BERKELEY HEIGHTS, NJ – As we are all out enjoying the warmth of the summer while simultaneously trying to stay cool from the excessive heat, we are also busy catching waves and soaking up rays. As we frolic on the beach, enjoy outdoor sports, and tend to our gardens, we do not realize the impact as the sun beats down on our skin.
"It’s OK," we reassure ourselves with a false sense of security. "I’ve applied my sunscreen."
Sunscreen helps, but it alone is no match for the biggest star in our galaxy, that flaming ball in the sky, our sun.
The radiance from its beams offers challenges and dangers to our skin as we delight in our activities and spent our recreational time basking in it.
And the sunscreens, those veils of protection, which we rely on to guard our dermal layers, may not be doing the job some manufacturers assure us they will do.
Or worse yet, we may decide to do without, and forgo the sunscreen entirely. "It’s OK," we reassure ourselves again. "It’s only one time."
What many may not realize is an innocent day relaxing in the sun, or in the water (water absorbs light) can contribute later to skin cancers, including the deadly melanoma variety.
Additionally, year round, we deal with an onslaught of ultraviolet rays, even in the wintertime as it reflects off the snow onto our skin.
Plus, according to Dr. Naheed Abbasi, a Dermatologist with Summit Medical Group in Berkeley Heights, NJ, we absorb incidental ultraviolet rays throughout the day, as we sit in our cars during our commutes.
"We are all under a constant barrage of ultraviolet exposure, regardless of our skin type," said Abbasi.
Abbasi said a cumulative exposure to sun over a lifetime, rather than short exposure, increases vulnerability to skin cancers. Up to 75 percent of a person’s lifetime sun exposure comes during the first 25 years of life.
She suggests a daily and routine application of sunscreen and regular annual skin care exams as part of a person’s skin care regimen. Adults over the age of 18 should see a dermatologist once a year for a screening. Abbasi said a skin screening is typically covered by insurance.
Skin cancers tend to appear in a person’s 40’s or 50’s, although Abbasi has seen it appear in patients age 40 and younger.
Some Facts About Skin Cancers
A study from the Archives of Dermatology shows 2 million Americans develop non-melanoma skin cancers annually, which may manifest itself in the form of a non-healing sore or an uneven mole. These skin disturbances may be caused by basal cell carcinoma, which is non-deadly but can damage the skin and its surrounding areas. There has been an increase in this type of cancer of 4.2 percent this year over last year.
Melanomas, on the other hand, can have deadly consequences. They are less common than the average skin cancer, but cause 75 percent of deaths from skin cancer.
Abbasi said the greatest danger with melanomas is they spread more readily than the non-melanoma varieties, making them the most deadly.
"Melanoma is a big deal, it is a fatal form of cancer," she said.
New Jersey ranks higher than the national average in terms of melanomas. In a 2006 analysis of United States Cancer Statistics (USCS) by the Centers for Disease Control and Prevention (CDC), 21.4 percent of the cases of melanomas of the skin were recorded per 100,000 people. The national average was 18.2 percent per 100,000.
New Jersey is one of the top 13 states in the nation for incidences of melanomas.
Per New Jersey’s State Cancer Profile from the National Cancer Institute melanomas of the skin are especially in an upward trend in Burlington County. Burlington County is the largest county of the state, stretching across the lower half of New Jersey from the Delaware River to the Atlantic Ocean.
Abbasi said in her own practice most of the cancers she encounters are non-melanoma types, in the form of basal or squamous cell skin cancers. According to the American Cancer Society, basal cell carcinoma comprises 8 of 10 skin cancer cases and squamous cell, 2 of 10. Basal cell grows slowly, does not usually spread to lymph nodes, and may return in the same place where it was removed. It can deepen to fatty tissue and bone, if not treated. Squamous cell usually manifests on the face, and back of hands, and are more aggressive. They may migrate to lymph nodes, fatty tissues and other parts of the body.
"Most think cancers come in the form of a funny looking mole," said Abbasi. But this may not always be the case. Oftentimes, Abbasi said, patients will come in complaining of a persistent, reddish, scaly patch they have difficulty treating. This can be a sign of a pre-cancerous skin condition or skin cancer.
Regarding the higher incidence of skin cancers in New Jersey versus other states in the nation, Abbasi said, "There is no good data to explain the higher incidence." However, based on trends, and Abbasi’s clinical experience, she said one factor may be the higher use of tanning beds in New Jersey, as well as the state’s proximity to the ocean. The intermittent and intense sun exposure from both of these sources could be major contributors, Abbasi said.
About Ultraviolet (UV) Light
The CDC reports, "Research shows that most skin cancers can be prevented if people are protected from UV light."
