BE SUN SAFE
The Most Common Form Of Cancer
Skin cancer is the cancer most commonly diagnosed in the United States, but it’s also largely preventable by taking some simple steps to protect your skin. This might mean changing ingrained habits, but the steps are easy and relatively inexpensive.
There are more than 2 million new cases of non-melanoma skin cancer in the United States each year. These are the most treatable and account for less than 1,000 deaths. To show just how serious melanoma is, there are just over 76,000 cases in a given year, yet it leads to over 9,710 deaths.
Personal factors, like having fair skin and light eyes and a family history of skin cancer, do add to your risk, but sun exposure, especially deliberate tanning, is the overwhelming cause for most cases of skin cancer.
UV or ultraviolet radiation is the source of the problem. The sun emits UV light, as do some manmade lights, typically the kind used in tanning booths and beds. UV exposure stimulates your melanocytes, the cells in your skin that produce melanin, the pigment that changes your skin color, typically resulting in a tan or in a sunburn. Even though we’ve come to associate a tan with a “healthy” appearance, both a tan and a burn have the same negative effects: damage to the skin cells and the DNA within those cells that can lead to cancer.
Contrary to many tanning parlor claims, these lights are not “safer” than the sun, and the younger you are when you start using them, the greater your lifelong skin cancer risk since UV damage is cumulative. The World Health Organization classifies indoor tanning devices as carcinogens because of their link to the increased risk of skin cancer. Recent research estimates that, in the US alone, more than 400,000 cases of skin cancer, from basal cell carcinomas to melanomas, may be related to indoor tanning.
There are actually two types of UV radiation that damage skin and can lead to skin cancer, UVA and UVB. UVA rays penetrate the skin most deeply and do the most visual damage—wrinkles, loss of elasticity and sagging. UVA also worsens the effects of UVB, the rays that lead to sunburn.
There are several types of skin cancer that start in different skin tissues and present different health risks.
This is the most dangerous type of skin cancer. It forms in the skin’s melanocytes and may start in a mole or another pigmented tissue, such as an eye or even the intestines. A melanoma develops when the damage to skin cells triggers mutations, causing cells to multiply rapidly and form tumors. If diagnosed and treated early on, melanoma is almost always curable. But if not, it can grow and spread to other parts of the body, becoming hard to treat and possibly fatal.
Melanoma is caused mainly by the kind of intense, occasional UV exposure that often leads to a sunburn, especially in those who are genetically predisposed to the disease. The growths are typically irregular and black, brown or a mix, but can be pink, red, purple, blue, white or skin-toned. Unusual, or atypical, moles called dysplastic nevi sometimes look like melanoma. They’re usually benign (non-cancerous), but having a lot of them seems to increase melanoma risk, and the more of these moles you have, the higher the risk. For instance, people with 10 or more have 12 times the risk of the general population. And if you have both dysplastic nevi and a family history of melanoma (that means two or more close blood relatives with the disease), you have an extremely high risk of developing melanoma yourself.
It’s important to monitor dysplastic nevi just as you should all skin growths. Taking photographs of them will make it easier for you and your doctor to identify any changes to them over time. If you have many dysplastic nevi, your doctor may advise an in-office skin exam once or twice a year. If you also have a family history of melanoma, more frequent skin exams, such as every 3 to 6 months, might be needed.
Often the first sign of melanoma is a change in the shape, color, size or feel of an existing mole, according to the National Cancer Institute, though it can also be a new colored area on the skin.
If you notice any of these characteristics, get an exam from your primary healthcare provider or dermatologist:
Asymmetry. The shape of one half of the growth doesn’t match the other half.
Border that is irregular. The growth’s edges are ragged, notched or blurry. The pigment may spread into the surrounding skin.
Color that is uneven. Be suspicious if a growth has various shades of black, brown and tan; you may see white, gray, red, pink or blue areas as well.
Diameter. Look for a change in mole size, usually an increase. Melanomas can be tiny, but most are larger than ¼” wide.
