Picture yourself on a white sandy beach. A slight sea breeze sprays a mist of salt water across your face and over the crowded beach. You’re at the mecca for the area’s best bikini contest, Coconuts on the Beach, Cocoa Beach, Florida. It’s 10 a.m. and like a Thanksgiving turkey, you’ve planned to baste your day away in the heat of the sun.
Lying next to you is Ms. Goldentan, the woman that keeps Coppertone suntan lotion in business. Like a shining diamond, her soft, beautiful, bronze skin glistens under the intense sun light. Does it get any better? Remember another fairy tale beauty named Cinderella? As Queen of the Ball she was the envy, of all but at 12:00 her time was up and back to her humble hovel she went. Just like Cinderella, time (and those damaging sunrays) will also catch up with Ms. Goldentan.
Fast-forward twenty years, remember that bronze beautiful body? If Ms. Goldentan didn’t wise up and limit her time in the sun, she may now look like an old tattered brown leather boot — and that may not be her only problem. Worse yet is the possibility of cancer, particularly skin cancer. Skin cancer is the most common form of cancer in the United States, with about one million new cases diagnosed each year. It accounts for about 2 percent of all cancer deaths. The incidence of melanoma rises rapidly in Caucasians after age 20, especially in males, possibly as a result of increased recreational exposure to sunlight. Over 90 percent of melanomas that arise in the skin can be recognized with the naked eye. It’s estimated that in 2000, about 47,700 individuals developed melanoma and almost 7,700 died. The National Cancer Institute estimates that 40 to 50 percent of Americans who live to age 65 will have at least one episode of skin cancer. Most skin cancer is diagnosed after age 50.
What Is Skin Cancer?
According to the National Cancer Institute, skin cancer is a disease in which cancer (malignant) cells are found in the outer layers of your skin. The purpose of your skin is to protect your body against heat, light, infection, and injury. It also stores water, fat, and vitamin D. Melanocytes are found in the epidermis and they contain melanin, which gives the skin its color. The skin has two main layers and several kinds of cells. Skin cancer can occur anywhere on your body, but it is most common in places that have been exposed to more sunlight, such as your face, neck, hands, and arms. Skin cancer can look many different ways. The most common sign of skin cancer is a change on the skin, such as a growth or a sore that won’t heal. Sometime there may be a small lump. This lump can be smooth, shiny and waxy looking, or it can be red or reddish brown. Skin cancer may also appear as a flat red spot that is rough or scaly. Not all changes in your skin are cancer, but you should see your doctor if you notice changes in your skin.
The top layer of skin is called the epidermis. It contains three kinds of cells: flat, scaly cells on the surface called squamous cells; round cells called basal cells; and cells called melanocytes. The three most common skin cancers are: squamous cell carcinoma, basal cell carcinoma, and malignant melanoma:
- Squamous Cell Carcinoma. This presents as a firm irregular fleshy growth usually on sun exposed skin. The growth can increase rapidly in size giving rise to a large lump that may sometimes break down to form an ulcer. If untreated, the cancer may spread to the surrounding lymph glands. Squamous Cell Carcinoma usually appears in elderly patients. Chronic sun exposure is an important contributing factor in the development of this type of skin cancer. –
- Basal Cell Carcinoma. This is a slow growing painless skin cancer. The cancer often presents as an indolent ulcer with a shiny or translucent raised margin. The ulcer is often pigmented. This cancer commonly appears on the face. –
- Malignant Melanoma.This is a cancer of the pigment cells of the skin. It is a highly malignant skin cancer. It presents as dark brown or black skin growth or ulcer. It may look like ordinary moles, but unlike the common mole:
– It grows rapidly.
– Its surface has several shades of red, black or blue colors.
– Its margin is irregular.
– It tends to be large.
– It tends to be thick.
Melanoma is a more serious type of cancer than the more common skin cancers, basal cell cancer or squamous cell cancer, which begin in the basal or squamous cells of the epidermis. You should see your doctor if you have any of the following warning signs of melanoma: change in the size, shape, or color of a mole; oozing or bleeding from a mole; or a mole that feels itchy, hard, lumpy, swollen, or tender to the touch.
