There’s no such thing as the perfect tan

If I were to enter a contest to see who has the highest risk for skin cancer, I might win. Thumbs down. My risk factors include:

Lighter natural skin color; skin that burns and freckles easily, blue or green eyes, blond or red hair. Check all of the above. Born blonde with blue eyes, they called me “freckle-faced Burke.”

Family history. Check. Both my parents had/have multiple squamous cell carcinomas, a form of skin cancer that develops in the cells of the outer layer of the skin, treatable with topical medications and surgery.

Excessive sun exposure. Check. When I was a kid growing up on Long Island, the summer sunburn was something we all expected, and wore like a badge of honor.  Moving to South Florida in my late teens, I stayed tan year-round until I finally wised up.  But not until my late 20s.

Tanning beds. Check. A.K.A. Stupid behavior. When I was 28, I was set to visit Hawaii on a business trip. By this time, I’d moved back to Manhattan, and in January, I was my natural, pasty white color.  I decided I needed to be tan.  So, I visited an indoor tanning salon a few times to assure (myself) that I’d look great.  That was a really dumb idea, because my skin, according to the Centers for Disease Control and Prevention (CDC) is classified II: Burns easily, tans minimally.  Well, I knew that.  But what price vanity?  Read more here to learn about the six types of skin, based on how likely it is to tan or burn.

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But being tan looks healthy, right?  Nope. The Skin Cancer Organization reports that there is no such thing as a “good” tan.  They say, “A tan, whether you get it on the beach, in a bed, or through incidental exposure, is bad news, any way you acquire it. Tans are caused by harmful ultraviolet (UV) radiation from the sun or tanning lamps, and if you have one, you’ve sustained skin cell damage.No matter what you may hear at tanning salons, the cumulative damage caused by UV radiation can lead to premature skin aging (wrinkles, lax skin, brown spots, and more), as well as skin cancer.” They also report, “Using a tanning bed before age 35 increases your risk for melanoma by 75 percent.”

Excessive Moles. The only risk factor not applicable to me, the American Cancer Society (ACS) says that babies are not usually born with moles — they typically appear in children and young adults.  However, people with irregular or large moles have an increased risk.

SkinCancer.org says, “If you spot it, you can stop it.”

According to the ACS:

The 3 main types of cells in the top layer of the skin (called the epidermis) are:

Squamous cells: These are flat cells in the outer part of the epidermis that are constantly shed as new ones form.

Basal cells: These cells are in the lower part of the epidermis, called the basal cell layer. These cells constantly divide to form new cells to replace the squamous cells that wear off the skin’s surface. As these cells move up in the epidermis, they get flatter, eventually becoming squamous cells.

Melanocytes: These are the cells that can become melanoma. They make a brown pigment called melanin, which gives the skin its tan or brown color. Melanin protects the deeper layers of the skin from some of the harmful effects of the sun. For most people, when skin is exposed to the sun, melanocytes make more of the pigment, causing the skin to tan or darken. Melanoma is much less common than basal or squamous cell cancers, but it is more dangerous because it’s more likely to spread to other parts of the body if not caught early.

Both BCC and SCC are directly correlated with sun accumulation over many years, and the most common locations are areas that are typically exposed to the sun, including the face, ears, hands, and legs, although it’s possible that these cancers may appear on non-sun-exposed areas.

Melanoma, when caught early, has a very high cure rate, about 95%.  Each of the cancers appear differently, and none may be painful or even bothersome.  However, if you spot any of the signs, see your dermatologist right away.

1. A skin growth that increases in size and appears pearly, translucent, tan, brown, black, or multicolored

• A mole, birthmark, beauty mark, or any brown spot that:
• changes color
• increases in size or thickness
• changes in texture
• is irregular in outline
• is bigger than 6mm or 1/4″, the size of a pencil eraser
• appears after age 21

2. A spot or sore that continues to itch, hurt, crust, scab, erode, or bleed
3. An open sore that does not heal within three weeks

So, today I’m cautious in the sun, but a visit to my dermatologist reminded me that here in Cuenca, we need to be especially mindful of the sun. At 10,000 feet you’re exposed to 50% more ultraviolet (UV) than at sea level.  UV is one of the main causes of skin cancer.