Evolving. Watch for any mole that changes over a few weeks or months.
Basal Cell Carcinomas
Most skin cancers are basal cell cancers. They form in the outer layer of the skin and are often the result of a combination of cumulative UV exposure and more intense occasional exposures. Only in very rare cases will this cancer spread beyond the original tumor site to other parts of the body and become life-threatening, but it can be very disfiguring. A basal cell cancer’s appearance can vary considerably. Look for signs such as:
- A persistent open sore that might bleed or ooze, crust over, heal and then open and bleed again.
- A reddened or irritated patch of skin that may or may not bother you.
- A bump that’s pearly or translucent pink, red, white, tan, black or brown.
- A pink growth with a slightly raised border and a crusted indentation in the center.
- A white, yellow or waxy area that looks like a scar with poorly defined borders and skin that looks shiny and taut.
Squamous Cell Carcinoma
Squamous cell cancers form in the flat cells that make up the skin surface, the squamous cells. This type of skin cancer often looks like a scaly red patch, an open sore, an elevated growth with a central depression or a wart. It may crust, itch or bleed. Squamous cell skin cancer is mainly from UV exposure over the course of a lifetime. It can appear anywhere on the body, but is most common on areas that suffer frequent sun exposure and show sun damage like wrinkles, spots and actinic keratoses (see the next section). Vulnerable areas include the rim of the ear, the lower lip, face, a bald scalp, neck, hands, arms and legs.
Actinic Keratoses: Pre-Cancers
These scaly or crusty growths usually appear on areas of the body frequently exposed to the sun, such as a bald scalp, face, ears, lips, backs of the hands and forearms, shoulders and neck.
At first, they can be so small that you feel rather than see them. They typically develop slowly, reaching between a 1/8″ and ¼”. Most become red, but may be light or dark tan, pink, red, a combination of colors or even the same color as your skin. Occasionally they itch, feel prickly or tender or become inflamed.
Actinic keratoses indicate sun damage and a greater likelihood of developing any kind of skin cancer. Some experts view them as the earliest stage of squamous cell cancer.
You may be surprised to learn that up to 10 percent of all skin cancers occur on the eyelids, primarily the lower lids, which get the least protection. Though few cases are deadly, these cancers can cause tissue damage and blindness. They can also spread behind the eye.
Eyelid tumors often grow under the skin for years before you can see them on the skin surface. Early warning signs include a persistent lump or bump that frequently bleeds, persistent red eye or inflammation of the eyelids, flat or elevated pigmented lesions with irregular borders and an unexplained loss of eyelashes.
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Avoiding all exposure to the sun isn’t realistic or even a wise idea since a lack of exposure to light can lead to depression, and enjoying outdoor activities is good for the body as well as the mind. The key is sun protection.
Sunscreen: Start With This Skin Cancer Protection Essential
Everyone over six months of age needs daily sun protection (babies under six months shouldn’t be exposed to the sun because their skin is too sensitive to both the sun and the ingredients in sunscreen—they need shade).
Many skin preparations labeled with an SPF 15, from moisturizer to aftershave to makeup, contain enough sun protection for your face for casual outdoor exposure, like going in and out of your home to your car and office (know that windows in buildings don’t filter UVA rays). However, if you work or exercise outside, are going sightseeing or just having lunch at an outdoor café, you need a dedicated sun protection product. And this is true even on cloudy days, when up to 40 percent of the sun’s UV rays still get through.
While sunscreens are the starting point in serious sun protection, it’s important to realize that all products aren’t the same and that even the best product will need to be reapplied if you’re outdoors for more than two hours and even more frequently if you get wet.
Understanding SPF numbers. The SPF, or Sun Protection Factor, of a sunscreen is a guideline that tells you how long it should protect you from UVB, the rays that burn. A product with SPF 15 is the minimum you should use. The theory is that it will keep you from burning 15 times longer than it would take you to burn unprotected, which is roughly 20 minutes. That would equal about 5 hours under ideal circumstances, meaning that you aren’t sweating or swimming, both of which will shorten that time frame. The truth is though that the protection rarely lasts that long. In fact, the FDA has ruled that test results proving staying power must be submitted before a product can claim it provides sun protection for more than two hours.