Melanoma can also appear on the body as a new mole and commonly occurs on the fingers, toes and face. Men most often get melanoma on the trunk (the area of the body between the shoulders and hips) or on the head or neck; women most often get melanoma on the arms and legs. The Cancer Information Service states melanoma is 100 percent curable if treated prior to the onset of the vertical growth phase with its metastatic potential. For example, in Queensland, Australia, which has the highest incidence of melanoma in the world, the overall survival rate for 1,187 patients was greater than 82 percent. (Source: National Cancer Institute)
What Causes Skin Cancer?
Sunburn and Sunlight
Overexposure to the sun can led to sunburn and the ultraviolet (UV) light has the potential to damage your skin and induce skin cancer. Other factors increasing your risk are heredity and the environment you live in. However, the total amount of sun received over the years, and overexposure resulting in sunburn is what causes skin cancer. By the time most people are 18 years old, they will have received 80 percent of their lifetime exposure to the sun. The bottom line for parents is to make sure to protect your children! Your skin’s protective reaction to prevent further injury from the sun’s UV rays is tanning. However, it does not prevent skin cancer; skin cancer is very slow to develop. The sunburn you receive this week may take 20 years or more to become skin cancer. If there is a history of skin cancer in your family, you are probably at a higher risk.
People with fair skin or with a northern European heritage appear to be most susceptible, but do not think you are not at risk if this does not describe you!
The level of UV light today is higher than it was 50 or 100 years ago. This is due to a reduction of ozone in the earth’s atmosphere (the Ozone Hole). Ozone serves as a filter to screen out and reduce the amount of UV light that we are exposed to. With less atmospheric ozone, a higher level of UV light reaches the earth’s surface. Other influencing factors include elevation, latitude, and cloud cover. UV light is stronger as elevation increases. The thinner atmosphere at higher altitudes cannot filter UV as effectively as it can at sea level. The rays of the sun are also strongest near the equator, as you might guess. One factor that actually reduces UV light exposure is cloud cover. Climates with regular cloud cover may have a 50% lower level of UV light and the density of the clouds affects the actual amount.
How Can I determine My Personal Risk?
An estimated 1 out of 7 people in the United States will develop some form of skin cancer during their lifetime and it only takes one serious sunburn to increase the risk by an alarming 50 percent; more to think about while you enjoy the sun. The effect UV light has on your skin is dependent both upon the intensity and the duration of your exposure. How your skin reacts to the amount of exposure received is related to your genetic background. Even if you rarely sunburn, sensitive areas such as your lips, nose, and palms of the hands should be protected. Individuals with moderate freckling have a two- to three-fold risk of developing melanoma.
The following is a list of categories to help you figure out your particular skin type:
|Always burns, never tans, sensitive
|Burns easily, tans minimally
|Burns moderately, tans gradually to light brown
|Burns minimally, always tans well to moderately brown
|Rarely burns, tans profusely to dark
|Never burns, deeply pigmented, not sensitive
(Source: American Academy of Dermatology)
Precautions That Will Reduce Your Risk
“Skin cancer is one of the few diseases which can be minimized if people protect themselves from the sun,.” said Dr. Lynn Drake, President, American Academy of Dermatology (AAD).
Eighty four percent of the people in a recent survey thought they only need to use sunscreen if they are going to be outside for an extended period of time or when they are participating in activities, such as swimming, boating or playing sports. “The fact is that people need to wear sunscreen every day year-round even on cloudy days, since 80 percent of the sun’s rays can penetrate light clouds, mist and fog,” cautioned Drake. “The skin has a memory, upon which new sun damage builds, that’s why it’s so critical for people to avoid the sun and use sun protection methods, such as sunscreen, every day.”
There is also confusion about who should wear sunscreen. Thirty-five percent of those surveyed believe that only people who burn easily need to use a sunscreen with an SPF of 15 or higher. Certain people do have a higher risk for melanoma including those who burn or blister easily or have fair complexions, a family history of melanoma or more than 200 moles (50 if under age 20). But no one is exempt from the possibility of getting skin cancer. Even people with dark complexions can get a sunburn, which is the most preventable risk factor for skin cancer.
How Do I Protect Myself From The Sun?
