No tan is a good tan:
How to protect your family from melanoma

June 2007--The long-awaited arrival of summer means most of us will be spending more time outdoors in the garden, on the links and at the beach. That means it’s time to reevaluate the steps you must take to protect your skin and eyes from the hazards presented by the sun.

“The days of the ‘healthy tanned look’ are long over,” warns PinnacleCare Chief Medical Officer, Dr. Miles J. Varn. “We need to protect our skin from the radiation the sun produces all year long to help manage our risk factors for skin cancer.”

Skin cancer is the most common form of cancer, accounting for approximately 50 percent of all cancers according to statistics gathered by the American Cancer Society. Though melanoma only makes up 3 percent of skin cancer cases, it is responsible for a majority of deaths related to skin cancer.

Researchers at Memorial Sloan-Kettering Cancer Center, a PinnacleCare Center of Excellence, explain that the bulk of skin cancers are caused by exposure to the sun’s ultraviolet radiation. The UV exposure damages genetic cellular material and impairs the cells’ ability to regulate how and when cells divide which can lead to cancer, including melanoma, though they note that the precise link between UV exposure and melanoma is not yet clear. UVB radiation has the greatest amount of energy and causes the largest amount of damage, while UVA radiation, though not as powerful, penetrates more deeply into the skin. Regular small doses of UVA, which is the type of light used in tanning beds, can result in long-term skin injury even if you never get sunburned.

Everyone is at risk

Fair skin boosts melanoma risk significantly. In fact, the risk is 20 percent higher for Caucasians than African Americans, with people with red hair, light eye color and the fairest complexions at the greatest risk. This does not, however, mean that darker skinned people can ignore sun safety. In fact, a study found that melanoma is deadlier for African Americans, who have a 45 percent survival rate versus a 69 percent rate for Caucasians. One researcher speculates that high mortality rate is linked to later detection in African Americans, many of whom did not consider skin cancer a probable health risk.

In addition to a fair complexion, people with a large number of moles (more than 25), known as atypical nevi, and those with a family history of melanoma are also at greater risk. Studies have found that for people with atypical nevi and two first degree relatives who have been diagnosed with melanoma, the risk of developing the disease increases 500 percent.

People with weakened immune systems, including those with immunosuppressive diseases like lupus and HIV/AIDS and those whose immune systems are purposely suppressed like organ transplant recipients, are also at an increased risk of developing melanoma. In addition, a study at Massachusetts General hospital found that women with breast cancer also faced an overall 16 percent melanoma risk increase.

Another factor people often overlook is that a wide range of medicines increase sun sensitivity, making the skin much more vulnerable to UV damage. The medicines with this side effect include many antibiotics, drugs used to treat acne, birth control pills, Xanax and even diphenhydramine, the active ingredient in many anti-allergy drugs. Be sure to ask your doctor if any of your medications increase your sensitivity to the sun.

Slip, slop, slap: the basis of a good prevention strategy

Though genetics and other factors figure into your level of risk for developing melanoma, the key to protecting yourself against skin cancer is to consistently limit exposure to the sun all year long. "I am a proponent of the approach advocated by the [American] Cancer Society,” says Dr. Martin Weinstock, Professor of Dermatology at Brown University and chairman of the American Cancer Society's skin cancer advisory group. “It's called Slip-Slop-Slap. Slip on a shirt, slop on sunscreen, slap on a hat. That's the way to be safe during outdoor activities.”

It is extremely important to use sunscreen properly:

• Use about a shot glass full for each application
• Apply it 20 to 30 minutes before going out to allow for maximum coverage and absorption
• Apply again if you are outside for a several hours, after vigorous activity or swimming even if the formula is “waterproof”
• Minimum SPF should be 15 though many dermatologists recommend 30 or higher
• Wear sunglasses with at least 95 percent UV absorption help protect eyes, which are also vulnerable to melanoma

Dermatologists say that if you’re only using one bottle of sunscreen per summer, you are probably not applying it in an adequate quantity or often enough.

Sunscreen is not enough

A recent study by dermatologists in Switzerland offers similar advice, but cautions that sunscreen is a poor second to adequate coverage of skin when in the sun and avoidance of the sun whenever possible, especially between 10 am and 4 pm when the rays are strongest. “Wearing sun-protective clothes and a hat and reducing sun exposure to a minimum should be preferred to sunscreens,” advises study author Dr. Stephan Lautenschlager, Outpatient Clinic of Dermatology at Triemli Hospital in Zurich. The study also found that tightly woven fabrics like denim offer far more sun protection than summer’s traditional cottons and linens.

Two new formulations of sunscreen that offer better UVA protection have recently come on the market in the U.S. One, called Helioplex™, increases UV protection and slows the degradation of avobenzone (the active screening ingredient). The second relies on a new sun filter known as Meroxyl™, which has been used in Europe and Canada for a number of years. Experts caution, however, that sunscreens have not yet been demonstrated to protect against either melanoma or basal cell carcinoma. They also advise keeping skin covered as the best defense.

Know your skin, save your life

According to specialists at Sloan-Kettering, regular, comprehensive skin self-examination may reduce the risk of death from melanoma by more than half. Look for changes in moles, unusual sores, lumps, tenderness, redness, swelling or scaly patches. A thorough skin examination by a qualified physician is also recommended every three years between the ages of 20 and 40 and annually after that.

Melanoma often strikes at a younger age, so even adolescents should perform self-exams and have a regular check by their family doctor or a dermatologist. Many skin cancer screening and prevention programs offer an extra tool to people at higher risk for melanoma. At each visit, digital photos are taken so suspected changes in the skin can be compared to the photographic record.

New diagnostic tools hone risk assessment

At the Johns Hopkins Melanoma Program, researchers are exploring a wide range of diagnostic tools that will help physicians more accurately assess melanoma risk. From the genetic perspective, they are looking at mutations in the BRAF gene which are present in 60 percent of melanomas and using the information they uncover to develop a blood test for melanoma as well as to test the effectiveness of drugs that can neutralize proteins created by the mutated gene. Researchers are also at work on a skin cream that reacts with pigmented cells that are dividing at a rate faster than normal. This may help sort out lesions that require additional examination and biopsy.

In Europe, a strand of hair may hold the information needed to determine melanoma risk. Dr. Stefano Rosso and his colleagues have found that the melanin content in hair can help determine an individual’s risk of developing the disease. The test works by measuring levels of an acid known as PTCA. People with a PTCA concentration below 85ng/mg had a more than four times greater risk.

A PinnacleCare Advocate can help you build a healthy skin strategy

PinnacleCare Members can team with their Advocates to develop a comprehensive skin cancer risk reduction strategy. From finding a dermatologist to help assess the well being of your skin to providing complete, objective information on melanoma and other conditions, your Advocate is your partner for healthier skin all year long.