by Olivia Overman
The warmth of the sun on your face, the sounds of the waves breaking softly on the beach as you relax after a long, snowy winter in Northern Virginia…summer is here, and we all want to get outside. Before you go to soak up some rays, have you protected yourself and your children from sun exposure? While we are not trying to ruin your time away from the hustle and bustle of the daily grind, there are a few steps you should take to safely enjoy yourself to the fullest.
Prevent Sunburn, Prevent Cancer
Given that skin is our largest organ and the one most exposed to the elements, let’s start there. “One sunburn dramatically increases the risk of skin cancer in later life. The most important advice I can give is to try to prevent sunburn as much as possible, and the much less chance you have of developing skin cancer,” said Dr. Kurt Maggio of Renewal Dermatology and Medspa, and a provider at Novant Health Prince William Medical Center. Data from the American Society for Dermatological Surgery states that one in five Americans will get some form of skin cancer over the course of their lifetime.
To prevent sunburn and lessen your risk, follow these precautions:
1. Generously apply sunscreen and lip balm with sun protection factor (SPF) 30 or higher at least 30 minutes before going outside.
2.Cover your head, neck and ears with a wide-brimmed hat. If you wear a baseball cap, make sure to apply plenty of sunscreen to your ears and neck.
3.If possible, wear a shirt that protects you from the sun. Look for swim shirts with UVA protection built in.
4.Invest in sunglasses with 100% UVA and UVB protection.
5.Avoid going out when the sun is at its strongest, between the hours of 10 a.m. to 4 p.m.
6.Avoid or limit use of tanning beds.
“I personally, in my practice, tend to see patients at an earlier stage of skin cancer overall; however, I am seeing a significant increase in the number of skin cancers that are appearing in anatomic areas not traditionally exposed to sunlight and many of these patients have a long history of tanning bed use,” said Dr. David McDaniel, board certified dermatologist and a member of the American Academy of Dermatology.
Skin cancer is the most common form of cancer in the United States, according to American Cancer Society data, resulting in more than half of all cancers here. In the latest data released (2011) by the Centers for Disease Control (CDC), among men, whites had the highest rate of melanoma (the deadliest form of skin cancer), followed by American Indian/Alaska Native men. Among women, whites also had the highest melanoma rate, followed by Hispanic women. African Americans had the lowest incidents. That same year in Virginia, doctors diagnosed approximately 1,270 new cases of melanoma. “People with red and strawberry blonde hair have a dramatically increased risk of developing melanoma,” said Dr. Maggio. “These people should be screened annually from the age of eighteen.”
While those with fairer colored skin are more susceptible to sun damage, it can strike anybody who doesn’t take proper precautions with the sun. “Regardless of color, one sunburn can lead to skin cancer in later years,” said Dr. Maggio. “It is true that darker skinned people get melanoma less frequently than lighter skinned people, [but]they have a lower survival rate. This is because of the later detection rate.”
“I believe that, unfortunately, disparities still exist regarding the skin cancer risk for Hispanic, Asian and African American patients,” said Dr. McDaniel. “A recent study from Florida for skin cancer in Hispanic skin seems to indicate that there is a lack of awareness of the risk both from the patient side as well as perhaps from the health care provider side. … So I encourage anyone with skin of color who has changing skin lesions to be checked by a dermatologist.”
Recognize the Most Prevalent Skin Cancers
Defined by the CDC as “a malignant skin tumor composed of cells similar to those from the basal cell layer of the epidermis,” basal cell carcinoma is the most common form of skin cancer in the United States, affecting more than one million people each year. It can appear as a reddish patch of skin or a pink elevated bump and can be treated successfully if detected early. These are most commonly found on areas of the skin that are frequently overexposed to the sun, such as the chest, face, neck, scalp and back.
“I used to sunbathe all the time, trying to get that golden glow so I could wear those cute summer clothes,” said a 40-year-
old woman, who recently moved from Woodbridge and spoke anonymously. “When I developed basal cell carcinoma, the kind that can be treated with a topical cream, I knew that was the end of long summer days by the pool for me.”
She noted getting physically ill three times during her six-week course of Imiquimod cream. “I’m not sure if there was a connection, but… if there is a connection, I can’t imagine what people go through with stronger forms of treatment,” she said.“I have another month before I return to my dermatologist to see if the treatment has worked.”
Squamous cell carcinoma (SCC) is another form of skin cancer that develops in the upper layer of the skin, appearing as a crusty, scaly area of skin with a red area that looks like a bump. Like the basal cell, SCC type also develops in areas that are exposed to the sun, however, it can develop anywhere on the body and can spread quickly.
