When tans turn deadly

[Times photo: Krystal Kinnunen] Tiffany Brozenske, 16, a junior at Alonso High School in Tampa, was diagnosed with melanoma at 14 when a mole was removed from her back. “Living in Florida you’re not safe unless you take care of yourself,” she says.

By SUSAN ASCHOFF, Times Staff Writer
© St. Petersburg Times
published September 10, 2002

Sun exposure can lead to melanoma, a sometimes fatal skin cancer. So why do so many teens still want to catch some rays?

TAMPA -- When Tiffany Brozenske noticed the large mole in the middle of her back, she was too young to be worried about cancer and too well-informed not to wonder.

The 14-year-old had learned about skin cancer in health class. The mole was about the size of her thumbnail, and watery, she says. Her mother took her to Tampa dermatologist Robert Norman. "He didn't think it was going to be anything," but excised a portion for biopsy, Brozenske recalls.

Her mother told her the results on Halloween. "She told me I had melanoma. I looked it up in a book," Brozenske says. "It said it was a potentially deadly form of cancer."

Now 16, the Alonso High School junior has an "ugly" eye-shaped scar on her back where the mole and several inches of adjacent and underlying tissue were surgically removed. Lymph nodes under each arm were also biopsied to make sure the cancer had not spread. The days of missed school, the weeks unable to carry her own backpack, are past. But every six months Brozenske goes for an exam.

"It was kind of shocking," she says. "Who would have thought a 14-year-old had melanoma?"

Norman says he has seen melanoma in two teenagers in as many years.

"Melanoma is still extremely rare, particularly in teens, but I'm seeing precancers at much earlier ages," he says. "I see people in their 20s with basal cell (basal and squamous cell are surface, more-curable, skin cancers) all the time."

An alarming increase in the incidence of melanoma, the most deadly form of skin cancer, has prompted education efforts worldwide to warn about the dangers of sun exposure. About 53,000 people will be diagnosed with melanoma in the United States this year and an estimated 7,400 will die, reports the American Academy of Dermatology.

Doctors have known for some time that skin cancer is overwhelmingly caused by exposure to sunlight. And although the majority of cases are diagnosed in the elderly, it is the high doses of sunlight, particularly to the point of blistering sunburns, received as children and teenagers that cause the irreparable cell damage that elevates risk.

"A lot of my friends at school want to have a tan. It's still in," says Brozenske, whose mother, Sharon Erwin, is now reluctant to let her work in the yard.

Most teenagers do not use sunscreens. Many say they will sunburn to get a tan, reported researchers at Boston University after a survey queried more than 10,000 children. Survey results, published in the journal Pediatrics in June, found that only 34 percent of youths ages 12 to 18 used sunscreen routinely. A like number had suffered three or more sunburns the previous summer. By age 17, 35 percent of the girls were using tanning beds, also considered a risk.

Those questioned about their sunning habits were the children of nurses and would presumably be more aware of the dangers. Yet the attractive, sexy glow attributed to tanned skin held sway. Two-thirds of teens think they look better with a tan.

Norman says children must understand their habits are an investment. People get about 80 percent of their lifetime sun exposure in childhood. "It's cumulative. Besides skin cancer, it causes premature aging," Norman says. "Compare how old someone who has had lots of sun looks to someone whose skin has been protected."

For the first time, researchers recently proved that the individual risk of melanoma depends on the intensity of sunlight received over a lifetime. Results published in the journal Cancer Research in July show risk grows with increased time outdoors for non-Hispanic whites, even for those who have deep tans. Researchers measured lifetime exposure by mapping where participants resided and relocated.

There is as much as a 10 percent difference in intensity even between two Southern locations, New Orleans and Atlanta, says Thomas Fears, author of the paper and a scientist at the National Cancer Institute in Bethesda, Md.

Residents of sun-drenched Florida, says Norman, need to be particularly cautious.

Melanoma is a cancer of the pigment-producing cells in the skin, known as melanocytes. Melanocytes are in the skin's outer layer and produce the brown pigment melanin, which is responsible for skin color and tanning. A tan is proof the skin is being damaged. When melanocytes become cancerous, they grow and invade other tissues.

The goal is to detect melanoma early, says the American Academy of Dermatology, when it is still on the surface of the skin and has not spread to blood and lymphatic vessels. It is most common on the backs of men and the legs of women. It is usually brown or black colored, but sometimes red, white or nude. It may be new, or growing on a pre-existing mole. Skin cancer changes and grows, explaining the need for regular visual inspections of one's body.

Fair-skinned, sun-sensitive people are at greatest risk. Those who burn easily, who suffered sunburns while a child and teenager, and who have more than 50 moles are more susceptible. African-Americans rarely get skin cancer.

Melanoma also runs in families. "If you have a parent, brother or sister with a history of melanoma, you need to be checked every six months," Norman says.

But most important, even teenagers brimming with youth's sense of invincibility should invest in their future health.

"If it takes you a few seconds to put on some sunblock, then do it," Norman says.

On the Web

• www.skincancer.org/children/
• www.nlm.nih.gov/medlineplus/skincancer.html

© St. Petersburg Times. All rights reserved.