Expat Life

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.

Article continues below graphic.

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
  1. A spot or sore that continues to itch, hurt, crust, scab, erode, or bleed
  2. 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.


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


  • LadyMoon

    Melanoma is a really ugly way to die. I have that visual from holding my brother’s hand as he died from Melanoma in 1983…so I am a total nut case about tanning! This is so important, I hope everyone (especially here in the high mountains) reads it.

    • HI Lady M.
      so sorry about your brother. It appears that melanoma is one of those diseases that may have a genetic component, but there are precautions we can take to protect ourselves. Kinda like smoking. Some people never smoke a cigarette in their life, but get lung cancer. But smoking is the number one cause of lung cancer.

  • sueb4bs

    Important information –What happens as you age, sad to say, is that the lovely tanned face from your youth turns to deep facial wrinkling. I regret my so-called Mediteranean skin ( I don’t have pale, ‘English skin’) I became very wrinkly and all the microdermabrasions and treatments today don’t work, IMO.
    Asi es la vida…

  • A reader shared his recommendation for BanxBlock. It looks like a great product, broad-spectrum, without nano particles, developed by a board-certified skin surgeon who practices in the Outer Banks of North Carolina. more info here: https://outerbanksvoice.com/2014/08/12/obx-physician-creates-a-natural-skin-friendly-sunscreen/

  • LadyMoon

    I know of no other person in my family who has died of skin cancer…everything else! but not that. It’s suspected his was as a result of Agent Orange exposure (“it was all over the…I waded thru it” he said) in Vietnam. He and many others will never be on The Wall….

    • Angelica Barrett

      So, so sorry. All of us have been told lies about the reality of war.

  • This is a timely article for us seniors, Susan. I have had several skin cancer surgeries for squamous cell cancer on both legs, both in US and EC, over 8 years.
    My IESS oncology surgeon is a wonderful Ecuadorian, Dr. Willan Ortiz. Can’t say enough about the care I receive from him, the nurses in “Recuperacion,” and surgery staff-major and minor.
    When you begin to notice a sore that causes pain, and won’t heal, meet with a dermatologist, and maintain a bimonthly consultation.

  • Actually it has nothing to do with tanning. It has to do with a lack of collagen. I had many burns as a child but barely a wrinkle since I supplement with collagen.

    • Skin cancer. Cancer. From overexposure to the sun. Protect yourself. Your “N of 1” is irrelevant to this conversation. From ScienceBasedMedicine.org (a website that takes no advertising) “Collagen is a protein: a triple-helix, long chain protein. It’s the product of an elaborate synthesis process that occurs throughout the body. When we consume collagen, usually in the form of food, the long chain proteins are broken down during digestion to their original amino acids. Only then can they be absorbed. Once absorbed, these amino acids are available as building blocks to support collagen synthesis throughout the body. So from a dietary perspective, your body doesn’t care (and can’t tell) if you ate a collagen supplement, cheese, quinoa, beef, or chick peas — they’re all sources of protein, and indistinguishable by the time they hit the bloodstream. The body doesn’t treat amino acids derived from collagen any differently than any other protein source. For this reason, the idea that collagen supplementation can be an effective treatment for joint pain, osteoarthritis, or any other condition, is highly implausible, if not impossible in principle.”

    • sueb4bs

      Always one in a crowd who knows EVERYTHING …In my case, dear reader, it has EVERYTHING to do with tanning and burning and we all know collagen is an issue for all skins past 60 or maybe earlier.

  • LadyMoon

    Susan…I spent several years in my teens broiling (literally with olive oil) in the south Arkansas summer sun. I got very dark, but having to work the rest of my summers, haven’t done it since. And…my skin (for my advanced age!) ain’t too bad re: wrinkles. For wrinkles, isn’t there a major genetic component?

    • Not so much a “major genetic component” but your risk for burning depends on many factors, including your own skin type which, of course, is dictated by genetics. People burn or tan depending on their skin type, the time of year, and how long they are exposed to UV rays. The six types of skin, based on how likely it is to tan or burn, are—

      Always burns, never tans, sensitive to UV exposure.
      Burns easily, tans minimally.
      Burns moderately, tans gradually to light brown.
      Burns minimally, always tans well to moderately brown.
      Rarely burns, tans profusely to dark.
      Never burns, deeply pigmented, least sensitive.
      Although everyone’s skin can be damaged by UV exposure, people with skin types I and II are at the highest risk.

  • Andrew

    The country with the highest rates of skin cancer is Australia. The more exposure to sunlight and it’s elements means more cancers, period. The Squamous type are most easily detected and therefore treatable because they usually occur in a visible area i.e. face. To cause real harm they have to flourish in that area and eventually breach the brain blood barrier to metastasize to other parts of the body.
    The melanoma cells especially in a mole are the most deadly. Most people don’t see the change in the mole or dismiss it as not very important. The single most effective treatment is surgery to remove the mole and any spread of infection from the area. If you have a body that already has a number of moles or on areas that get rubbed i.e. shirt collar you are the most vulnerable. You need a monthly , usually assisted checkup. Most other cancers start locally ,grow , spread in the body but have to have penetrate the blood brain barrier. Because of body changes in the womb , moles do not have to go through that barrier. They are literally the highway to hell. Five year survivability rates are Zero and death usually occurs much sooner. There is no cure. Lung and breast cancer get the money and attention because of the number, treatability and emotional impact. Numbers are low with melanoma but far more deadly. Recognize how serious this problem is and institute a regular check up routine. Its one thing to see a loved one die it’s another to watch yourself die