Made In The Shade: Keep Sun Exposure At A Minimum To Prevent Skin Cancer

June 3, 2003

(The Los Angeles Daily News) -- Worship shade. That's the message from those party poopers, the dermatologists, to all would-be sun gods and goddesses.

Cover up. Bathe in sunscreen. Remember as you head out to Memorial Day beach parties and barbecues that sun is not your friend.

"The sad state of affairs is that people don't get serious about sun protection until they have skin cancer," said Dr. Jeff Ashley, a dermatologist with Providence St. Joseph Medical Center in Burbank. "Just like smokers don't quit until they have lung cancer."

Every year, more than 1 million Americans are diagnosed with skin cancer, the most common type of cancer in the U.S. Of even greater concern to dermatologists is that incidents continue to rise. Since sun damage is cumulative, prevention efforts need to start with children. Most of the damage, anywhere from 50 percent to 80 percent, occurs by the age of 18.

"You're adding all the sun you've been exposed to since you were born -- the hour when you were 10 years old playing basketball, the hour when you were 20 years old at the outdoor mall," said Dr. Michael Lin, a dermatologist with Encino-Tarzana Regional Medical Center. "By the time you're 50 or 60, that's a lot of sun. The more you can avoid, the better."

GOT IT COVERED?

The problem is people think they can dab on a little sunscreen and then tan away. However, sunscreen only slows but does not prevent damage to the skin. And most people use only a quarter of the amount of sunscreen needed to receive the protection stated on the bottle. A sunscreen with a sun protection factor of 15 will be closer to SPF 3 unless it's applied liberally, Ashley said.

"If you cup your palm, you have to fill it up just to cover your face and neck," he said. "You have to glop it on."

In response to having the highest skin cancer rates in the world, Australia has promoted sun safety in its schools. The slogan, "Slip! Slap! Slop!" reminds Australian children to slip on a shirt, slap on a hat and slop on sunscreen, Ashley said.

Ashley recently started a program called Sun Safety for Kids www.sunsafetyforkids.org , urging parents and schools to make sure children limit their sun exposure. Ashley wants to see schools encourage use of hats, sunglasses and sunscreen at recess and lunch breaks. Picnic tables and playground equipment should be placed in shaded areas, he said.

Dermatologists say avoiding the sun at peak hours is the most important tactic in the effort to prevent skin cancer. Ultraviolet rays are most intense between the hours of 10 a.m. and 4 p.m. Next, doctors recommend covering up as much skin as possible. Wear lightweight long-sleeve shirts with collars and pants. And don't forget a wide-brimmed hat or legionnaire's cap - the kind with a flap over the neck. Sunscreen should be applied to any areas not covered by clothing.

Don't like the greasy feel of regular sunscreen? Look for moisturizers and makeup products that contain sunscreen. Sunscreen gels and sprays also tend to be less greasy, Lin said.

People about to embark on an outdoor trip or who are at high risk for skin cancer should consider purchasing sun-protective clothing. Makers of such clothing use fabrics with a tighter weave to block more ultraviolet rays. Laundry rinses available in many drug stores and supermarkets can give all clothes more protection from ultraviolet rays, Lin said.

When choosing sunglasses, don't go by color or cost. The American Academy of Ophthalmology suggests looking for labels that promise 99 percent to 100 percent protection from ultraviolet rays, both UV-A and UV-B. Sunglasses should wrap to your temples to keep UV rays from entering from the sides. While polarized sunglasses cut down on glare, consumers should still check to make sure the glasses offer full UV protection.

Sun exposure can damage the eyes by causing the outer layers to degenerate. Wearing sunglasses also protects the eyelids from skin cancer. The lower eyelid is more prone to skin cancer. Any tumors found there should be caught as early as possible to minimize the reconstruction process, said Dr. Mark Baskin, an ophthalmologist at Encino-Tarzana Regional Medical Center.

SUSPICIOUS GROWTHS

Preventive efforts also should include annual skin checks from head to toe, dermatologists say. About 70 percent of skin cancers are basal cell. They often appear as either reddish patches, pink growths with crusted indentations at the center, or a shiny translucent bump. About 20 percent are squamous cell. Squamous cell growths resemble warts and often crust or bleed. Reddish or skin-colored scaly patches that persist can evolve into squamous cell cancers.

While basal and squamous cell carcinomas are the most common, the odds of the tumors metastasizing are low. Still, they can't be ignored. People who wait too long risk losing large areas around the growth, such as parts of their noses and ears, said Dr. Han Lee, assistant professor of dermatology at the University of Southern California Keck School of Medicine.

Melanoma, the most deadly and feared form of skin cancer, is among the remaining 10 percent. Melanoma can be cured if caught at an early stage. Only about one-third of melanomas evolve from moles, Lee said.

When examining moles for potential cancer, dermatologists cite the ABCD rule:

- Asymmetry, where one side of the mole is unlike the other.

- Borders that are ragged.

- Color that varies.

- Diameter greater than that of a pencil eraser.

With so many outdoor activities beckoning in Southern California year-round, Lee knows most people would rather live in ignorant bliss. While she doesn't want to scare people from leaving the house, she'd like to see sun protection become habitual.

"Being in Southern California, I don't tell people not to enjoy life. Just be smart about it," Lee said.