FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

PALE SKIN TODAY MEANS LESS CANCER TOMORROW

Question: It seems like I'm constantly badgering my teenage daughter to use sunscreens or to stay out of the sun because I'm afraid that she will get cancer. She says that she rarely burns and that a tan actually protects her skin from sun damage. What is the truth?

Answer: The skin is the largest organ of the body, and it is as essential for life as the heart or the lungs. Limiting your sun exposure is practicing preventive medicine just as surely as controlling your cholesterol reduces the risk of heart disease.

Light from the sun and tanning beds works the same way. It penetrates the outer thickness of skin and produces irritation of the deepest skin layer where new cells are growing. The ultraviolet wavelengths of light are able to do this most easily, so they produce the majority of the irritation. As a response to the ultraviolet light, melanin, the pigment which darkens the skin, is produced. This dark pigment is incorporated into the new cells as they grow and rise to the surface. When there are enough of them, these cells help block the ultraviolet light and keep it from penetrating to the deep growing layers. You and I call this melanin-rich skin a "suntan," and your daughter is correct. The increased amount of melanin does limit the damage the sun can do to the skin.

The damage to skin caused by sun exposure may take 20 or more years to appear. The skin loses some of its elasticity and becomes leathery and wrinkled. A good example of this is the skin on the back of the neck of a farmer or someone who spends many hours out in the sun. Your daughter may want to consider the importance of her tan today in context of how she may feel with leathery skin at age 45. If you spend a lot of time in the sun or at the tanning parlor, this is a real possibility.

In addition to wrinkles, sun exposure is directly related to the development of skin cancer. Just as with wrinkles, it takes years for the cancer to form. One severe childhood or adolescent sunburn doubles the chances of developing skin cancer as an adult. Because our society in the last 50 years has developed a love affair with suntans, we are now experiencing a "skin cancer epidemic." There are currently more than 600,000 new cases of skin cancer reported each year, and the numbers will continue to increase as long as individuals value having a suntan.

Sun exposure also produces even more frequently than cancer raised rough-surfaced skin lesions called actinic or "solar" keratosis. Fortunately, these are not associated with any life-threatening health condition, but they sure are ugly.

Question: Will using sunscreen keep my daughter from getting these skin problems?

Answer: The regular use of sunscreen products from the age of 1 to 18 cuts the risk of developing skin cancer by 78 percent. Most serious sun damage is done in those years and the consequences show up by middle age as wrinkled, old-looking skin, skin cancer and actinic keratosis. The American Academy of Dermatology recommends that fair-skinned individuals always use a sunscreen with a sun protection factor (SPF) of at least 15. This extends the time you can be exposed to the sun without burning by 15 times. If you would normally burn after 20 minutes on the beach, you can stay out for 5 hours (15 x 20 = 300/60 = 5) before burning when you apply a 15 SPF factor sunscreen. The sunscreen should be reapplied after heavy perspiration, swimming, or toweling off to maintain adequate protection.

In my grandfather's day sunscreen products weren't available. His technique for sun avoidance still works today. He covered his skin with a tight-knit fabric! He wore a long-sleeve shirt, winter or summer, and shaded his neck with a wide-brimmed hat.

I guess the decision about tanning is ultimately your daughter's, not yours. If she can be content to be pale today, she increases her chances of living a healthy life tomorrow.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.