The more fair-skinned you are, the more easily you’re likely to burn—for some, that’s after just 5 minutes, so a higher SPF, like 30 or 50, is a better choice. It’s also a must for anyone planning on being outside for an extended period of time.
On the other hand, sunscreens higher than SPF 50 may not offer any better protection than SPF 30 to 50. According to the Environmental Working Group (EWG), SPF 100 doesn’t offer twice the protection of SPF 50. In fact, it blocks merely 1% more of the burning rays—99% vs. 98%—than SPF 50 and may also lead to a false sense of security, that you can stay in the sun longer without damaging and that you don’t need to reapply it during the day, both of which are false.
Sunscreen products filter higher amounts of damaging UVB rays, but guarding against a burn is only part of the protection you need. You also want a product that screens out UVA rays. Such products are labeled “broad-spectrum.” Broad-spectrum sunscreens with SPF 15 or higher are able to state specific verbiage: “If used as directed with other sun protection measures, this product reduces the risk of skin cancer and early skin aging, as well as helps prevent sunburn.”
However, even if the label says broad-spectrum, sunscreens with SPF of between only 2 to 14 have not been shown to help prevent skin cancer or early skin aging and must display this fact as a warning.
Look for key ingredients. The idea behind sunscreens is to put a shield between your skin and the sun. Some formulas contain chemicals that absorb rays while others have barrier agents that repel them.
Better sunscreens combine several active chemical and physical sunscreen ingredients to give you that broad-spectrum protection. A typical mix may include PABA derivatives, salicylates, and/or cinnamates like octylmethoxycinnamate and cinoxate for UVB rays; benzophenones like oxybenzone and sulisobenzone for shorter-wavelength UVA rays; and avobenzone, ecamsule, titanium dioxide or zinc oxide for the remaining UVA spectrum. Titanium dioxide and zinc oxide are minerals considered physical barriers, and some people find that they are less irritating to skin than chemicals. These ingredients used to be heavy formulations that went on like a white coating, but today they are refined and go on almost invisibly.
While there is a broad range of sunscreen products approved for consumers, there are concerns about some of the chemicals. The Environmental Working Group, a watchdog agency, reports that oxybenzone in particular penetrates the skin, gets into the bloodstream and acts like estrogen in the body. It can trigger allergic reactions and, more worrisome, early studies suggest a link between higher concentrations of oxybenzone and health issues, like giving birth to lower birth weight daughters and, in older women, endometriosis. Unfortunately oxybenzone is in the majority of products.
To see the brands that meet the EWG’s criteria, including products with newer sunscreen agents, visit http://www.ewg.org/2014sunscreen/best-sunscreens/best-beach-sport-sunscreens/
Other product cautions. The EWG and other organizations have expressed concern over aerosol spray sunscreens. Though easy to apply, they may pose health risks from unintended inhalation. The FDA is looking at both their effectiveness and their safety. Opt for lotions or pump bottles, a safer way to spray. If you have no other options available, apply spray sunscreen outside, keeping your eyes and mouth closed. Spray it on a hand to apply to your face.
The FDA is also evaluating sunscreen wipes, powders and towelettes—none of which appear to have the effectiveness of regular products and, for the powders, seem to pose inhalation risks of their own. The EWG suggests avoiding them.
How much is enough. Another possible problem with a spray is that you might actually miss patches of skin. The ideal amount of protection involves applying one full ounce (the volume of a shot glass) over your entire body. Note that rays can penetrate some regular clothing, so apply all over–before you get into your swimsuit. Chemical sunscreens need to be applied 30 minutes before sun exposure to allow the ingredients to fully bind to the skin.