The third and most dangerous type is melanoma. It appears as a brown or black spot, however, it can also be pink, tan or even white in color. It can spread rapidly, and once inside the body can be difficult to cure. According to the American Cancer Society, melanoma is responsible for most skin cancer deaths, but accounts for less than five percent of all skin cancer cases.
Understanding UV Impact on Aging, Skin Damage
Sun exposure also plays a role in premature aging of the skin. Dr. McDaniels, who is also director of Laser & Cosmetic Center in Virginia Beach as well as at the Institute of Anti-Aging Research, noted that “the role that UV light and infrared, and even some visible light, plays in premature aging continues to evolve both in the scientific research world and also in education of the general public.”
He recommends finding sunscreen that is broad spectrum. “I prefer micro particle tinted SPF for most of my patients as there is growing scientific evidence that infrared and even visible light cause premature aging of the skin and may contribute to skin cancer risk. There is a lot of research right now about these added risks,” said Dr. McDaniel. “So think not just sunburn or even skin cancer risk but also premature aging. Recently, some potent botanical antioxidants and DNA repair enzymes are being included in sunscreens and they have some very helpful benefits, ranging from sunburn [prevention]to dealing with free radicals that damage DNA and accelerate aging.”
Candi McGowan, an esthetician at Dansk Day Spa in Occoquan, said that everybody should be exfoliating their skin about three times a week. “This helps dissolve the dead skin that has built up and evens out your skin tone [preventing the signs of skin damage],” she explained. She also recommends sunscreen for all her clients. “Everybody can burn, even if you have dark skin,” she said. “If you don’t like sunscreen, wearing tinted moisturizer is also an option.”
Based on an experience with her daughter, McGowan also recommends wearing a hat while playing sports. “My daughter had to have a spot removed from the top of her head after it developed while playing soccer,” she said. “You need to be active in your own skin care, be cautious about reapplying sunscreen and protecting your skin.”
“Soccer is becoming one of the more popular sports in the U.S. and no one wears a hat. As a result, the cancer incidence rate is going up,” said Dr. Maggio, adding that thankfully the death rate is not increasing because of early detection.
Keep Eyes Safe
While skin cancer and aging are the most common sun-related concerns, your eyes also need protection from UVA and UVB rays. Like our skin, eyes can be damaged by the long-term effects of sun exposure. Such damage includes the worsening of cataracts, macular degeneration (vision loss) and photokeratitis (burning eyes), as well as skin cancer around the eyes.
“We see a lot of surface issues such as pterygium that leaves scar tissue on the surface of the eye,” said Dr. Babur B. Lateef, an ophthalmologist at Advanced Ophthalmology Inc., located in Woodbridge and Manassas, and a doctor at Novant Health Haymarket and Prince William. “Pterygium is believed to be caused mainly by exposure to UV light.” It is often a benign growth that grows inwards towards the cornea and can be vision threatening. “This type of issue is very common among people from sunnier climates such as Africa and Asia as well as people who work outside a lot,” Dr. Lateef said.
However, anybody can develop sun-related eye damage. “If you plan to be outside in the sun for 10 to 15 minutes, you should be wearing sunglasses,” said Dr. Lateef, adding that the best protection comes from glasses that provide 99-100 percent UVA and UVB protection.
According to The Skin Cancer Foundation, people with lighter colored eyes are at increased risk for some eye diseases simply because they have less of the protective pigment, melanin. The thin skin of eyelids is also particularly prone to developing cancer.
Like with any disease, the earlier the issue is discovered, the more treatable it is. While some treatments may simply include the use of eye drops, other conditions may require more serious forms of treatment including surgery.
The Future is Bright
The good news is that more people are protecting themselves from the sun. “Education continues to improve and the American Academy of Dermatology has some wonderful educational resources as well as community screening efforts,” said Dr. McDaniel. “Public awareness of the dangers of UV light, sunlight or indoor tanning, continues to improve and that is encouraging.”
Dr. Maggio referenced the skincare model used in Australia, where skin cancer rates have declined over recent years. “They have seen a decrease in melanoma cases,” he said. “This is a result of improved shade structures on playground equipment as well as the wearing of hats, and sun-protective clothing is mandatory in schools and for recreation. I don’t believe this model would work in the U.S., but we can see it works.”
Here, it is up to us to heed the warnings and to be proactive. For darker skinned people, who do not burn as easily, Dr. Maggio says it is particularly important to protect your nails, palms of hands and the soles of your feet, at a minimum. For everybody, he recommends sun-protective clothing and hats (which he believes are more valuable than sunscreen) and sunscreen or sunblock every day of the year. So this summer, enjoy time outdoors, which can boost Vitamin D levels, improve your mood and keep you active; just follow these doctors’ orders and do it safely!
A graduate of American University’s School of Communication, Olivia Overman writes articles for online and print publications. She can be reached at firstname.lastname@example.org.