SOS Save Our Skin

Cancer Creeps Up On Sun Worshippers Of Every Age

By Janine S. Pouliot

It’s a routine day at the office and Dr. Christine Glavey of Alpharetta Dermatology is discussing acne with a teen patient. All of a sudden, she stops. She’s spotted something that takes this conversation to a whole new level. It’s no longer about pimples; she’s staring down a case of skin cancer. In a 16-year-old? It’s more common than most people realize, and it’s no longer a disease of the old and wrinkled.
     The incidence of skin cancer does appear to be increasing in a younger population, according to the U.S. Department of Health and Human Services (HHS). Patients still in their 20s and 30s are requiring treatment like never before. HHS reported roughly one million new cases of skin cancer are diagnosed each year, and the end seems nowhere in sight.
    “I do see a trend of skin cancer in a younger generation,” concurred Dr. Tiffani Hamilton of the Atlanta Dermatology, Vein & Research Center. “I’m seeing so many more cases of melanoma, the most dangerous form of the disease, in people in their 20s. It’s becoming a problem.”

Getting Burned
    The question is obviously why. Much of it has to do with behavior. “People are involved in more outdoor activities like tennis and biking,” pointed out Dr. Carl Washington, an associate professor at the Emory University School of Medicine and director of the cancer unit in the dermatology department. “It’s just part of our culture.”
     So not only are we more active outside than our counterparts, say, a century ago, we’re doing it under a sun that’s more relentless. “We’ve losing our protective ozone layer, which makes the sun more potent,” Hamilton noted. Compound this with the fact that we wear less clothing than our proper Victorian ancestors and you’ve got a recipe for disaster.
     But something else is going on that helps explain the abrupt rise in skin cancer in younger people. Years ago, researches found that the ultra violet light called UVB was responsible for sunburn. So it was assumed that UVB was the most dangerous form of radiation from the sun. Its sister ray called UVA was considered harmless. As a result, sunscreens were developed that prevented UVB from penetrating the skin. A rating system was created called SPF (Sun Protection Factor) that indicated the level of chemical screen contained in each type of product sold.
     There was just one problem. The researchers got it wrong. Within the last decade, it’s been discovered that while UVB does cause burning, it’s actually UVA that penetrates more deeply into the dermis, causing severe damage to the tissues beneath the surface of the skin. So deeply does it infiltrate the body, that it bypasses the external exposed skin, which is why you don’t see any signs of sunburn. But this intense radiation zapping by the sun is what leads to the incidence of skin cancer.
     What’s happening is that inside the body, a team of surveillance cells called Langerhans is circulating around in search of infections and viruses. If something is wrong, the Langerhans quickly notify the immune system to attack the offender and destroy it. “They tell the body there’s a need for some sort of reaction at the site,” Washington explained. “A tan is the skin’s increased reaction to DNA damage, producing more melanin in an attempt to protect itself from further damage. There is no such thing as a good tan.”
     As the body continuously experiences exposure to UVA, however, the Langerhans begin to lose their effectiveness. Their numbers die off and a person loses the ability to fight off cancer.

False Security
    The use of sunscreens has produced an odd outcome. Because people were confident that they were protected after applying them, they actually spent more time in the sun than they ordinarily would have, Hamilton noted. “They ended up with more exposure to UVA than ever before.”
This is particularly sobering for youngsters because 80 percent of skin damage occurs before the age of 18, Glavey said. “Parents are really dropping the ball. They think a rosy-cheek look in their children is cute. The whole problem is that it is attractive. There’s no question people do look good with a little color.” Coming home from a day at the beach with that sun-kissed look is certainly considered proof of an enjoyable day.
     Yet another phenomenon is taking place that has even more far-reaching and devastating effects in a younger generation. Enter the hazardous
world of the tanning bed industry. “The American Academy of Dermatology has been trying for years to get tanning beds outlawed,” Glavey said. “But it’s a fight. You’re looking at a $2-billion industry. It took until 2002 for the EPA to finally put tanning beds on their list of carcinogens.”
     There’s no question that use of tanning beds among the young has reached epidemic proportions. And the fallout is devastating. “Originally, tanning beds used UVB, but people were getting burned, so the industry stopped their use,” Glavey noted. “They switched to UVA, which eliminated the risk of a burn. It gave a much longer lasting tan. But it also did an incredible amount of permanent damage. I liken it to cigarettes. With each cigarette you smoke, you add to the damage in the lungs.”
     You can blame Hollywood for this inclination, Glavey continued. “Fashion dictates a tan. Years ago, if you had a tan, it meant you were of a lower socioeconomic status. It meant you were a farmer who worked in the fields. Parents wanted their girls to have a peaches and cream complexion, so they protected them. But then Coco Chanel came out with really dark tanned models and a trend was started.”
     Tanning beds became all the rage with teens anxious to mimic the look of supermodels and fashion icons. And just try arguing with a teenager already obsessed with their appearance and worried about fitting in with the crowd. The fear of potential skin cancer flies out the window. So convincing teenagers to discontinue their visits to the tanning salon may be an uphill battle. If tan is in, parents’ advice is out.