The Dana-Farber Cancer Institute interviewed Dr. Jennifer Lin, who specializes in melanoma detection and treatment.  Click here for her sun safety tips.

Dr. Lin said that the UV index — a measure of the strength of ultraviolet radiation from the sun — is more important than elevation when it comes to skin safety. Depending on the time of year and latitude, the UV index will vary. I downloaded a UV Index app on my iPhone, and see that in Cuenca, the warning is “11-Extreme.”  Guayaquil is “5-High” and Quito, like Cuenca, is “Extreme.” See different smartphone apps for monitoring UV index here.

Regardless of your skin tone, the most important step to staying safe from the sun is to avoid getting burned.  Although some sun is helpful for vitamin D production, it should never be long enough to turn your skin pink. Learn more from the Vitamin D Council about how much sun is safe at different latitudes and times of year here.

As the American Cancer Society reports, most types of skin cancer can be cured if diagnosed early.  Dermatologists recommend a monthly full-body self-exam … for everyone. But especially if you:

Have a history of skin cancer, for you or for your family

Are currently tan, or have a history of tanning, and especially burning.

You use a sunscreen now, but didn’t when you were younger.

How to do a thorough self-exam.

The best time is just after a bath or shower.  Find a bright room with a full-length mirror in the room.  Get a partner or friend to help with your back, the back of your head and neck, and your scalp.

Face the mirror: first check your face: use a hand-held mirror to really look closely.  Look at your neck before checking your arms and shoulders. Women, lift your breasts to check beneath them.

Look underneath your armpits and both sides of your arms.  Check the tops and palms of your hands, between your fingers, and fingernails.

Sit down and check front of the thighs, tops of feet, between the toes, and toenails.  While sitting, use a hand mirror to check the bottoms of the feet, calves, and back of the thighs.

Then use the hand mirror and check your rear end, genital area, lower and upper back, and back of the ears and neck (a partner is really helpful here.)  If you don’t have a partner, stand with your back to a wall mirror using a hand mirror and take a comb or hair dryer to part your hair and check your scalp.

Sources

The American Cancer Society has a very comprehensive ‘how to’ page, with instructions about what to look for and photos and illustrations that allow you to really understand what ‘abnormal’ looks like.  Remember, if you spot it, you can stop it.

American Cancer Society. Skin Self-exam Gallery. https://www.cancer.org/cancer/skin-cancer/galleries/skin-self-exam-gallery.html

American Cancer Society. What is melanoma skin cancer? https://www.cancer.org/cancer/melanoma-skin-cancer/about/what-is-melanoma.htm

Centers for Disease Control & Prevention. What are the risk factors for skin cancer? https://www.cdc.gov/cancer/skin/basic_info/risk_factors.htm

DailyBurn.com. 5 Sun Safety Apps for Monitoring UV Index. http://dailyburn.com/life/tech/sun-safety-apps-for-uv-index/

Dana-Farber Cancer Institute. Five tips for staying safe in the sun. http://blog.dana-farber.org/insight/2014/07/five-tips-for-staying-safe-in-the-sun/

SkinCancerFoundation.org. Even one pre-prom tan can be dangerous. http://www.skincancer.org/prevention/tanning/prom
SkinCancer.org. If you can spot it, you can stop it. http://www.skincancer.org/skin-cancer-information/early-detection/if-you-can-spot-it-you-can-stop-it

Vitamin D Council. How do I get the vitamin D my body needs? https://www.vitamindcouncil.org/about-vitamin-d/how-do-i-get-the-vitamin-d-my-body-needs

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