Doctors warn against exposure to summer sun

Ah, summer.

Memorial Day often marks the start of longer days, vacations, relaxed schedules and sun-kissed skin.

The latter may more accurately be described as a “pre-cancerous glow,” according to Dr. Lance Henry of Advanced Dermatology and Skin Cancer Center in Fayetteville.

“That’s a good way to look at it,” Henry said. “A tan is damaged skin.”

Unfortunately, that damage can, in some cases, be fatal.

While skin cancer is often treatable and mortality rates have improved, melanoma can still be deadly. The American Cancer Society estimates that 9,180 Americans will die this year of melanoma. They anticipate 76,250 new cases will be diagnosed in this country alone. And it’s a disease that is claiming victims at ever-younger ages
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Researchers at the Mayo Clinic announced study results in April that showed the incidence of melanoma, the most deadly form of skin cancer, has increased sharply over the last several years, with young women being the hardest hit. Researchers suspect the culprit is the increased use of tanning beds and adolescent sunburns among girls.

The population-based study used records from the Rochester Epidemiology Project, a decades-long database of all patient care in Olmsted County, Minn. Mayo researchers looked for first-time diagnoses of melanoma in patients aged 18 to 39 from 1970 to 2009. Melanoma rates increased eightfold among young women over the course of those years and fourfold among young men. And while men are typically at higher-risk for developing melanoma over their lifetime, in those younger years, female risk is much higher. Results of the study, funded in part by the National Institutes of Health, were published in the April issue of Mayo Clinic Proceedings.

“It’s an epidemic of skin cancer,” Henry said. “Without a doubt, I see lots of sun damage: sunburns, tans, skin cancers.” Henry does more than 1,000 skin cancer surgeries a year from his Fayetteville clinic.

There’s really no safe sun exposure, the doctor said. “What I do every day is cut off people’s body parts and soft tissue, usually on their face,” Henry said, “a piece of nose, ear, eyelid.”

Nonmelanoma cancer is also caused by ultraviolet exposure and is the most common type of cancer, according to the National Cancer Institute. More than 1 million people annually are diagnosed with nonmelanoma cancer. Unlike melanoma, it rarely spreads to other parts of the body and, if detected early, is treatable and has excellent survival rates.Despite the high numbers of diagnosed skin cancers, many people – especially adolescent girls and young women – continue to tan, especially in tanning beds, helping the indoor tanning industry earn an estimated $5 billion annually.

“Its effects are delayed on the order of decades,” said Henry, who compared sun damage to obesity in which people don’t immediately see the internal damage being done to their bodies. “It may not harm them today. The sun is the same thing. You’re not going to wake up with skin cancer next week (from today’s burn), next month, maybe not next year.”

Not seeing immediate damage is one reason teen-agers continue to use tanning beds, Henry said, in addition to the youthful feeling of invincibility.

“Unfortunately, with the use of tanning beds, we’re seeing more and more young people with skin cancer,” he said. “It’s very dangerous.”

Arkansas is one of 31 states with legislation limiting the use of tanning beds for minors. State law requires tanning facilities to get parental consent before allowing anyone under 18 to use the tanning beds. Act 707 requires parents to sign that they’ve read a warning describing the dangers of UV exposure in the presence of the tanning operator.

Dr. Julia Gregory, a pediatrician at UAMS Centers for Children in Lowell, said of tanning beds, “I would not recommend them to anyone ever. It’s not a risk I would recommend anyone take.”

Gregory recommended spray tanning for anyone who insists on that sun-kissed look. She also said people should not rely on a tanning-bed tan to protect them from a burn in the sun.

“I know even if you have even a very good tan, you can still get a very bad burn,” Gregory said. “A big thing we see is teen-agers coming in because they didn’t wear sunscreen and have a bad sunburn.”

Some recent studies have shown many people are deficient in Vitamin D and some reports have said very limited sun exposure – 15 minutes a day unprotected – could curb that deficiency.

“I typically don’t agree with that,” Gregory said. “My feeling about the sun is if you’re going to be out in the sun, be covered (with clothing). If you’re not covered, then be covered in sunscreen.”

The American Academy of Pediatrics recommends children wear sunscreen with an SPF (sun protection factor) of at least 15. Sunscreen isn’t recommended for children from 6 months old to 2 years old, Gregory said, because they should just be out of the sun and always covered.

Henry recommends taking care of any Vitamin D shortfalls with an oral supplement, rather than sun exposure. And he recommends SPF for his clients of 30 every day, along with wide-brimmed hats and lightweight clothes to cover exposed skin.

Parents should look for sunscreens that are offer “broad spectrum” protection, meaning they protect against both UVA and UVB rays. SPF just refers to protection against UVB rays, Gregory said. A new star rating on sunscreens shows the level of protection against UVA rays. One star is bad; four stars is best, she said.

Gregory cautioned that sunscreen also needs to be applied 15 to 30 minutes before going into the sun so it can be absorbed and create that protective barrier. It should be reapplied often, at least every two hours.

Even with all that protection, sun exposure should be limited between peak hours of 10 a.m. and 4 p.m., Gregory said.

Dr. Lawrence J. Schemel, owner of Northwest Arkansas Clinic for Families in Springdale, said, “Be especially careful with kids. Even one blistering sunburn as a kid increases your chances of getting cancer.”

Schemel said he sees the effects of the sun daily in his practice.

“I definitely see a lot of sun-damaged skin that looks old before its time. I see a lot of tumors, both benign and malignant, some on really young people,” Schemel said. “We get people in their 40s showing up with skin cancers that need to be treated.”

Schemel said it’s a misconception that skin cancer is something you only get in old age.

Schemel said he’s not seen in his practice as big of an increase in early skin damage as some studies suggest. The tanning bed craze was already underway when he began practicing 19 years ago, he said, and we do live in a sunny Southern state. But he is seeing more damage earlier to chests and backs and other area that used to not be so exposed. “It used to be more on arms, hands, ears.”

It’s not that people are outside more. In fact, older generations were probably outside more often than today’s young people, but they used to cover up more when they were out in the sun, Schemel said.

Schemel said people should examine themselves, know where their existing moles and marks are, and check them often for changes. Any change in coloration, development of a white ring around a mole, itching or burning, or a mole that come off and grows back should all be seen by a doctor.

“Anything that looks suspicious, go to your doctor,” Schemel said.

Gregory said parents also need to be careful to not damage their children’s eyes. Buying sunglasses based on how cute they are isn’t the best criteria. Many glasses have tinted lenses, which means children don’t have to squint their eyes – an instinctive way people protect their eyes – to avoid the sun’s glare. However, dark lenses don’t always mean the lenses protect against UV rays. Parents need to look for the UV information before purchasing sunglasses for their children, Gregory said.

For additional information, Gregory recommends the sun-safety section at healthychildren.org.