 >> their DNA into 48:22 >> DNA that causes cancer, skin cancer. 48:26 That’s the story of Australia. 48:30 >> Yes. Sometimes, whatever happens in our 48:34 lives is also fate, isn't it, Doctor? 48:38 >> It is God's will. That is correct. Yes, 48:40 it is fate, correct. 48:42 >> But, for the most part, we... 48:45 >> for the most part, God has opened the 48:47 doors of knowledge for us. 48:49 >> He he. 48:50 >> So, what is the 48:52 >> answer? 48:52 >> Self-awareness. Don't sunbathe during 48:56 the hot hours when ultraviolet levels 48:58 are high. And pay attention to 49:01 everything the doctor just mentioned. 49:05 Okay, perhaps at the end, you can share 49:08 a closing idea, a closing statement for 49:11 our discussion regarding Sakuri. Please 49:15 , Doctor. 49:17 >> Thank you. So, Mbak Nuning, it is 49:20 important for us to be able to examine 49:24 our skin independently to prevent skin 49:27 cancer on our bodies. Sakuri 49:30 examination is easy, isn't it? We can 49:34 examine ourselves in a closed room 49:37 using tools like a large mirror, a 49:40 small mirror, and then, uh, a hair 49:43 dryer, and so on. The goal is so that 49:48 we can recognize by ourselves or 49:53 identify any skin abnormalities we have 49:56 , so we can refer or report them to a 50:02 doctor, whether there are any changes 50:05 or any new skin abnormalities. Now, how 50:10 often? Maybe every 6 months, or at 50:14 least once a year, or if you detect any 50:17 new changes. I think with Sakuri, the 50:22 self-skin examination, everyone can 50:24 empower themselves to recognize and 50:26 identify any changes or new lesions on 50:29 the skin and then report them to a 50:31 doctor. That is all, perhaps, Mbak 50:34 Nuning. Eh, 50:36 >> Yes. Thank you very much, Dr. Aida 50:40 Sofiati Dahlan Humardani, a senior 50:42 specialist in dermatology, venereology, 50:45 and aesthetics, for being with us for 50:48 an hour. So remember, don't forget to 50:52 check our skin, starting from the soles 50:55 of our feet, check the entire skin 50:57 surface with a mirror, and one more 50:59 thing, don't mess around with the 51:01 scorching sunlight, Doctor. Thank you 51:04 very much. Hopefully next time we can 51:07 discuss other topics that our brothers 51:10 and sisters are really curious about. 51:14 Thank you. Billahi taufik wal hidayah. 51:16 Wasalamualaikum warahmatullah 51:18 wabarakatuh. 
