A Dermatologist Warns That Skin Cancer Is the Burning Issue on the Beach
Why is skin cancer increasing at such an alarming rate?
For one thing, our society now is geared to a more active outdoor life. Before World War II white milky skin was fashionable; darker skin belonged to outdoor workers. Now a tan means you're a member of the leisure class. Fashion magazines and TV ads are filled with gorgeous bodies frolicking in the sun. We are beginning to see the damaging cumulative effects of all that sun and it scares the dickens out of me.
Do environmental changes play a role?
It's said that if we continue to pollute our atmosphere, the ozone layer will be destroyed and more ultraviolet rays will reach the earth's surface. While government studies have found no critical change in the layer yet, it could happen. We don't know whether there are other things in the atmosphere—chemicals, toxins, pollutants—that can cause skin cancer. Sunlight is such a tremendous factor that anything else seems irrelevant.
How does sunlight cause skin cancer?
The sun's ultraviolet rays penetrate deep into the skin. UV rays are a form of radiation, and when they reach the center of the reproducing cells they damage the cells' function. The skin is constantly replacing itself; humans are always shedding, which is how the skin repairs itself. But when reproduction is impaired, the cells can lose control, multiply wildly and then generate abnormal forms. Eventually the skin won't produce normal cells.
Why are fair-skinned people more susceptible to skin cancer?
The more pigment in skin (the content is determined genetically), the more protection the skin has and the longer it will take for sunlight to damage it. Fair-skinned Caucasians don't have as much pigment and don't form new pigment as readily as darker-skinned Caucasians. So people with light hair and light eyes, people who freckle or who burn rather than tan, have little in the way of self-protection. Black people can get darker and sunburned, but they rarely get skin cancer.
Why is the problem so bad in Arizona?
As you get closer to the equator the incidence of skin cancer increases tremendously. Altitude is also a factor. In Tucson we are 2,400 feet above sea level. We have more clear than cloudy days and almost no pollution. The year-round climate is conducive to wearing fewer clothes, and people spend more time outdoors. In 1960 southern Arizona had 104 cases of nonmelanoma skin cancer reported per 100,000 people. In 1981 this went up to 720 cases per 100,000—a 600-plus percent increase in two decades.
What happens to the skin during the tanning process?
The body has two ways of protecting itself. One is the thickening of the dead top layer of skin. The other is the tan. That process begins when UV rays damage the pigment cells on the skin's surface. Over a period of days, as deeper pigment cells migrate upward and then multiply, the skin darkens. The more you expose yourself to the sun the more susceptible you are to wrinkles, freckles and age spots. Those pretty young girls on the beach are getting gorgeous tans today, but in their 30s and 40s most of them will look at least 10 years older, and they will need facelifts to fix the wrinkles.
What are the types of skin cancer?
The most common types are basal-cell and squamous-cell carcinomas. They are the results of chronic sun exposure. They appear more frequently among people over 50 and almost exclusively on sun-exposed areas—the head, tops of the hands, arms and neck. The basal cell can start as a little, flat, shiny spot—pinkish or a pearly color. It sometimes becomes dome-shaped or has tiny blood vessels on the surface. Squamous cells are faster-growing cancers that appear as rough scaly spots, sores that don't heal, or as crusty spots the size of a pea with a yellowish tan color.
What is the most dangerous type?
The least common, but most dangerous, is malignant melanoma. It spreads rapidly throughout the body and is potentially fatal. We are seeing more melanoma cases now among people under 49 and as young as 14. We believe this sort of cancer is not the result of chronic sun exposure, but develops after short, acute sun exposure. It occurs most frequently on the back and the lower legs. Some 60 percent of these melanomas develop from preexisting moles—if you notice any change there in size, shape, color, any itching or bleeding, consult a dermatologist. There are more cases of malignant melanoma than ever before—a 340 percent increase in southern Arizona in the 10 years between 1969 and 1978. But the survival rate (close to 70 percent) is greater than it was a decade ago.
How are these cancers treated?
Surgery. If basal-cell and squamous-cell carcinomas are caught in time, there is a 90 percent cure rate and little risk of recurrence.
Do you approve of tanning salons and reflectors?
They are terrible. You get no long-term tan, and you can get bad burns. Some tanning centers advertise harmless ultraviolet rays. Nonsense. They actually augment the damage done by natural tanning. And sun reflectors are horrible. If you take a piece of aluminum or a mirror and focus the sun's rays on a piece of paper, it's going to burst into flames. Is that what you want to do to your skin?
What is the best treatment for sunburn?
Don't get a sunburn. Once you do and peel, that skin is not going to be normal for two to three months. For an average burn I like an old-fashioned remedy. I mix four cups of skim milk, six ice cubes and eight cups of cold water in a bowl, then put compresses of this on the burned area. Aspirin is good for cutting down inflammation.
How effective are sunscreens?
Everyone who spends time in the sun should use a sunscreen, but I'd throw away any that don't have a sun-protection factor (SPF) of 15. There are two types: the total sun block, like zinc oxide, which blocks out all UV rays, and chemical sunscreens. When the UV light hits those chemicals on the skin they cause a reaction that prevents the rays from penetrating. You can still get a tan wearing a sunscreen, and you can burn if you stay out long enough.
How can you coax a young sunbather out of the sun?
At that age you think you're invincible. But we are trying to educate people. We just want to encourage them to use a sunscreen or to go out before 10 a.m. or after 3 p.m., when the sun is less severe. It would save so much heartache and expense. It might put me out of a job, but I fear it won't.