Skin Care Prevention: Be wary of sun

ALBANY -- Southwest Georgians tend to have a love/hate relationship with the sun during the summertime. On one hand, the days are long and pleasant and many people return from their weekends and vacations with the familiar brown glow that has become an important aspect of personal appearance.

But on the other hand, the heat can be unbearable and that pleasant brown glow is often preceded by bright red skin, blisters, and peeling. The desire to be beach-bronze can lead to extreme behaviors such as excessive tanning in tanning beds and lying out in the sun, unprotected, for hours on end.

This compulsion to achieve the perfect tan has even led to an obsessive condition known as tanorexia which compels people to tan constantly, both in the sun and in tanning beds.

Dr. Joshua Lane of Lane Dermatology in Columbus said he believes tanorexia is a very real condition that stems from the pleasant feeling that sunshine provides and because most "everyone likes to be tan." But what price are we willing to pay for beauty?

Exposing skin to the sun's harsh UV radiation without protection can lead to the development of abnormalities in both surface and deep skin cells. These abnormalities can sometimes develop into cancer cells.

Skin cancers are divided into different classifications depending upon the depth of the cancer in the epidermis, which is the outermost layer of skin. Squamous and basal cell carcinomas are the two most common forms of skin cancer and are found in the outer layers of the epidermis. Because of their proximity to the surface, these cancers are more easily removed.

Melanoma, however, is found deeper within the epidermis and, in severe cases, can lead to further illness or even death. The Centers for Disease Control and Prevention reported 8,441 deaths from melanoma in 2006.

Although the two most common forms of skin cancer can be caused by frequent small doses of exposure, Lane warns that "melanoma can come from a few severe sunburns. Say you're 17 and you go to the beach for Spring Break and get fried. That makes you more at risk."

As Southwest Health District Health Director Dr. Jaqueline Grant said, "... (M)elanoma, the third most common [skin cancer], is more dangerous, especially among young people."

But according to the CDC, also in 2006, "Only 43 percent of young adults aged 18-24 used one or more sun protective methods, whereas 58 percent of those 25 years of age and older reported using one or more methods."

This statistic shows that less than half of the group surveyed actually take proactive measures to prevent sun damage, a fact that has led the CDC to begin a program known as the Sun Safety for America's Youth Toolkit, which seeks to educate children and young adults about sun safety in order to lower both the incidence of skin cancers and the mortality rate that results.

For more information on this program, see www.cdc.gov.

There is a widely-held belief that skin cancer risks are lessened by visiting tanning beds, rather than tanning outdoors, but this notion is false because the damaging ultraviolet radiation from the sun is also present in tanning beds and tanning lamps.

This should set off warning bells for those who tan indoors, but the unprotected tanning bed visits continue despite the risks. Lane said that visits to the "tanning bed almost guarantee skin cancer" and that outdoor tanning, even with sunscreen, is unsafe because "there is no safe tan. A tan means that the sunscreen didn't work."

It is important for young people who tan regularly, both indoors and out, to know that "... [the] risk of skin cancer is related to your lifetime exposure to UV radiation" and that the "... damage you do at an early age may not show up for years," said Grant.

Likewise, the CDC stated that, "Research shows that ... skin cancers can be prevented if people are protected from UV light"

Dr. Melinda Greenfield of the Albany Dermatology Clinic said that there are common risk factors that make certain people more susceptible to skin cancers, including fair skin, extended sun exposure and family or personal histories of skin cancer.

Greenfield said that those who are "fair-complected have less protection" from sun damage because of less pigment in their skin.

Also, the National Cancer Institute warned that those who are undergoing radiation therapy, have chronic skin conditions or suppressed immune function are more likely to contract skin cancer. Awareness of these risk factors should encourage those at higher risk to take more precautions with regard to sun safety.

Should skin cancer still develop, there are several effective treatment options. Lane explained that some topical creams are effective, as are excision (surgical removal under local anesthetic) and radiation therapy, but Mohs micrographic surgery (named after surgeon Frederic Mohs, who developed the procedure) has proven to be the most effective for the less severe forms of skin cancer.

With this method, the surgeon removes the affected area with a scalpel or a sharp, round instrument known as a curette and immediately checks for cancerous cells under a microscope. The process is then repeated until all of the cancerous cells have been removed. Greenfield said that Mohs is the most effective "for basal and squamous [carcinomas] especially in the head and neck areas and in recurrent cases".

For melanoma, however, excision, or complete removal of the affected area, is required. With a total surgical removal, there is sometimes scarring, though Greenfield emphasized the fact that "it depends on the size and the location of the cancer."

Lane said that "most [skin cancer removal] surgeries have a 99 percent cure rate, making skin cancer treatments highly effective, but Greenfield said, "It is very important to catch it early."

Prevention of sun damage is simple but requires careful and constant limitations of exposure to damaging ultraviolet rays. In the late spring and summer, especially, many people are outdoors in bathing suits and exposing skin that is normally protected by clothing. This can lead to accidental, but still damaging, sunburns.

The most obvious method to avoid sunburn is to simply seek shade. Also, by just wearing clothing (hats, loose-fitting clothing, bathing suit cover-ups, and sunglasses) to cover up exposed skin, the risks of sunburns and sun damage are drastically reduced. Some companies, such as Coolibar and Solartex, offer clothing that has built-in protection from ultraviolet rays, further decreasing the chances of sunburn.

If this method is unavailable or undesirable, the application of SPF15 and above sunscreen will help to protect exposed skin. Dr. Stuart Goldsmith of Southwest Georgia Dermatology said that the SPF, or sun protection factor, is not the most important thing to consider with sunscreen.

Goldsmith said, "It is not so important to have a high number, but to reapply" as often as possible and "avoid the middle-of-the-day sun" and its damaging rays. He adds, "I think that with some sun-protective efforts and common sense, everybody can have fun outdoors without risk of harm."

Goldsmith recommends using both methods by covering up as much skin as possible and protecting exposed skin with sunscreen in order to achieve the most effective prevention.

Grant warns that "UV rays can damage your skin in just 15 minutes," which is why Goldsmith advocates the frequent reapplication of sunscreen and staying in the shade to effectively lower the likelihood of contracting skin cancer.

For more information about risks and prevention, see www.cancer.gov/cancertopics.