May is Melanoma/Skin Cancer Detection and Prevention month. Dr. Dennis Morgan, MD weighs in on the SERMO poll, showing 64% of physicians believe there is no such thing as a safe tan.
~ Dennis Morgan MD
Apollo was the god both of medicine and the sun(1). The sun’s warmth and light makes us feel good and generates our native vitamin D. But the ultraviolet rays in sunlight are carcinogenic and can be as deadly as alien death rays — they just take longer. All too often the injury is self-inflicted. This makes human behavior the most common cause of skin cancer and of death from melanoma.
In the United States the incidence of melanoma is slowly rising despite efforts at public education. The number of deaths anticipated for 2015 approaches ten thousand(2). Factors leading to skin cancer include genetic susceptibility for melanoma and, for skin cancer in general, chemical exposure (including drugs) and HPV infection . But for most skin cancers it is exposure to excessive amounts of ultraviolet (UV) rays, whether from natural or artificial source, that plays the biggest role. And our degree of Sun exposure is almost always a matter of choice.
As to choice, the wrong one is typically driven by vanity, ignorance or hubris. People know not to stare at the sun or they’ll go blind. But some of these same people will over-expose their skin to the sun’s rays purposely to get a tan or neglectfully out of ignorance. Yet others, teens and young adults I would suggest, seem to think they are invulnerable. Because of the long duration needed for malignant transformation from sun exposure, most people have trouble heading the warning.
We need to treat the risk of melanoma the way we would a terrorist threat — “If you see something, say something.” This simple dictum when headed can lead to cure, as with a member of my own office staff. Ignoring the clues invites disaster, as with the husband of one of our hospital’s nurses. He was diagnosed shortly after the honeymoon with a fatal nodular melanoma the size of a gumdrop. Any number of times I have noticed someone on live television where I wanted to yell out, “hey that pigmented lesion needs attention!.”
Every doctor’s office would do well to post a picture of the ABCDEs of melanoma detection — Asymmetry, Border irregularity, Color, Diameter and Evolution(4). (See Figure). In the office, at the beach or in line at the grocery store be alert. Your knowledge of how to identify and prevent skin cancer can save lives — but only if shared. And, as it turns out, Apollo was also the god of knowledge.
An expert from the National Cancer Institute recently stated on the American Cancer Society web site(3) “If you read no further, know this: there is no such thing as a safe tan. … A tan is the body’s response to injury from UV rays. … every time you engage in … tanning, you increase your risk of melanoma.”
64% of SERMO physicians agree with this statement, that there is no such thing as a safe tan. However, 36% voted that “… a little glow will not hurt you as long as it is done with appropriate safety measures such as sunscreen”(5).
As to safety measures, prevention tips by age and occupation are available from the American Academy of Dermatology’s “Spot Skin Cancer” web site(6). These include use of water-resistant sun screen (SPF 30+) that is broad spectrum (blocking UVA and UVB rays) to be applied every two hours; avoidance of peak sun intensity (10AM-2PM) with caution near reflective terrain (water, snow, sand); and use of hats, sunglasses and shaded areas. The EPA issues UV alerts that can inform decisions about exposure according to time, date and location(7). In any case avoid tanning beds and don’t burn!!
Do you think physicians offices should play a prominent role in preparing patients for a safer pursuit of that “little glow”?
Dennis Morgan, MD is Assistant Clinical Professor University of Connecticut Health Center, Emeritus Staff Johnson Memorial Hospital and Medical Center Stafford CT and Past President Connecticut Oncology Association as well as Past Medical Director Phoenix Community Cancer Center, Enfield CT