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."