Skin cancer awareness

Protecting the skin against the sun's hazards.
Skin cancer awareness
By Harvard Medical International
Tue 10 Jun 2008 04:00 AM

Protecting the skin against the sun's hazards.

As the golden days of summer approach, it is important to remember that while a radiant tan may look good now, it can come back to haunt later on. Besides prematurely aging and wrinkling the skin, the sun's rays increase the risk of skin cancer, which is a growing health problem worldwide.

The World Health Organization estimates that between two and three million non-melanoma skin cancers and 132,000 melanoma skin cancers occur globally each year - and that one in every three cancers diagnosed is a skin cancer.

The problem may be particularly pronounced in the UAE, where the UV-rating is high, sunbathing is a year-round pursuit, and expatriates from cooler climates may be unaccustomed to the intensity of the region's sunshine.

Expatriates from cooler climates may be unaccustomed to the intensity of the region’s sunshine.

The risks of sun exposure cannot be overemphasized, says Dr. Harley Haynes, vice chair of the Department of Dermatology, at Brigham and Women's Hospital, an affiliate of Harvard Medical School in Boston, Mass. He adds: "The only safe tan is one you are born with.

In this "In Practice" article, Haynes explains the most common types of sun-related skin cancer, their risk factors, and ways to safely enjoy time spent outdoors.

Avoiding sun exposure

The strongest sun of the day occurs at noon, when the sun is most vertical. "We tell people to try to avoid exposure between two hours before and after noon -- and if that is not possible, to use protection," says Haynes

Such protection should include a hat, preferably with a brim all around, long pants and long-sleeved clothing (ideally, with sun protective fabric) and sunscreen.

While experts sometimes recommend using a sunscreen with a sun protection factor, or SPF, of at least 15, Haynes cautions that this number is far too low, unless a person slathers on a hefty layer of cream.

"Most people apply 25% of the thickness required to get the protection listed on the label," he explains. For this reason, he recommends dividing the SPF number by four - or simply using a product with an SPF of 50 or higher. Personally, Haynes uses a product with SPF 70 on his face and hands every day, he says.

The three main forms of skin cancer caused by exposure to sunlight are melanoma (the deadliest form), squamous cell carcinoma, and basal cell carcinoma. Each has different risk factors and cure rates.

Melanoma

Melanoma is the most serious, but least common, form of skin cancer. The primary risk factor for melanoma is getting sunburned as a child. Getting intermittent excessive sun exposure also increases a person's risk for melanoma. The cancer appears in mixed shades of tan, brown, and black, although, it can also be red or white. It is most often found in areas that are exposed when a person wears a bathing suit but are covered by business attire, explains Haynes.

People who relocate from sun-deprived countries to tropical or dessert climes may be at a particularly high risk for melanoma caused by intermittent sunburns, observes Haynes.

People who don't know what it means to be in a high UV area are taken completely by surprise when they are out for 10-15 minutes at noon and find they have a sunburn."

Heredity also plays a role in melanoma. If a person has a family member with melanoma or a large number of moles (over 50), that person is at increased risk for developing melanoma and should learn the warning signs, do regular self-exams and have a dermatologist check their entire skin at least once a year.

Melanoma is cured roughly 80% of the time when it is detected in its early stages, so it is important to catch and treat it quickly.

Squamous cell carcinoma

Squamous cell carcinoma is more common than melanoma. Chronic non-burning sun exposure increases a person's risk for this form of cancer, which is primarily found in fair-skinned people. It is cured 95% of the time, but like melanoma, if it isn't detected early it can metastasize (spread to other parts of the body).

If squamous cell carcinoma spreads beyond local lymph nodes it extremely difficult to cure, says Haynes. As with all skin cancers, it is important to get early treatment.

Basal cell carcinoma

Basal cell carcinoma is the most common type of skin cancer. It appears frequently on the head, neck, and hands as a small, fleshy bump, nodule, or red patch, but can also appear on other parts of the body.

Basal cell carcinomas rarely occur in dark skin. They usually grow slowly, but if they are not treated, they may bleed, crust over, heal, and repeat the cycle, and eventually spread below the skin.

Basal cell carcinoma is rarely deadly, but can cause considerable local damage. "At the very least, skin cancer will lead to some kind of scar. At most it will lead to huge disfigurement or death," says Haynes. "It is not trivial.

Basic precautions

That's why it's so important to protect oneself against all forms of sun-related skin cancer. Haynes recommends taking the following precautions:

• Lather up: Generously apply a water-resistant sunscreen to all exposed skin. Look for a brand with a Sun Protection Factor (SPF) of at least 50 that provides broad-spectrum protection from both ultraviolet A (UVA) tanning rays and ultraviolet B (UVB) burning rays. Re-apply sunscreen after swimming or sweating.

• Form a habit: Use sunscreen regularly - not just when you are going out into the sun. Regular use has been shown to be significantly more effective than using sunscreen only when you think you need it.

• Cover up: Wear protective clothing such as a long-sleeved shirt, pants, a wide-brimmed hat and sunglasses, where possible. (Ideally, wear clothing made of a sun-protective material).

• Avoid the strongest rays: Stay out of the sun when appropriate, remembering that the sun's rays are strongest between 10 a.m. and 2 p.m.

• Protect children: Play in the shade, use protective clothing and apply sunscreen religiously.

• Consider location: Use extra caution near water and sand as they reflect the damaging rays of the sun, which can increase your chance of sunburn.

• Fake your tan: If you want to look tan, consider using a sunless self-tanning product. But avoid tanning beds.

• Check your skin: Perform a self-exam every year, and if melanoma runs in your family, see a dermatologist for annual checks.

The warning signs of melanoma• Changes in the surface of a mole.

• Scaliness, oozing, bleeding, or the appearance of a new bump.

• Spread of pigment from the border of a mole into surrounding skin.

• Change in sensation including itchiness, tenderness, or pain.

Consult a dermatologist immediately if any moles or pigmented spots show:

• Asymmetry: One half does not match the other half in size, shape, color, or thickness.

• Border irregularity: The edges are ragged, scalloped, or poorly defined.

• Colour: The pigmentation is not uniform. Shades of tan, brown, and black are present. Dashes of red, white, and blue add to the mottled appearance.

• Diameter: While melanomas are usually greater than 6mm in diameter (the size of a pencil eraser) when diagnosed, they can be smaller. If you notice a mole different from others, or which changes, itches, or bleeds (even if it is small), you should see a dermatologist.

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