Slather It On
    As an alternative, young adults should consider the new sunless tanners. Today’s self-tanning potions are light years away from the old-fashioned lotions that left consumers looking slightly orange and streaked.
    “The tanners now are very nice and natural looking,” Hamilton pointed out. “You can put it on every day and it looks extremely natural. The new tanners have chemicals that bind to the protein of the skin to create a tanned look. Studies have shown them to have no harmful effects. The only problem is with sprays. I tell my patients to hold their breath so they don’t inhale them.”
     A more lasting solution may simply be to impress upon young adults the importance of the proper use of sunscreen. “Most people don’t put it on appropriately,” Hamilton said. “You need to apply it 20 minutes before you go out and then reapply every two hours, whether or not you go in the water. The container says it lasts all day. It doesn’t. You need a pretty heavy layer.”
     Most importantly, sunscreen should be incorporated into a daily hygiene routine, regardless of whether or not you plan to be outdoors. “People talk about wearing sunscreen on weekends when they’re out playing tennis or running around,” Washington added. “They ignore Monday through Friday, which means they’ve missed a tremendous opportunity for protection. If a young person has had skin cancer, they should wear sunscreen if they’re leaving the house and it’s not nighttime. That’s the only decision they need to make — is it day or night?”
     Even sitting at home can have ill effects, if you happen to be near a window. UV rays do go through most plate glass, even the windshield of a car.

Second Skin
    The other issue is finding a sunscreen that actually protects against UVA. “The only thing the FDA found that entirely blocks UVA is zinc oxide,” Hamilton said. “We recommend sunscreen that contains at least 7 percent zinc oxide.” While traditional sunscreens contain chemicals that bind to the skin to prevent penetration of UV rays, zinc oxide sits on top of the skin and reflects UV away. Therefore, it needn’t be applied 20 minutes ahead of time, a big plus when dealing with careless teens.
     What’s more, young adults no longer have to worry about looking like last decade’s lifeguard with a bright white nose. The new zinc oxide sunscreens blend in well enough to be invisible.
     One happy summertime side benefit is that parents shouldn’t fret if their kids roll out of the house dressed like a slob in an old T-shirt. They may actually be doing themselves a big favor. Apparently, the fibers swell in old clothes, leading to a better block against the penetrating effects of UV rays. Alternatively, parents can wash their children’s newer garments with an innovative laundry powder manufactured by Rit Dye that enhances the sun protection attributes of cotton.

Health Check
    But what if your child has done everything they shouldn’t have and now faces a case of basil cell or squamous cell skin cancer? Are they doomed? “Even if most of the damage for cancer occurs before the age of 20, a person can always have an impact on their future,” Washington affirmed. “The big issue is if by the age of 20 you already have basil cell cancer, it’s an indication your sun exposure is too great. It’s a predictor of an accumulation of further sun damage. But studies show that if someone begins to do the right things, they lower their risk.”
     No studies to date link the incidence of skin cancer with other types of internal cancers. While melanoma, the most serious form of skin cancer, is fatal if left untreated, other types should be viewed as a wake-up call in young adults. Being proactive goes a long way in preventing serious problems later on. “It just takes a second for a doctor to look at your skin and tell you if you’re OK,” Glavey stressed. “Skin cancer is a type of cancer you can see, unlike others.”
     Younger generations should ensure they get regular checkups with a dermatologist. Vigilance and precaution are the best ways to avoid skin cancer at any stage in life.