Safety in the Sun: How to Protect Your Kids From Skin Cancer

More teenagers and young adults are being diagnosed with skin cancer than ever before. This includes a rise in the deadliest form of skin cancer — melanoma. Dr. David Leffell is professor of dermatology at the Yale School of Medicine and author of the book, “Total Skin,” and on NBC’s “Today” show, he offers some advice on how to identify and protect yourself and your kids from the harmful affects of the sun. Read some of his tips below.

WHY ARE WE SEEING MORE CASES OF SKIN CANCER IN PEOPLE IN THEIR TWENTIES AND THIRTIES?

Not only do children and teenagers spend a lot of time outdoors, teenage girls especially often frequent tanning parlors which cause the same damage as natural sun. Even without tanning parlors, children spend about three times as much time in the sun as do adults. Young people want to look glamorous and sexy so they imitate their pop-stars like Britney Spears and others, who all look tan. Just yesterday, I saw three teenage girls oiling themselves with baby oil at the pool — no sunscreen, just oil in the belief that it will speed up the tan — it’s tough to get the message about cancer across since kids, as we all know, are immortal.
In addition to melanoma, we’re starting to see an increase in a form of pre-skin cancers called actinic keratosis. This is important because it’s a sign of serious sun damage and risk of getting true skin cancers.

ARE CHILDHOOD SUNBURNS TO BLAME?

Sunburn in childhood — when we are estimated to get about 80 percent of our lifetime sun exposure — is considered a key risk factor for melanoma, the most dangerous kind of skin cancer, because it can be lethal. Just one blistering sunburn in childhood is estimated to double the risk of getting melanoma later in life. The flip side of this is that if we can prevent sunburns in kids, skin cancer and death from skin cancer should decrease. The Australians have already made progress in this way.
People who burn easily in the sun, who lack natural pigment protection, are most at risk for skin cancer.

WHO IS MOST VULNERABLE TO SKIN CANCER?

People who burn easily in the sun, who lack natural pigment protection, are most at risk for skin cancer. Typically, people with fair skin, blonde or light-colored hair, green or blue eyes and people who freckle easily are at greatest risk. But people with darker complexions aren’t out of the woods. Skin cancer can occur in people of Hispanic background as well. Certainly, people who have had a family member with melanoma should pay special attention to sun protection.

EVEN IF YOU TREAT SKIN CANCER SUCCESSFULLY AT A YOUNG AGE, CAN THAT INCREASE YOUR CHANCES OF GETTING ANOTHER SKIN CANCER LATER IN LIFE?

People who have had one non-melanoma skin cancer have a 40 percent chance of getting another one and certainly if you have had melanoma you are at increased risk for getting another one later in life.

WHAT ARE SOME OF THE WARNING SIGNS?

These are general guidelines — really flashing yellow lights that should cause you stop and get your growth checked out. These can be a sign of any type of skin cancer. Bleeding is not normal. If you have a bleeding mole, pick up the phone and call your dermatologist immediately.
If you have a sore that appears and heals up, the assumption is that it is gone — and we all want problems to be gone. But if a sore reappears in the same place, make sure it is not a skin cancer.

ANOTHER THING YOU LOOK FOR IS CHANGES IN COLOR, SHAPE AND TEXTURE. CAN YOU TAKE US THROUGH THE A,B,C AND D’S OF IDENTIFYING ONE?

In some ways, skin cancer offers you a way to take charge of your own health because you can see the problem developing. That isn’t the case with other conditions like high blood pressure, or diabetes. So take advantage of the fact that when it comes to skin cancer you can be the first line “doctor.” Just pay attention to any of the following changes in skin growths:
Melanomas can be...
ASYMMETRIC: That means that if you look at the growth and imagine it folded in half, the sides wouldn’t match.
BORDER: Look at the edge of the mole. Is it smooth or jagged or irregular? Sometimes you might even see a sharp notch in the edge of the mole. This can also be a sign of melanoma.
COLOR: This is easy to pick up on. Melanoma can often have many different colors like: brown, tan, black, pink or even white. The red and white are sometimes a sign that your body has been trying to destroy the melanoma. Normal moles have very uniform color — tan or brown most often.
DIAMETER: We generally look at any mole that’s larger than a pencil eraser which is about five to six millimeters.
Note: Remember that not all growths that meet these descriptions are melanoma — some may be atypical moles which are not cancerous but require you to see your dermatologist as well.