The AAD is the world’s largest organization of dermatologists representing 11,500 physicians who are experts in treating skin, hair and nails. The AAD recommends that regardless of skin type, people spending time in the sun should use a sunscreen year-round, choosing a broad-spectrum sunscreen that protects the skin from both UVA and UVB rays, and has a SPF of at least 15.
The AAD also recommends the following measures be taken to help protect you from the sun:
- Wear a wide-brimmed hat, sunglasses that block UVA and UVB rays and protective clothing. Dark, tightly woven clothes are the best as they filter out the sun and reflect heat to keep you feeling cool.
- While 76 percent of the people who responded to the American Academy of Dermatology’s survey say they wear sunglasses, less than half (43 percent) wear protective clothing, and only slightly more than one-third (36 percent) wear a wide-brimmed hat.
- Avoid the midday sun, especially between the hours of 10 a.m. and 4 p.m. when the sun’s rays are strongest. Only 35 percent of survey respondents claim to avoid the sun during these hours of the day. Be especially careful near reflective surfaces such as sand, concrete, water or snow. These surfaces can reflect up to 85 percent of the sun’s damaging rays.
If you live in or plan to visit an area with high altitudes or tropical climates, consider using a sunscreen with a higher SPF as solar radiation in these environments is more intense. Certain drugs and herbs (for example, birth control pills, Prozac, and St. John’s Wort) can make skin more sensitive to the sun’s ultraviolet rays. If you or your child is taking any medication, talk with your doctor or pharmacist to determine if special sun safety precautions are necessary. To prevent sun damage to the delicate skin of infants up to six months old, keep them out of direct sunlight. Do not apply sunscreen to infants under six months. After six months of age, use a sunscreen made especially for a baby’s sensitive skin. Infants should also always wear a hat whenever they are outdoors.
Reapply sunscreen every two hours, even on cloudy days. Also reapply after swimming or perspiring. Stay in the shade whenever possible. Avoid tanning beds. Tanning booths emit high doses of UVA, which can reduce the skin’s natural ability to fight melanoma, the most dangerous type of skin cancer. According to the Canadian Dermatology Association, “Without proper protection, such as eye goggles usually provided by the tanning salon, overexposure can harm the retina and cornea. Long-term use of tanning machines may lead to cataracts.” And finally, according to the Mayo Clinic, “The bottom line is that you should prevent ultraviolet skin damage by avoiding excessive exposure and using sunscreens of at least moderate SPF strength. Avoid tanning salons — they are not safe. There is no such thing as a healthy tan.”
The best defense against skin cancer is to completely protect yourself from the damaging and harmful ultraviolet rays of the sun. Often, through early detection, most skin cancers (including melanoma) can be cured. The AAD urges everyone to examine his or her skin regularly. Regularly examine your entire body including your back, your scalp, the soles of your feet, between your toes, even the palms of your hands. Remember if you notice any changes in the size, color, shape or textures of a mole or any other unusual changes in the texture of your skin, see your dermatologist or personal physician immediately.
Isn’t it ironic that what we consider to be attractive today — a glowing tan — was once the sign of a common laborer and looked down upon? Pale skin was a status symbol that indicated you were a member of the leisure upper class while darker skin indicated a life of outdoor labor. The paler one’s skin, the higher the class, and men and women went to great lengths to be pale. However around the 1900s, the tan became a sign of wealth and status. According to recent polls, 70 percent of people surveyed indicated they felt better about themselves with a tan. After reading this article, there’s just one more question: Is the fun in the sun worth the price you will most likely pay later?
For more information related to sun safety and melanoma, please check out the following information sources:
American Academy of Dermatology: Cancer Information Service at 1-800-4-CANCER (1-800-422-6237)
American Academy of Dermatology
Coppertone tanning products
National Toxicology Program Advisory Group
Vanderbilt University Psychology Department
Rob Wilkins is a Technical Sergeant in the US Air Force stationed at Patrick Air Force Base, Florida. Wilkins is also a Special Assistant to the International Federation of Bodybuilders (IFBB) and a recipient of the IFBB Gold Medal (Oct ’00). To contact Wilkins e-mail him at [email protected].