Dermatologists are very busy people, and just getting busier.
“Skin cancer is out of control,” says Dr. Joel Cook, a dermatologist at the Medical University of South Carolina who devotes his entire practice to combating the disease. “It’s a national epidemic and every year I’m seeing more patients and more patients who are younger.”
Dr. McLean Sheperd of Sheperd Integrative Dermatology in Mount Pleasant approaches the problem with a similar urgency.
“One hundred percent of our practice is devoted to skin cancer prevention because despite the fact that only about 50 percent of our patient visits are scheduled for this specific purpose, our mission is to educate every single patient who walks through our door,” says Sheperd.
“The creative part is working with patients’ specific motivation to influence behaviors. ... When we are talking about skin, anti-cancer measures also keep us more attractive because sun protection prevents ‘photo aging’ ” (demonstrated by skin that is routinely exposed to the sun compared to areas that are not).
Dr. Diana D. Antonovich, also a dermatologist at MUSC, joined Cook and Sheperd in explaining risk factors and prevention efforts at different stages of life, but reiterated that protective measures span all age groups.
Antonovich stresses the importance of avoiding midday sun from 10 a.m. to 4 p.m. and seeking shade when outdoors; wearing long sleeve shirts and UPF-rated (Ultraviolet Protection Factor) clothing, broad-brimmed hats and sunglasses; applying sunscreen (SPF 30 or higher) with UVA and UVB protection; performing personal skin checks; and having routine checks by dermatologists.
As awareness campaigns kick off in May with “Melanoma Monday” and Skin Cancer Awareness Month, here are some guidelines for five basic stages of life:
From infancy to age 12, skin cancer occurrence is rare, but it’s one of the times when protection from the sun is of utmost importance. And parents and other guardians certainly bear the burden not only of protecting young ones but educating them about protecting their skin.
“Infants under six months of age fall in a special category and should be kept out of the sun,” says Antonovich.
“They are very susceptible to the sun’s ultraviolet rays and thus sunburn easily. Skin at this age is not efficient in making melanin (the compound that the skin produces to naturally protect itself from the damaging affects of ultraviolet rays),” she says.
She adds that skin in early infancy also is more sensitive to chemical agents applied to it, including sunscreen, which can be too harsh and should not be used in this group. Sunscreen can be used on children age six months and older.
As children get older though, playing outdoors at a playground, park, pool or beach is inevitable and healthy. But it can mean too much sun exposure.
“Sunburns during childhood are common and this can have substantial consequences down the line,” says Antonovich. “Five or more sunburns during childhood doubles an individual’s lifetime risk of developing a melanoma. Any sunburn that causes blistering further increases the risk.”
Antonovich says protective measures in this age group include parents using strollers with shading or a canopy, dressing children in lightweight protective clothing that covers arms and legs, getting them to wear wide-brimmed hats.
“It is important to start good habits early when it comes to sun protection,” says Antonovich. “A real payoff is getting your child used to wearing protective clothing like UPF swim shirts — they offer great protection, better than your best sunscreen — and you don’t have to worry about getting them to tolerate putting a messy sunscreen on as large of a surface area.”
She adds that reapplying sunscreen, which should be done every two hours or after swimming or sweating, will also be less cumbersome if much of the skin is already covered with a long-sleeved swim shirt.
“Children should also be acclimated early to wearing broad-brimmed hats and sunglasses, and taught how to apply sunscreen correctly. Sunscreen sticks are easy to use and a great way to get kids started in applying it themselves.”
Sheperd adds that for children older than six months, sunscreens should be used that are mineral-based and contain zinc oxide. And that any unusual moles and dark spots should be checked early.
“Sun exposure in general, even in kids who are likely to tan, not burn, is a risky behavior because tanning is a sign of DNA damage,” says Sheperd.
Cook, Sheperd and Antonovich all say the years between ages 13 and 25 can be among the most challenging for an age group prone to peer pressure and the conventions of fashion.
“Unfortunately, many in this group still associate a tan with looking more attractive,” says Antonovich. “Many teenagers and young adults actually just find applying sunscreen a hassle or they just forget.”
Cook says he thinks the problem is worse for young women than young men, particularly for those willing to go to indoor tanning beds, saying that women are more likely to be “habitual tanners.”
He notes that in 2009, the World Health Organization’s the International Agency for Research on Cancer added tanning beds and tanning lamps to the list of dangerous devices and substances that emit cancer-causing radiation. Cook says tanning beds are “inefficient for tanning and efficient at delivering radiation.”
One of the most effective ways to continue efforts to inform this age group of the dangers of sun exposure is to appeal to their vanity.
“Some individuals are more responsive to the threat of skin aging resulting from sun exposure than they are to the risk of skin cancer,” says Antonovich. “So teenagers and young adults should be reminded that tanning not only increases the risk of developing a skin cancer but also causes premature aging: wrinkles, permanent skin discolorations and spots.”
