Dermatologists Advises—

There Is No Such Thing As A Healthy Tan

 By Kaaren Valenta

Each year about one million people in the United States learn that they have skin cancer. And while the majority of skin cancers are easily treated, and have good outcomes, almost 10,000 people died from skin cancers last year.

“The risk of having skin cancer has easily doubled and tripled over the last few decades,” dermatologist Grace Ling Federman said. “It wasn’t until the decades between the 1950s and 70s that tanning became desirable. That lag time is what we are seeing as cancers appear now.”

Dr Federman, who lives in Newtown, is associated with Advanced Dermcare, PC, of Danbury, Southbury, and Ridgefield. She presented a program about skin cancers, treatments, and how to protect skin from aging at a meeting sponsored by the St Rose Parish Nurse Ministry last week.

Most people really are not aware of how damaging exposure to the sun can be, Dr Federman said.

“Freckles are a sign of unprotected sun exposure. You don’t get freckles on your bottom, or anywhere the sun doesn’t shine,” she said. “If you look at a picture of a red-headed kid with freckles, that’s sun damage. He wouldn’t have [freckles] if he lived in a cave.”

Similarly, the brown spots that many older people refer to as liver spots or age spots also are really sun damage. “Look at the other side of your arm. The underarm does not have these spots,” she pointed out.

The accumulation of sun damage over the years can lead to cell changes that cause skin cancer, the most common type of cancer in the United States. Skin cancers fall into two broad areas: nonmelanoma skin cancer (basal-cell cancer and squamous-cell cancer), and melanoma.

Basal-cell and squamous-cell carcinomas are the most common type of skin cancers. Basal cell are small skin tumors that might look like nothing more than an odd bump. “They often start to bleed spontaneously, then heal over, then bleed again,” Dr Federman said. “They can also spread. The big ones are obvious. The scary ones are the little tiny ones. They are the ones you want to find.”

Squamous-cell skin cancers are more aggressive. “They grow faster and can spread to the lymph nodes,” Dr Federman said. “They are often found on the lips, caused by sun damage or smoking, and if they travel along the nerves, they can go much deeper. They are much more common in Caucasians because fairer skin is more at risk. And they are 200 times more common on the head than on the trunk. “

Researchers now believe that people may be more at risk for skin cancer if they get sunburned repeatedly on vacations than if they have outdoor jobs where they usually work in the sun.

“There may be more risk with repeated sunburns than with chronic everyday exposure,” Dr Federman said. “Every blistering sunburn doubles the risk for melanoma.”

Melanoma, the deadliest form of skin cancer, is the seventh most common cancer in the United States, and is increasing at faster rates than any other cancer. According to the National Cancer Institute (NCI), current estimates predict that one in 75 Americans will develop melanoma during his or her lifetime. In 1960, only one in 600 Americans was expected to develop this cancer. Now more than 7,000 people die from it each year.

Melanomas usually start in nevi, or moles, on the skin and can occur anywhere on the body. “Use an A,B,C,D guideline to do a self-examination for this type of skin cancer,” Dr Federman said. “Is the mole asymmetrical? Are the borders irregular? Is the color variegated or has it changed? And is the diameter greater than six millimeters, about the size of a pencil eraser?”

A raised mole is not necessarily at risk for melanoma, she said. “Elevation is not a distinguishing feature. Melanoma can be flat or raised. People are more at risk for melanoma if they have a first-degree relative with melanoma, or if they have a lot of basal and squamous cancers.”

The thickness of the melanoma reflects the diagnosis, she said. “The thicker, the more aggressive it is,” she said.

While nonmelanoma skin cancers generally are slow growing, more easily treated, and rarely lead to death, they can grow large enough to be disfiguring and can spread. Squamous-cell cancers now cause an estimated 2,200 deaths in the United States yearly, according to the NCI.

“The standard treatment for skin cancer is still surgery — cutting it out,” Dr Federman said.

Other treatments depend upon the stage that the cancer is in when it is diagnosed. These treatments can include chemotherapy, including creams with chemotherapy, therapy that stimulates the immune system, and light treatment. “Radiation is far down the list,” Dr Federman said.

Early detection is the key to curing skin cancer but prevention is still the best choice, she said.

“There is no such thing as a healthy tan. This is a hard thing to convince people in the United States. Sometimes I have patients ask if it’s okay to do a little tanning, like at the tanning salons. That’s like asking if it’s okay to one or two cigarettes a day instead of two packs. As a physician, I can’t recommend it.”

Dr Federman said the best way to get a tan is to use topical tanning creams.

“These chemicals just stain the top layer of skin and seem to be safe,” she said. “Or there is now spray-on tanning at tanning salons. These tans look more natural, and you are not increasing the risk of skin cancer.”

It is important to use sun blocks, even in the winter, because the ultraviolet rays from the sun hit the skin all year around.

“For many years sunscreen with 15 SPF was the criteria because it offered 94 percent protection,” Dr Federman said. “But this is true only if it applied like it was in the lab for the test. It has to be used in a perfect manner — two ounces on the whole body. That’s like one-fifth of the bottle and it has to be reapplied every two hours. You’d need to bring cases of sun block to the beach to protect your family. So [dermatologists] upped the number and most now recommend sun blocks with 30 SPF or higher.”

Sun blocks with zinc and titanium oxide also are available and are no longer the white, pasty, formulas that lifeguards used to use on their faces. Now these products have microfine particles that look more natural on the skin.

“And don’t forget to wear sunglasses to protect damage to eyes that can cause cataracts,” Dr Federman said.

Everyone should get annual skin cancer screenings at age 40, she said. Persons who are at risk should get them even earlier.

There is a simple saying that that dermatologists use when talking about skin cancer, she said.

“See spot. See spot change. See a determologist.”