UV radiation, as described by the Skin Cancer Foundation, derives from invisible wavelengths from the sun. There are three types: UVA, UVB, and UVC. UVA and UVB are the only ones people need to be concerned about; UVC rays are blocked by the earth’s ozone layer.
UVA is a longer type of ray than UVB. UVA radiation comprises 95 percent of the total. They are not as strong as UVB, but they are 30 to 50 percent more common, and sneak their way through clouds, and glass.
UVA rays are more responsible for wrinkling, and for damaging skin cells in the deeper layers of the skin, where skin cancers are typically born.
Tanning results from overexposure to UVA rays and, the change in our skin tone is due to injury from the UVA exposure.
Here enters UVB rays, the culprit for sunburn. These are also helper rays for skin cancer and also contribute to some tanning and photoaging, or premature aging to the skin from sun exposure.
Both of these rays not only raise the levels of premature aging to the skin and skin cancers, but they hamper the immune system, lowering its defenses against premature aging and skin cancers.
If a person is looking for the lesser of two evils, UVA and UVB rays are equally dangerous. UVA rays may tan, but they also penetrate the skin to its deepest levels of the dermis.
"UV radiation causes DNA damage after a certain level, and gives way to the carcinogenic," said Abbasi.
Tanning Salons as an Equal Danger
People may have an additional false impression of tanning salons being a safer alternative. On the contrary, tanning booths essentially crank out ultraviolet rays 12 times greater than the sun.
Abbasi said young women under the age of 30 are typically led to tanning salons. "They go to get color and look healthy and they tell me they know they’re not supposed to be doing it," Abbasi said.
At the same time, she describes the tactics of tanning salons as sneaky. "They are not portraying the risks as they should." Additionally, tanning salons may try to state there are benefits by using the beds, and how tanning improves Vitamin D synthesis.
"I tell patients there are no true benefits, and Vitamin D synthesis can come from taking in casual sunlight while coming in or out of the store, or getting in and out of a car, and through diet, and supplementation," Abbasi said.
In sum, about tanning beds, she said, "They expose people to unhealthy doses of UVA and UVB rays and the melanoma risk increases 75 to 90 percent."
Abbasi tells patients a safe alternative to tanning beds are the spray tans, performed often by many salons. "They are perfectly safe and a nice idea."
How Do People Protect Themselves From UV Rays?
The Skin Cancer Foundation suggests a sunscreen with a Sun Protection Factor (SPF) 15 or higher. Fifteen means it will take 15 times longer for the skin to get redder than it would without sunscreen, and it blocks 93 percent of the UVB rays.
Abbasi recommends an SPF level minimally at SPF 30 or higher. She urges patients to use a facial moisturizer with an SPF 15 and in the summer, even higher, with SPF 30. The products she advocates the most includes those by Aveeno and Neutrogena.
To effectively block the sun, UVA and UVB protection is the best bet. Ingredients such as Avobenzone, Ecamsule (Mexoryl), Oxybenzone, Titanium Dioxide, and Zinc Oxide provide sun-shielding properties.
The Environmental Working Group (EWG), a team of researchers, thoroughly investigated the sunscreens on the market. They, however, are opposed to the use of Oxybenzone and Vitamin A sunscreens because of their hormone disrupting properties. They give a thumbs up to sunscreens with Zinc and Titanium Dioxide.
They relegate some particular brands of sunscreens in their "Hall of Shame": those which come in a powder form, or have high SPF’s of 50 to 100 when they do not offer the protection they claim, or have contradictory labels (for example a sunscreen product for babies, claiming mildness but having warnings to keep out of reach of children).
Overall, they rate many of the popular sunscreens on the market for their effectiveness, claims and other health concerns they may present.
Abbasi said the SPF does matter; however, a sunscreen must protect against UVA and UVB radiation. She noted that there are products on the market with SPF’s up to 100.
A consumer may also prefer a sunscreen which is clear when applied, for example, or may shun those which apply filmy or white to the skin. Abbasi said it is up to the consumer to find the sunscreen they are most comfortable with.
In any case, Abbasi advocates sunscreen application every two to three hours (first apply a half hour before going outdoors), as the sunscreen sweats off, or comes off in the water. She said to carry the sunscreen with you and reapply.
Other tips for sun protection include: avoiding the sun between 10am and 4pm when it is the strongest and wearing an attractive wide-brimmed hat, cotton and linen clothes or sports clothing with UV protection in the fabric, and UV blocking sunglasses.
"The key is to find strategies that don’t cramp your style," Abbasi said. "Doctors don’t tell people to be hermits and hide indoors. Being in the sun and outdoor exposure is a normal part of life and we recognize that. A doctor’s job is to mitigate those risks and promote smart living."