Published Jul 1, 2010 8:00 AM
One in five Americans will develop skin cancer at some point in their lifetimes. When melanoma, the most deadly form of the disease, is detected early, at least 95% of patients are cured. But when it has an opportunity to spread, the survival rate drops significantly. UCLA dermatologist Jenny Kim shares the latest thinking on how to reduce harmful exposures and to ensure that skin cancer is caught when it can still be effectively treated.
Remember when getting sunshine was considered healthy? Today we know better. But for all the talk about the danger of UV exposure and the importance of protecting ourselves when we do go out, behaviors have been slow to change, particularly among young people.
"Often you don't see the damage until years later," says Jenny Kim M.D. '91, Ph.D. '01, a dermatologist at the David Geffen School of Medicine. "So if you're in your 20s and getting tan and looking good, it's easy not to think about the risk."
But there are risks — of premature aging and of skin cancer. One in five people in the United States will develop skin cancer in his or her lifetime. The most common types, basal and squamous cell carcinomas, are unlikely to kill, but they occur most commonly in the face and neck area and leave scars when removed. Melanoma, on the other hand, can be lethal — particularly when it has had the opportunity to spread. It is the most common cancer in the 25-29 age group and the second-most common cancer for ages 15-29. It's not clear whether the increasing incidence of melanoma is related to depletion of the ozone layer — allowing more UV radiation to reach us — but what is certain, Kim says, is that we need to change our sun-worshipping ways once and for all. Her advice:
See the Light
The American Academy of Dermatology is a gold mine of information on the topic of skin cancer. To find out more about skin conditions, learn how to take your own examination or correct skin-care myths, visit www.aad.org.
Know the Risk
If you have fair skin, light hair, blue eyes and freckles, you probably don't have to be told that you are at higher risk for both benign and malignant skin cancers. Additional factors — from genetics to a large number of moles and atypical moles — are associated with greater susceptibility to melanoma. But if you have dark skin, Kim notes, it's easy to have a false sense of security. "The pigment of the skin can provide some protection, but you can still develop skin cancers, as well as premature aging, from too much exposure," she says. Likewise, don't assume you are at risk only when you're outside on a sunny day. Check the UV index — cloudy skies don't offer a complete shield. Nor does being in your car with the windows up.
Everyone, regardless of burning risk, should cover all exposed parts of the body with a water-resistant sunscreen that has a sun protection factor (SPF) of at least 30, Kim says. (Although an SPF of 30 doesn't provide twice the protection of a 15, the higher numbers do confer greater protection.) The product should protect against both types of harmful rays: ultraviolet A (UVA) and ultraviolet B (UVB).
Many of the best-intentioned sunscreen users don't always do it right, Kim notes. If you're lathering up too late, too infrequently or too sparingly, you are inviting damage. Sunscreen needs 15-30 minutes to take effect — and it might not protect you for as long as you think. "People assume that if they put it on in the morning, it lasts all day," says Kim. "If you're going to be in the sun, you need to apply it about every two hours for it to be effective — and if you're going to be swimming or sweating, you need to reapply." Many fail to put on an adequate amount, Kim adds. Certain spots are commonly missed — the back of the neck and ears for people with short hair; the exposed scalp; and, for women who like to wear V-neck tops, the exposed chest and neck area.
Limit Your Exposure
"It's important to remember that just because you have sunscreen on doesn't mean you are going to get 100-percent protection," says Kim. The only foolproof way to shield yourself from UV rays is to avoid the sun altogether. To the extent that some exposure is inevitable, Kim recommends being selective in when and where you get out. The UV index is highest during the hours between 10 a.m. and 4 p.m., so if you're a runner, you'll get less exposure if you exercise outside that window. Whenever possible, seek shade and wear protective clothing — long-sleeved shirts, pants, wide-brimmed hats and sunglasses to protect the eyes from UV damage. While it's true that most Americans are vitamin D-deficient, Kim and other dermatologists recommend getting your fill of vitamin D not from the sun but through a healthy diet and, where needed, vitamin supplements.
Avoid Indoor Tanning
Each year, nearly 28 million people seek to darken their skin away from the sun, according to the American Academy of Dermatology. The demographic most likely to frequent tanning salons: young Caucasian women and teens. Many mistakenly assume that because they don't burn from the experience, it is safer than browning in the sun. Not so. "These salons take out the UVB, which causes the burn, but UVA can also cause severe damage — it can lead to premature aging as well as skin cancer," says Kim. Melanoma is rising faster among females than males in the 15-29 age group, with the torso being the most common location. You do the math.
Kim recommends conducting a thorough self-exam of the skin from head to toe at least once a month. Knowing what to look for is as simple as A-B-C-D-E:
Asymmetry: a mole that looks different on one side compared to the other.
Border: irregularity on the outer edges of the mole, such as a jagged, blurry or protruding border.
Color: changes in color, or the appearance of multiple colors.
Diameter: anything greater than 6 millimeters, particularly if there is a relatively rapid increase in size.
Evolution: changes in A, B, C and D, as well as the onset of itching, pain and/or bleeding.
The importance of performing the monthly self-exam and reporting any suspicious finding to a dermatologist is underscored by the numbers. When melanoma — the cause of the majority of skin cancer deaths — is caught and treated before it spreads to the lymph nodes, the five-year survival rate is 99 percent. But only two-thirds survive five years when melanoma has spread regionally and just 15 percent when it is discovered at the advanced stage.