Reapplication tips. Reapplying sunscreen is as important as putting it on in the first place. Reapply that full ounce of product every two hours as well as immediately after swimming, toweling off or sweating a great deal. The Skin Cancer Foundation points out that for a full day at the beach, you’ll need to allot, about half of an 8-ounce bottle of sunscreen for each person.
Because of changes in FDA rulings the terms “sweatproof” and “waterproof” are no longer allowed on sunscreen labels because sunscreens will come off. The question is how fast. Sunscreens may be labeled “water-resistant,” in which case the product must specify whether testing showed it lasts for 40 or 80 minutes of swimming or sweating.
Next Step: Sunglasses
Your best defense against eyelid cancer (and other eye damage) is to wear sunglasses with lenses that block UV rays and to wear them year-round, even on overcast days.
While style is a factor for most people, function is key. Select from sunglasses that offer these lens features:
- Lenses that absorb and block 99 to 100 percent of UVA and UVB light and, if possible, protect against HEV light. HEV, or high-energy visible, light is high-frequency light in the violet/blue band and is a cause of age-related macular degeneration.
- Lenses big enough to shield your eyes, eyelids and surrounding skin. Look for wraparound styles with a close fit and UV-protective side shields.
- Lenses that meet ANSI and/or ISO standards for traffic signal recognition (strong color recognition) and are impact-resistant.
- Polarized lenses, which means that they eliminate glare when used while driving, in the snow and on the water.
Regular clothing can offer some protection from rays, and the more skin you cover, the better. Think long pants and long-sleeved shirts with a high neckline or collar to protect the back of the neck and a hat with a 3” or wider brim all around to block up to half of all UVB rays from eyes and eyelids.
However, you can greatly improve the degree of protection with clothes specifically designed for this job.
UPF: clothing’s sun protection indicator. Look for clothing branded with a UPF or Ultraviolet Protection Factor number, which lets you know what fraction of the sun’s ultraviolet rays can penetrate the fabric. For example, clothing with UPF 50 lets in just 1/50th of the sun’s UV radiation.
Clothing lines like Coolibar and Solumbra offer a variety of protective clothing for various activities, like swim shirts and rash guards that cover your upper body and leg guards for your lower body, yet are comfortable to swim in.
Some regular clothes in your closet offer UV protection for work and everyday wear:
- Tightly woven or closely knitted fabrics with smaller holes between the threads, like denim and wool
- Synthetic fabrics such as polyester and rayon
- Heavier, denser fabrics such as corduroy and velvet
- Glossy fabrics, like heavy satin, that deflect rays
- Dark or bright colors, like red or black, that absorb rays
Love the feel of natural cotton? The Skin Cancer Foundation suggests washing new cotton and cotton blend clothes two or three times before wearing to purposely shrink the spaces between the fibers, effectively raising their UPF protection.
A study published in the Journal of the American Academy of Dermatology found that nearly 53 percent of skin cancers in the US occur on the left—the driver’s—side of the body, meaning they could be related to UV exposure when you’re in your car.
Particularly vulnerable are your head and neck; next are the arms. In addition to applying sunscreen, follow these sun protection steps:
- Avoid riding/driving in a convertible with the top off or with an open sunroof; close the sunroof shield during daytime driving.
- Whether you’re the driver or a passenger, avoid resting your arm on an open window.
- Consider having transparent window film applied to your car windows. While windshields are partially treated to filter out UVA, side windows let in about 63 percent of this radiation. Rear windows are unprotected, too, leaving back seat passengers exposed. Specially treated window film screens out nearly 100% of UV rays without affecting visibility. Remember that the protection is there only when the car windows are closed.
Finally, lower your overall skin cancer risk by avoiding direct sun exposure during the brightness hours of the day, typically between 10 am and 4 pm. Outdoors, look for shady areas or sit under an umbrella with UV protection.
© 2005 Illustration, Bascove. All rights reserved
Illustrations may not be reproduced in any form without the express consent of Self chec, Inc.
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