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Ask the Expert

Skin Cancer Dangers: Sun Exposure, Tanning Beds, and Sun Lamps

Dr. Palestine

With summer quickly approaching, there’s no better time to learn about the dangers of too much exposure to the sun and its ultraviolet (UV) radiation. Over-exposure to the sun and artificial forms of UV radiation are major risk factors for melanoma, a highly malignant form of skin cancer. Dermatologist Dr. Roberta Palestine talks about what you and your children can do to protect yourselves every day.

Can exposure to the sun really cause skin cancer?
Yes, skin cancer rates are increasing and experts believe this is the result of increased exposure to UV radiation from the sun, tanning beds, and sun lamps. More than 1 million new skin cancer cases are likely to be diagnosed in the U.S. this year.

What are the different forms of skin cancer?
There are three main types of skin cancer: Basal cell carcinoma, squamous cell carcinoma, and malignant melanoma. While the two most common skin cancers are basal cell and squamous cell carcinoma, the most serious form of skin cancer is malignant melanoma. Melanoma has the highest death rate of any of the skin cancers. A diagnosis of any form of skin cancer puts an individual at a higher risk for melanoma.

What is melanoma?
Melanoma is a type of cancer that begins in cells called “melanocytes”—cells that produce the brown pigment called melanin. Melanomas often first appear in moles that change in size, shape, color, or feel. The moles may appear to be black or black-blue in color. The appearance of a new mole may also be a sign of melanoma.

How frequently is melanoma diagnosed?
In 2006, more than 62,000 new cases of melanoma were diagnosed in the United States. In women in particular, the occurrence of melanoma is increasing at a faster rate than every other cancer except lung cancer. What’s even more alarming is the increase in the number of children and teenagers who are being diagnosed each year.

How dangerous is melanoma?
Melanoma is the most serious form of skin cancer. If not caught early, melanoma can be fatal. Every hour in the U.S., someone dies from metastatic melanoma. That’s more than 8,000 people every year. The good news is that melanoma is one of the few conditions that are preventable. What’s more, when detected at its earliest stage, surgical removal cures the disease in most cases. That’s why early detection of melanoma is critical.

What are the risk factors for melanoma?
Family history is an important risk factor for melanoma, as are numerous prominent moles and atypical moles. Having had one or more severe sunburns, especially during youth, also increases your chances of developing melanoma. Those of Caucasian ancestry who have fair skin and light hair color are also at increased risk.

According to the American Academy of Dermatology, the U.S. Department of Health & Human Services has declared ultraviolet (UV) radiation from the sun and artificial sources—such as tanning beds and sun lamps—as a known carcinogen (cancer causing substance). Overexposure to ultraviolet radiation in sunlight is believed to be a contributing factor for many cases of melanoma. Frequent visits to tanning salons will also increase your exposure to ultraviolet radiation and, therefore, increases your risk.

Isn’t melanoma an older person’s disease?
No. The majority of a person’s lifetime skin exposure and skin damage occurs before the age of 18. The median age of melanoma diagnosis is currently 57, and that age is likely to decrease as more children and teens are diagnosed. Melanoma is currently the second most common cancer in women between the ages of 20 and 29.

Are my kids at risk for melanoma?
Yes. The fact is that the incidence of melanoma in kids is on the rise. Capturing kids’ attention on sun safety is a major priority. Just one blistering sunburn in childhood can more than double the risk of developing skin cancer as an adult, according to the American Cancer Society. Teenagers need to understand that there is no such thing as a healthy tan. Any change to the color of your skin is a sign of UV damage.

What is being done to educate children and teens about melanoma?
To combat the rising rates of skin cancer, the Suburban Hospital Cancer Program and the Sidney J. Malawer Memorial Foundation have joined together to promote sun safety to children of all ages.

Since 2004, the Block It Out sun safety initiative has targeted Montgomery County middle school students with an hour-long curriculum and related projects to promote sun safety. In 2006, the Block It Out program was expanded to include activities for elementary students as well.

This year, Suburban Hospital and the Sidney J. Malawer Memorial Foundation have targeted high school students with the Sun Safety Prom Promise. As part of a pilot program, high school students will be encouraged to sign a letter promising to avoid tanning beds during prom season and to practice safe sun habits if they desire a tan.

For more information on the educational programs sponsored by the Sidney J. Malawer Foundation, go to http://www.blockitout.org/.

Are there simple things my kids can do to stay safe?
Yes. There are simple precautions that everyone can take to stay safe:

  • Limit time in the midday sun.
  • Apply sunscreen of SPF 15 or higher every two hours.
  • Wear sunglasses with UVA and UVB protection.
  • Wear a hat with a wide brim.
  • Wear protective clothing.
  • Avoid tanning salons and sun lamps.