IN ADDITION TO THE SIGNS OF MELANOMA WE JUST DESCRIBED, YOU’D LIKE TO RECOMMEND ANOTHER ONE ... SUSPICION. CAN YOU EXPLAIN?

In other words, if you have a mole that doesn’t necessarily have the features we just described but you just don’t like the way it looks, get it checked out. And if your doctor is not concerned but you still don’t like it, even if you don’t know why, ask your dermatologist to biopsy it. Remember, when it comes to your own health, in this situation, I like to think that the customer is always right.

YOU SHOULD ALSO KEEP A CLOSE EYE ON YOUR FINGERNAILS. WHAT ARE WE LOOKING FOR HERE?

We are looking at a pigmented stripe in the nailbed, just under the fingernail itself. One part of the body that can be overlooked are the nails. Although nail pigmentation is often normal, in some cases melanoma can develop under the nails, so when you have your full body skin examination for melanoma, make sure you are not wearing nail polish. This type of melanoma is more often seen in Hispanics than in whites.

WHY DON’T PEOPLE GET HELP SOONER. IS DENIAL A BIG PROBLEM?

Unlike other medical problems, where the symptoms may not be obvious, when it comes to skin cancer, it can often be as plain as the spot on your hand. But it’s human nature for fear to take over. Denying symptoms or problems is only human; but taking care of them is potentially lifesaving.
Sometimes we see patients who have had a changing mole for some time but somehow convinced themselves that there was no problem. When it comes to a question about melanoma or other skin cancer, “When in doubt, check it out.”

HOW OFTEN SHOULD YOU SEE YOUR DERMATOLOGIST?

It is recommended that adults have a full body skin examination, that means from head to toe, from a dermatologist every year. If you have a family history of skin cancer or have a lot of moles, your dermatologist may want to examine you more frequently.

We don’t think twice about going to the dentist twice a year for our teeth to be checked. Going to a dermatologist once a year to check for skin cancer at its earliest curable stages seems another reasonable way to stay healthy.

Your dermatologist should have you take all your clothes off, including shoes and socks and ask you to get into a gown. He or she would then carefully examine all your skin, from the scalp to the soles of the feet, including in between the toes. Any unusual or worrisome growth would then be recommended for biopsy — a simple office procedure. Be sure to use this visit to learn about what you should look for — your dermatologist can point out what is normal and what isn’t; you can even learn how to do a full self-skin exam.

WHAT ARE TEENS AND PARENTS OF YOUNG CHILDREN DOING WRONG?

Children and teens will always march to their own drummer when it comes to taking instructions from their parents. However, if you practice good sun protection when your children are very small, they will be the ones reminding you to wear sunscreen and hopefully in the teen years will avoid tanning parlors and excess sun exposure.

WHAT ELSE DO YOU RECOMMEND WE DO?

Every year we give these suggestions on being sun smart and the reason is that if you follow these guidelines, you will decrease your risk of skin cancer. Remember that the most important element of any sun protection program is common sense but your plan should include the following:

• Wear a sunscreen or sunblock with a sun protection factor of 15 that you apply 30 minutes before you go out. Some people maintain that 30 minutes is needed for the sunscreen to interact with proteins in the skin to become effective. Look for a product that also protects against ultraviolet a rays — the ingredient list will say Parsol 1789 or Avobenzone.
• Apply every couple of hours while active outdoors. For many this is a hassle, but a lot less of a hassle than getting sunburned or getting skin cancer.
• Wear a broad brimmed hat — baseball caps don’t protect the ears. Practically speaking, dermatologists know that this is hard to do, especially while boating or playing outdoors but try to find a hat that works for you that you can at least wear for a major part of the time you are outdoors.
• Wear sun-protective clothing. There are now special clothing lines and laundry additives that increase the sun protection value of clothing. Remember that a normal white T-shirt only gives an SPF (sun protection factor) of about 4 to 6.4. Avoid the sun between the peak hours of 10 and 4. This doesn’t mean hide in the cellar — it means seek shade, certainly don’t play or garden or work in direct sunlight without protection between 11 and 2.

Dr. David Leffell is professor of dermatology at the Yale School of Medicine and author of the book, “Total Skin.”  Internet: http://www.msnbc.com/news/774887.asp?pne=msn.  9 July 2002.