Weather 101 - Understanding Sun Safety

Updated 10/24/09

About 6 years ago, I noticed some scaly skin on my forehead and on my earlobe. I'd peel the dead skin off, but a few days later it was back. Lotions didn't help.

Then I got some bumps on my forehead. So, I visited my dermatologist and he "burned" them off. A few weeks later, the bumps returned, but in new places. I was convinced that I had some type of migratory fungal disease.

I moved to Florida (the Sunshine State) in 2005, but the bumps remained. So, I visited another dermatologist. And Dr. Kimberly Davidson (Riverchase Dermatology, Naples, FL) gave me some really bad news. The bumps on my forehead were a pre-cancerous condition known as actinic keratosis. This is distinctly different from seborrheic keratosis (non-cancerous) which often involves brown spots (like brown candle wax dropped on the skin). Dr. Davidson refers to my seborrheic keratosis spots as "barnacles."

Suddenly, "it can't happen to me," took on a new perspective.

In Retrospect

When I grew up (I was born in 1945), sun safety was not part of anyone's vocabulary. And, although I wasn't as avid a sun worshipper as others, I spent a lot of time outdoors working in my garden. Since I wasn't at the beach, I figured that I didn't need a hat or sunscreen. WRONG!!!

Over time, I got my share of sunburns and really didn't worry too much about them. That's because I didn't have any of the symptoms associated with skin cancer. At least I thought I didn't.

The many faces of skin cancer

My take on skin cancer was that it was synonymous with melanoma and that you needed to see abnormally colored, raised "freckles." Dr. Davidson quickly dispelled that and other related myths.

"Skin cancer can take many forms," she noted. You see view images of the three types of cancer (melanoma, squamous and basal cell) at the American Association of Dermatology (AAD) web site.

Of these, melanoma is the most serious and can occur even without exposure to the sun. However, ultraviolet (UV) rays from the sun and radiation from tanning beds can contribute to its formation. Melanoma involves the uncontrolled growth of pigment-producing tanning cells. They may appear quickly without warning, but also can develop from or near a mole. Some 75% - 80% of reported skin cancers involve melanoma.

Squamous is more common in people who spend a lot of time outdoors. Farmers, construction workers and beachgoers are among the most likely groups to be affected.

Basal cell cancer is linked to periodic intense sunburns, the kind you might receive if you spend a week in the sun after prolonged winter hibernation.

Actinic Keratosis, on the other hand, can appear as dry, scaly skin or as a lot of unexplained little bumps.

Detection

Recovery rates from any incidence of skin cancer are highest if there is early detection and the cancerous growth is removed before it gets too large or deeply rooted. You don't want the cancer to spread or metastasize to internal organs. Yet, even with so much attention to sun safety in recent years, the AAD estimates that there will be a million new skin cancer detections this year and 1 in 5 Americans will develop skin cancer in their lifetimes.
The best way to keep ahead of skin cancer is to routinely check your skin. This means ALL of your skin, even in "shaded" areas. You can use a hand-held mirror or have a spouse, family member or friend help you. I've even been told that some hair stylists and barbers have alerted customers to unusual marks on their skin. Showering with your spouse is definitely a plus! So, too, is checking out your birthday suit on your birthday and at other times during the year.
When looking for things unusual, follow the lead of the AAD and others concerned about sun safety and think ABCDE. Get concerned if any of your moles or pigmented spots exhibit:

• Asymmetry -- one half unlike the other half.
• Border -- irregular, scalloped or poorly circumscribed border.
• Color -- varied from one area to another; shades of tan and brown, black; sometimes white, red or blue.
• Diameter -- melanomas are usually greater than the diameter of a pencil eraser, but in their early stages, they can be smaller.
• Evolution -- any changes in size, shape, color, elevation or other trait, or new symptoms (e.g., bleeding, itching or crusting)

But, anything on your skin that is noticeably different from anything else, which changes (size does not matter), or which exhibits anything unusual, begs for attention.

Although the above were designed for detecting melanoma, they offer excellent guidance for locating anything suspicious on your ski. And, if you find anything that doesn't belong, and that includes scaly skin and bumps, check with your dermatologist immediately.

While periodic self-examinations are among the best way to detect skin cancer early, you should also have an annual examination from a qualified dermatologist. This is especially important if your family history or personal biological attributes favor skin cancer occurrence. Caucasians are more likely than people with darker skin to develop skin cancers. And fairer-skinned Caucasians (especially with naturally red or blonde hair and / or blue or green eyes) are the most likely candidates. While the chances of developing skin cancer grow as we age, you should treat your child's skin just as diligently as you do your own.

The AAD web site can help in many ways. It can help you find local free skin cancer screening events; it can send you annual skin cancer screening reminders; and it can help you find a local dermatologist.

Prevention

Before reading this section, I'd encourage you to visit the American of Academy of Dermatology's (AAD) web site and complete their "Rays Your Grade" sun smart survey. I completed the survey and thanks to answering honestly, I really earned a grade of B. The automatic grading system even had a few useful tips for me.

The AAD recommends that you stay out of the sun, especially during peak UV intensity times (10am to 4pm Local Daylight Time). When you are out in the sun, use a sunblock or sunscreen with an SPF of least 30 and reapply about every hour (especially if you are in and out of water or perspire a lot). An SPF higher than 30 provides only minimally more protection, but at a significantly higher cost (see related article at Math 101). The AAD now has a SEAL OF RECOGNITION® Program, designed to educate the public about the dangers of exposure to the sun. The program also provides, "a reliable method for choosing sun-protection products that have met a stringent set of evidence-based criteria established by the Academy using FDA guidelines and that have been verified by a panel of dermatologists and an independent scientist."

If you have many SPF products at home, check their expiration dates and discard any that are past their prime. Their SPF effectiveness does drop over time.

One easy way to protect against the sun is to wear hats, especially those that cover the face and ears. In recent years, I have seen many workmen become like French Foreign Legionnaires and wear towels under their hats that drop down and cover their necks (Figure 1). Donning longer sleeved shirts or cover-ups helps, too. And don't forget your left arm as you drive. Even if the window is rolled up, the sun's heat rays get through.

All clothing does not block the sun's rays equally. There are now at least two clothing lines - SOLUMBRA and COLLIBAR - that specifically embed sunblock protection in their clothing. There are also sun-protective swimming suits! Clothing is rated as SPF by Solumbra and as UPF by Collibar. Collibar notes that their UPF is similar to the SPF for sunscreens, but also considers effectiveness over time.

Covering up is most important for the very young as early skin damage makes one more at risk from skin cancer later. Thanks to the efforts of Teryl Brzeski, a skin cancer survivor, all elementary schools in Collier County, FL have now erected playground shade structures. Many private schools in the county have followed suit (Figure 2). For the youngest set, those head bonnets and stroller sunshades are more valuable than you can imagine.

Recovering...

I'm now fully recovered from my "near miss." Once she diagnosed my condition, Dr. Davidson prescribed Carac cream, a product specifically designed to attack keratosis. After several weeks of daily topical applications, my facial skin turned red and started to peel (Figure 3). A few weeks later the scaly skin and facial bumps were gone. Now, two years later, Dr. Davidson says I'm doing fine. And with my new hat wardrobe in use daily (along with SPF 30), I'm going to stay that way.

I'm glad I wound up getting a second opinion and that the treatment was painless, even though a bit ugly.

So please have a great time out of doors this summer, but keep sun safety on your mind (hat and clothing) and your skin (in SPF format).

Oh, and as Rhett Butler may have said to Scarlett O'Hara, "...Frankly Scarlett, I don't give a tan!"