A Safe Place in the Sun

0 Comments | Insight on the News, August 30, 1999 | by Karen Goldberg Goff

Alarmed by an increase in skin cancers, doctors are cautioning people about summers on the beach and winters in tanning booths. Here's how to play safe with ultraviolet rays.

Karen McFarlane never thought about skin cancer when she was outdoors without sunscreen or using a tanning bed. Then, a year ago, the 32-year-old mother of two was diagnosed with melanoma, a potentially deadly form of skin cancer. She had surgery to excise the mole on her left breast, but the cancer had spread to a lymph node under her arm. She now endures thrice-weekly injections of interferon, a substance shown to be helpful in preventing a recurrence of melanoma.

"I did this to myself," she says. "If I would have known how serious skin cancer could be, I wouldn't have gone in the sun. I think the highest sunscreen I ever wore was SPF 6 or 8 on my face. I was afraid of wrinkles but never afraid of skin cancer."

McFarlane's story is all too typical. Skin cancer has become the most common form of cancer, according to the American Cancer Society. About 1 million new cases are likely to be diagnosed in 1999 -- a 6 percent increase since 1998 and a 1,900 percent increase since 1930, according to the American Academy of Dermatology. About 41,600 Americans were diagnosed with malignant melanoma in 1998, and 7,300 died from the disease.

"From the 1930s through 1960s, skin cancer saw a slow, gradual increase," says Gary Peck, director of the Melanoma Center at the Washington Hospital Center. "Since the 1980s, incidences, particularly of melanoma, have taken off sharply."

Dermatologists have theories, but not hard evidence, about why skin cancer has increased so dramatically. Popular wisdom blames the environmental damage to the ozone layer, but Peck and other experts say that never has been proved. Certainly, Americans have had more time to work on a fashionable tan and have worn less clothing while out in the sun.

"People used to be covered up in the sun," says Mary O'Connell, director of skin-cancer initiatives for the American Cancer Society. "Women wore old-fashioned bathing suits, and men who worked outside wore hats and longsleeved shirts. Then people had more time to be in the sun and wore bikinis. Good sunscreens weren't even available until the mid-1980s. These are all contributors."

O'Connell advises people of all ages to cover up in the sun by donning a hat, protective clothing and lotion with an SPF, or sun-protection factor, of at least 15. Though skin cancer in children is very rare, damage done by sunburns at a young age may put them at increased risk of developing melanoma years later. "Skin cancer is the most preventable form of cancer there is," says O'Connell.

Tanning is caused by the increased production of the pigment melanin, which darkens the skin after sun exposure -- a response to injury, as the sun's ultraviolet, or UV, rays damage and kill cells. UV rays are present not only on sunny days but also on cloudy and overcast ones. They can reflect off cement, sand and snow and are strongest between 10 a.m. and 4 p.m.

Three types of UV rays exist. UVA is the most abundant source of solar radiation and penetrates beyond the top layer of human skin, causing damage to connective tissues and increasing a person's risk of developing skin cancer. UVB rays are less abundant (a significant portion being absorbed by the ozone layer), but the remaining ones are damaging to DNA, which triggers abnormal cell growth, wrinkling and burning. UVC radiation is absorbed completely by the stratospheric ozone layer -- a good thing, since UVC is extremely hazardous to skin.

Damage from UV rays can manifest itself as various forms of cancer. Basal-cell growths (which account for 80 percent of new skin-cancer cases, according to the American Academy of Dermatology) and squamous-cell growths (which account for about 16 percent) rarely metastasize to other parts of the body. The cure rate for these forms of skin cancer is better than 95 percent if they are found and treated early. "It may not be fatal, but it is still serious," says Lynn McKinley-Grant, a dermatologist with a practice in the Washington suburbs. "But the treatment can still be disfiguring."

Typical basal-cell growths are found on the face, hands or other body parts that have been exposed to sun, says McKinley-Grant. A basal-cell carcinoma can have several different appearances: a red patch; a small, pink bump; a white scarlike area or a sore that bleeds or oozes. A squamous-cell carcinoma usually occurs on the ears or faces of older people, often arising from a precancerous lesion known as an actinic keratosis, a rough pink spot that becomes raised from the skin surface if it is malignant.

A melanoma growth, meanwhile, usually is a dark pigmented growth that is new or nonhealing, she says. An atypical mole can occur almost anywhere on the body, but melanoma moles often are found on the chest, neck, back or abdomen, places that usually are not exposed to the sun. A malignant mole is at least one-quarter of an inch in size and has irregular borders.