What does SPF mean?
SPF, or Sun Protective Factor, measures the length of time a product protects against skin reddening from UVB (Ultraviolet B), compared to how long the skin takes to redden without protection. For example, if it takes 20 minutes without protection to begin reddening, using an SPF 15 sunscreen theoretically prevents reddening 15 times longer — or about five hours. SPF higher than 30 blocks only 4 percent more UVB, but may be helpful for those with sensitive skin and those already diagnosed with skin cancer.

The key to the effectiveness of any sunscreen product is that it be applied correctly. Daily use of sunscreen is extremely important. Sunscreen products should be reapplied every two hours, especially when participating in water activities. For children particularly, reapplication is critical. Apply sunscreen to your child before he or she heads off to school. Sunscreen should also be applied before recess, or any time when there will be outdoor exposure.

What’s the difference between UVB and UVA?
UVB are the burning rays. These short-wave rays produce sunburn and are considered the main cause of skin cancer. UVA are the aging rays. These long-wave rays penetrate the skin more deeply than UVB, adding to the UVB’s harmful effects, promoting skin cancer, wrinkles, blotching and premature aging of the skin.

What if my daughter wants to go to a tanning booth to get tan?
According to the American Academy of Dermatology, indoor tanning lamps emit UVA and UVB radiation at levels that are far higher than the sun. New, high-pressure sunlamps emit doses that can be as much as 15 times that of the sun. A number of recent studies have found that exposure to tanning beds before the age of 35 caused a 75 percent rise in melanoma.

Both the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) encourage people to avoid use of tanning beds and sun lamps. What many teenagers may not realize is that, thanks to great improvements in artificial tanning lotions, it is possible to look tanned without the use of a tanning booth. These new and improved tanning lotions and sprays are a wonderful alternative to tanning beds and sun lamps.

How can I screen myself and my children for melanoma?
A yearly skin examination by your dermatologist is highly recommended. This applies to children as well. Self skin exams can be performed in between dermatologist visits. Examining your skin regularly for any suspicious mole is the best way to detect skin cancer when it can still be surgically removed successfully. By examining yourself and your children regularly, you are more likely to notice when something looks out of place.

All parts of the body should be viewed — front, back, under arms, palms, backs of legs and feet, including the spaces between your toes and the soles of your feet. Use a mirror to examine the back of your neck and part your hair to look at your scalp. Have a family member or friend assist you to ensure that you don’t miss any hard-to-see spots. Many lives have been saved because of an alert hair dresser or massage therapist.

What kind of moles should I look for?
When checking yourself for melanoma, it’s important to remember the letters “ABCDE”: Asymmetry, Border, Color, Diameter, and Evolution. Melanomas generally have a shape that is asymmetrical; they have borders that are ragged, blurred, or irregular; their color is uneven and may include shades of black, brown or tan; they change in size (melanomas usually have a diameter of approximately ¼ inch, or about the size of a pencil eraser); and they evolve over time.

It’s important to pay particular attention to a mole that becomes itchy or tender, or bleeds or crusts over. Keep in mind that not all melanomas fit the above guidelines. Some are much smaller than a pencil eraser (and that’s an even better size to detect them), some are even in color (e.g., all black), some are completely round and dark (nodular melanoma), and many are flat. That’s why it’s crucial that you monitor yourself closely and watch for any changes in moles or a new mole that looks different than the rest. If you just have a funny feeling about a mole, have it checked by a dermatologist. When in doubt, check it out!

What is the treatment for melanoma?
Various forms of treatment are available, depending on the stage of the tumor, the patient’s age and physical condition, and any other conditions the patient may have. When a melanoma is detected early, usually surgical removal of the lesion and a small amount of skin around the lesion is the only treatment needed. Many clinical trials of new therapies are available through Suburban Hospital's Cancer Program and the National Cancer Institute in Bethesda.

For a referral to a dermatologist, or to use our free 24-hour Nurse Advice Line, call Suburban On-Call at (301) 896-3939.


About Dr. Palestine
Roberta F. Palestine, MD, is the founder and director of the Dermatology & Clinical Skin Care Center and has been in practice since 1982. Dr. Palestine is a board certified dermatologist, received her undergraduate degree from Cornell University and her medical degree with honors from the University of Rochester, and attended the world-famous Mayo Clinic for her dermatology residency. At Mayo, she received the coveted Paul A. O’Leary Award in recognition of excellence in patient care.

To learn more about the Dermatology & Skin Care Center, go online to http://www.dermskin.com/. To reach Dr. Palestine, call (301) 530-8300.



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