After a winter spent mostly indoors, a sunny day can make almost all of us want to get outside. We feel invigorated and maybe a little too invincible.
The sun is the source of life, but for humans who aren’t aware and who don’t exercise caution, it can be a source of a serious and sometimes deadly disease: skin cancer.
“One in five Americans will develop skin cancer,” says Dr. Todd Cartee, a dermatological surgeon at Penn State Hershey Medical Center.
Skin cancer is the most common of all cancers and accounts for nearly half of all cancers in the United States, according to the American Cancer Society.
There are many types of skin cancer, says Dr. Steve Caplan of Dermatology Associates of York, but the most common are basal cell carcinoma, the least aggressive; squamous cell carcinoma, an infrequent and occasionally aggressive skin cancer; and melanoma, which is less common but very deadly if not caught early. For Caucasians, there is about a one in 75 lifetime risk of getting melanoma, Caplan says.
Skin cancer is caused by the skin’s exposure to ultraviolet rays, either from the sun or a tanning booth or bed, and a person’s genes can make him or her more susceptible to it.
“People who are fair skinned and have a history of frequent blistering sunburns or heavy sun exposure are at increased risk,” says Caplan. “Family history of melanoma and having large numbers of moles are additional risk factors for melanoma,” he adds.
“While everyone is at risk for skin cancer, fair skinned Caucasians have the greatest risk, whereas skin cancer is quite uncommon in those of Indian or African ancestry,” says Cartee.
Skin cancer prevention basically comes down to having minimum exposure to the sun’s rays (or indoor tanning) and wearing clothing and/or sunscreen to protect the skin while in the sun.
But the American lifestyle promotes a different ethos.
“It is unfortunate that our culture emphasizes tanned skin as a symbol of beauty. This is a very recent historical phenomenon and represents the greatest impediment to our skin cancer prevention efforts,” says Cartee.
“It’s the ultraviolet radiation received in our youth that causes skin cancer in old age,” he says.
“Fortunately for our cause, artificial tanning products have greatly improved in recent years and now provide a natural-looking tan without risking your health. Professional spray tan applications available at many spas and salons, while more expensive than at-home options, can give exceptional results,” Cartee says.
Tanning is unhealthy, agrees Caplan, “whether natural or through a tanning booth.”
Cartee goes even further.
“The notion that sunlight is ‘healthy’ remains a popular myth. The only established health benefit of sunlight for people with otherwise normal skin is the generation of Vitamin D. While sunlight is an excellent source of Vitamin D, it is also a known carcinogen. Adequate Vitamin D is easily obtained through inexpensive, safe oral supplements,” he says.
“It is important to note, though, that strict sun protection and avoidance behaviors will put you at risk for Vitamin D deficiency. Diet alone rarely provides sufficient Vitamin D, so oral supplements are often necessary, and you should discuss this with your doctor,” Cartee adds.
A little bit of sun exposure is OK, Caplan says. “Depending on the skin type, 15 minutes three to five times a week should give you the vitamin D required for health. If you are out enough to get a tan, you have had too much sun,” he says.
Cartee tells his patients they can continue to enjoy outdoor activities.
“I still tell [them] to go out and live their lives.Just wear your sunscreen, and if you are going to be outside for a prolonged period—a ballgame, a long bike ride, at the pool—remember to re-apply every two hours. Try to do your yard work early in the morning or late in the afternoon when the sun’s rays are less potent. A wide-brimmed hat, long sleeves and pants also offer great protection during any outdoor activity. And, for heaven’s sake, don’t get in a tanning bed,” Cartee says.
Cartee and Caplan are in whole-hearted agreement about tanning beds.
“Certainly, with the advent of tanning beds, we are seeing more skin cancers in people in their youth, even in their teens or early twenties,” says Caplan.
Because of the link between tanning beds and skin cancer, Cartee says, “there have been successful legislative efforts to prohibit or restrict underage tanning in most states.”
“Studies have demonstrated that tanning bed use increases one’s risk of melanoma by 75 percent. It is widely believed by dermatologists that the dramatic rise in melanoma incidence in recent years among women aged 15-29 is directly attributable to indoor tanning. Just don’t do it,” Cartee stresses.
So, while tanned skin might remain de rigueur with popular entertainment media, Cartee and Caplan suggest people develop a thick skin about the media and peer pressure to darken skin using sunlight or tanning booths.
“Like smoking [and cancer], the linkage between tanning and skin cancer is overwhelming,” emphasizes Caplan.
Sun Screening
A major obstacle in people using sunscreen regularly is how it feels on the skin. The American Academy of Dermatology recommends that an SPF 30 or higher sunscreen be used daily.
Dr. Todd Cartee encourages patients “to try a few different products until you find one you like to use.” Look for ones that say “sheer,” “non-greasy” or “lightweight” on the label. “Sunscreens get more sticky and ‘paste-like’ at higher SPF, so if these features bother you, then stick to products between SPF 30 and 55. Be careful with sprays, he says, because to obtain the labeled protection, you have to spray on a lot more than you think, and you have to rub the product into your skin after spraying.”
Almost all sunscreens found on store shelves today are safe and effective at screening the skin from ultraviolet radiation, says Cartee, including some generic store brands, which were included in a widely circulated Consumer Reports study.
“Contrary to some recent media reports, there is currently no scientific literature demonstrating that any sunscreen ingredient poses any long-term health risks in humans,” says Cartee.
“The key is to find a product that you like to use, will apply regularly, but still fits within your budget,” he says.
“The most effective sunscreen is the one that actually gets applied to the skin.”
Made in the Shade
The Department of Dermatology at Penn State Hershey Medical Center is presenting how you can have “Healthy Skin Made in the Shade” on May 5 at the dermatology clinic. The day will include a free skin cancer screening that takes only a few minutes. Appointments are necessary. Call the CareLine at 1-800-243-1455.