Those who still seek a “tan,” she adds, should try self-tanning topical products that can give the desired “espoused glow” while skipping the ultraviolet radiation, though, the product carries no protection from the sun.
Sheperd says some of her patients gain extra motivation when they understand their skin will remain stronger if they protect it.
“Their hands and arms will be less prone to bruising and tearing, which we see in people in their 60s (and up) who have had a lot of sun on their arms,” she says.
From ages 25 to 40, many will face less sun exposure by virtue of the fact that they are starting careers and families. But it’s also an age that ushers in the first wave of skin cancer and premature aging, meaning that early detection dovetails with continued protective measures.
Antonovich says young adults often may ignore signs of problems.
“I see parents that come in tan and they tell me how their energy goes in to ensuring that their children are protected when in the sun and they then forget themselves. I remind them that an important way to get children to practice sun safety measures is to set a good example” she says.
Sheperd adds that, along with college-age adults, smoking combined with sun exposure can be a one-two punch for premature aging and skin cancer.
“In this age group, many people may have 9-5 work weeks, and so ‘weekend warrior’ outdoor sun behavior can contribute to a melanoma risk,” says Sheperd, reiterating the risks of one or more blistering sunburns for melanoma.
She recommends that young adults consider using a topical antioxidant for skin that is exposed daily.
“I prefer a triple anti-oxidant, which speeds up the skins ability to deal with damage eight times over baseline. ... If (your) skin is light- or medium-tone, I definitely would get a skin check yearly after your 30th birthday.”
She adds that people with darker skin tones, such as Latinos and African-Americans, go to a dermatologist for a baseline exam and a specific recommendation for future follow up which is based on that exam.
Even more attention to detection comes in at mid-life.
“Individuals in this age group may begin to see signs of the cumulative of effect of chronic sun exposure,” says Antonovich, of the age group from 40 to 65.
“This is the time many begin to pay the price for the sunburns and tans of their youth, in the form of sun-induced aging: poor skin tone, sunspots, wrinkles, precancerous lesions and skin cancers.
Individuals in this age group often become more motivated to protect their skin from the sun because they are starting to see and feel its deleterious effects,” says Antonovich.
She notes that the incidence of melanoma is greatest among white males over age 50.
While Cook calls it “prime time” for skin cancers, he adds taking the protective measures mentioned continue to be of importance.
Sheperd says not getting routine skin checks in middle age by a dermatologist constitutes a risk behavior as well, since early detection is crucial to treating skin cancer successfully.
“Any ‘sore’ which fails to heal or any ‘pimple’ which fails to clear in about six weeks should be checked as these may be skin cancers. Changing or new brown or dark spots and spots which don’t look like the others should be checked,” she says.
Sheperd adds that in addition to continued protection from the sun and routine checks, she says following other health practices will assist in preventing cancers.
“More prevention which is, in general, good for the body’s strength and immunity involves eating organic produce and clean meat, (meaning) pasture-raised or wild-caught). I like to say ‘eat from the rainbow of fruits and veggies,” she says.
“If you can get eight different colors of vegetables daily, you are getting phytonutrients, which can help restore and repair the body. A breath-based exercise program can help with circulation and oxygenation of tissues.”
Skin cancer risks go up even more with age. Not only is that due to the accumulation of sun exposure but more opportunities to be outside, according to Antonovich.
“An additional challenge in this age group is that retirees tend to have more free time to spend enjoying outdoor activities — golf, tennis, beach-walking, boating — further increasing skin cancer risk,” she says.
“One misconception many have is that much of the injury to the skin has already occurred during youth and that preventive measures later are futile. Not true,” she says. “While adverse effects of prior excessive sun exposure cannot be completely reversed, protective measures, even if taken later in the game, can still make a difference and are most definitely worth the effort.”
She adds that melanoma mortality is greatest in adults age 65 and older.
“Many of these develop on the back, which may lead to the melanoma going unnoticed longer. Enlisting a family member or friend to help to look at your back occasionally may help with earlier detection and curative treatment,” she says.
Despite rising awareness and increasing rates of skin cancer, Sheperd thinks efforts to prevent it are working, but that people other than the patient and physician need to be engaged in it.
“Changing behaviors is like steering a ship, not a car, but the prevalence of skin cancer awareness among all age groups is growing and so is people’s awareness of what to look for,” she says.
“In my practice, people come in already noticing what is ‘this thing which doesn’t belong.’ Hairdressers send in patients for spot checks on the face and scalp, which are early skin cancers. Strangers speak up in the grocery store line to suggest you ‘get that spot on your neck checked by your doctor.’ ”
“Are we making an impact? Yes, we are.”
Reach David Quick at 937-5516.