Humankind has long had a special relationship with the sun. Ancient Egyptians used to worship it, acknowledging the sun's awesome power and influence on life. Today, many people still find themselves irresistibly drawn to the sun, and blissfully soak up rays for hours at a time.
Although the warmth of the sun blanketing your skin might feel good, sun exposure can be deadly, and the popular notion that a tan makes a person look healthy is just plain wrong.
A tan is a sign of skin damage, says E. William Frank, MD, a Nashua dermatologist. As the sun's (or a tanning bed's) ultraviolet rays penetrate the skin, they can alter the DNA in cells, possibly leading to skin cancer.
How worried should current or former tan-seekers be, especially those who spent much of the 1970s greased up with baby oil in an effort to enhance the sun's tanning - and burning - abilities? Well, at a minimum, they should be aware that the odds of any of us getting skin cancer are quite good.
One in five Americans will develop skin cancer during their lifetime, according to the American Academy of Dermatology. It is the most common form of cancer in the United States, with more than one million skin cancers diagnosed annually. Although it is most likely to affect people with light skin, skin cancer can strike people of any color or age, including the baby boomers whose sunbathing days came and went years ago, and today's young tanning-booth devotees.
The three common types of skin cancer - basal cell carcinoma, squamous cell carcinoma, and melanoma - are all highly curable if caught early. However, chances of recovery from melanoma drop to 15 percent if detection and treatment are delayed.
Incidence of melanoma has risen dramatically during the past 20-30 years, Frank says, perhaps due to a combination of factors: a latency period between sun exposure and when skin cancer occurs; the fact that the odds of developing skin cancer increase as we age; and the legions of tanning parlor patrons and others who continue to recklessly expose themselves to ultraviolet (UV) rays.
Detection: Know Thyself
Since early detection of skin cancer is crucial, take the time to check your skin regularly. Some experts recommend that patients perform a self-exam monthly; others say to do it annually. The timeframe your doctor advises will depend on whether you have high-risk factors such as a family history of skin cancer, fair skin, an outdoor occupation or a history of sun exposure and uncomfortable or blistering sunburns. Check with your doctor to see what self-exam schedule is right for you.
When checking your skin, use a full-length and hand-held mirror so that you can see your skin from head to toe. Look for new skin growths or changes. Remember that skin cancers can vary in size, color and shape. Consider using the "ABCDE" or the "ugly duckling" methods when checking for signs of skin cancer:
A-Asymmetry: Is one half of a mole, freckle or age spot unlike the other half?
B-Border: Is the border irregular or poorly defined?
C-Color: Does the color vary from one part of the spot to another?
D-Diameter: Is the diameter of any spot larger than the size of a pencil eraser? (Be aware that melanomas can be smaller than that, however.)
E-Evolving: Has a mole, freckle, or age spot changed?
The ugly duckling method reminds us to look for any moles or spots that look different than surrounding ones. An "ugly duckling" might be noticeably larger, darker or lighter than nearby moles, for example.
Prevention: Be skin savvy
Experts recommend a three-step approach to skin cancer prevention:
1. The first important step toward protecting your skin is to avoid the sun during the hours of 10 a.m. to 4 p.m., when the sun's rays are strongest. This advice applies not just on hot, sunny days, but on cloudy ones, too, because even on cloudy days, harmful UV rays are present.
2. Modesty may or may not be a virtue, but it does lower your chances of getting skin cancer, so cover up. "Clothing is more important than sunscreen," Frank says. "Even the best sunscreen does not block out all the UV radiation, so clothing is critical."
The amount of protection offered by clothing will vary depending on the weave of the cloth and on whether the clothing is wet, Frank adds. If you can easily see light through a shirt, the sun's radiation will also easily pass through that shirt. And once wet, most clothing offers very little protection. Parents often put a t-shirt on their child at the beach to help avoid sunburn, but if that child is frolicking in the waves, parents should realize that a wet, white t-shirt has a Sun Protection Factor (SPF) of about three, says James Campbell Jr., M.D., a Dover dermatologist.
3. The third line of defense against the sun is sunscreen. An average person with no history of skin cancer should slather on a sunscreen with an SPF of at least 15 every day, year-round. Go for an SPF of at least 30 or 45 if you will be outside for more than half an hour. Resist the urge to consider sunscreen an excuse to stay out in the sun longer. "People unfortunately look at an SPF 30 and think they can be out for 30 times as long," Campbell says.
Remember to apply sunscreen liberally. Most people do not put on enough, rendering their sunscreen less effective. Apply sunscreen 30 minutes before going outside and reapply it at least every two hours after swimming or sweating. Keep in mind that a more accurate label for most, if not all, "waterproof" sunscreens would be "water-resistant." "The definition of waterproof is that it has half the [listed] SPF after 30 minutes of exposure in the water. It's not really waterproof," Campbell says.
Also, be sure to invest in a good quality sunscreen that covers both types of UV radiation. The SPF on a bottle of sunscreen relates to UVB rays only. Protection against UVA rays, a type of ultraviolet light emitted by the sun that does not typically burn skin but can cause dangerous cellular damage, is not included in SPFs. To defend against UVA rays, purchase a broad-spectrum sunscreen that includes among its active ingredients at least one of three agents: avobenzone, mexoryl or zinc oxide.
If you want to minimize your time spent with sunscreen bottles, Campbell and Frank both recommend sun-protective clothing, which comes rated with a specific SPF. Many brands and types of sun-protective clothing are cool and comfortable, and effectively block the sun's light. The clothing provides a great alternative to smearing on large quantities of sunscreen every day.
New treatments for skin cancer offer high cure rates, but remember that there is no substitute for early detection, Frank says. And if the thought of skin cancer doesn't convince you that sun avoidance and sunscreen are worth the hassle, perhaps an appeal to your vanity will: According to the Skin Cancer Foundation, up to 90 percent of the visible changes commonly attributed to aging are, in fact, caused by the sun. NH
This article appears in the August 2008 issue of New Hampshire Magazine