Skin cancer isn't just a threat as we age. In this climate, youngsters are also at risk. Protect yourself.
By KEISHA I. PATRICK
Published July 1, 2003
[Times photo: Chris Zuppa]
In August 2001, doctors amputated Scott Lindstam’s right ear. Skin cancer was evident throughout it. Two years earlier, he thought his ear just had a pesky, slow-healing sore.
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Dark skin not immune to sun damage
African-Americans, Hispanics and others with substantial amounts of melanin in their skin must also beware of the dangers of too much sun.
[Times art: Teresanne Cossetta]
Too much exposure?
Floridians especially should be aware of the health risks associated with prolonged sun exposure; damage done to the skin is cumulative. Sunscreen provides some protection, but it might not be enough. So before you head to the beach, take time to learn the basics of sun protection.
Before he hit the beach, Jim Marohnic's mother lathered him with sunscreen and slapped a hat on his head. It was routine.
"At the beach, he always had a hat and sunscreen," said Sue Marohnic, Jim's mother. "Nonbeach, in the back yard, we weren't as concerned."
Jim getting skin cancer was the farthest thought from his family.
Then, one day Jim was brushing his hair and felt a little irritation behind his right ear. It was a mole.
No big deal, right?
The family doctor removed the mole during a routine office visit. Jim was back doing the things 12-year-olds do.
About three months later, the mole reappeared. Doctors referred Jim to the H. Lee Moffitt Cancer Center in Tampa. In fall 1992, he was diagnosed with melanoma, the most severe form of skin cancer.
In early 1993, Jim, who has blue eyes, brown hair and fair skin, had modified radical neck dissection surgery to remove the skin cancer. Forty lymph nodes were removed from his neck and shoulder. He had just turned 13.
Since his original diagnosis and surgery, Jim has had two additional surgeries to remove swollen lymph nodes: once during high school and again in his freshman year in college. He has also had two plastic surgeries to help regain mobility in his neck and shoulder.
So what causes skin cancer?
About 80 percent of a person's lifetime exposure to the sun occurs before 18, according to the Skin Cancer Foundation's Web site. "Early sun exposure is the major risk factor for melanoma" and other forms of skin cancer, according to the foundation.
"The biggest problem for sun exposure is that cumulative damage can make a person prone to skin cancer," Tampa dermatologist Dr. Robert A. Norman said. "Statistics say that three blistering sunburns can affect chances of skin cancer later on."
Jim Marohnic, now 23, believes sun exposure caused his melanoma.
As a child growing up in Brandon, Marohnic played soccer and tennis competitively. He was also on a swim team, but his outdoor activities were no different from that of his older brother or any of their friends, Marohnic said.
"I spent the average amount of time in the sun for a kid growing up," he said. "In Florida, we have good weather, so we're out a lot."
Many people think sun protection is only necessary for recreational activities, said Dr. Henry Wiley, a Tampa dermatologist. Not true, he said.
"Ultraviolet damage doesn't correlate with whether you're having a good time," he said. "We tend psychologically not to think it's not important when mowing the lawn ... in Florida, it's whenever you're outside."
Children need more protection from the sun than adults because their immune systems are still developing, and they're more susceptible to sun damage, Norman said.
Marohnic's case is unusual because he was diagnosed at a young age with melanoma. Sun damage usually takes longer to manifest into cancer. There may be a 20- to 30-year lag before the cancer appears, said Dr. Neil A. Fenske, director of the division of Dermatology and Scataneous Surgery at the University of South Florida College of Medicine.
In Florida, skin cancer may appear during a person's late 20s or early 30s, Norman said. Pinellas Park resident Scott Lindstam is one such case.
At first glance Lindstam appears to be an average 37-year-old man. He stands about 6-foot-1. His hair is strawberry blond, his eyes are light blue and his skin is fair.
But a second look reveals the absence of Lindstam's right ear. He lost it to skin cancer in August 2001.
"I grew up playing sports, being outdoors. I do a lot of fishing," Lindstam said. "I never used sunscreen until my mid 20s."
It wasn't until Lindstam was 34 that skin cancer was discovered in what appeared to be a sore inside his right ear. This sore didn't get wider, but it wouldn't go away, Lindstam said.
A radiologist friend encouraged Lindstam to have the sore examined. When he did, the doctor found cancer in every place he examined, Lindstam said.
"People thought it was weird that I had cancer eating at me and I didn't feel it," Lindstam said. "You don't feel anything, it's just a sore, and it eats away deeper and deeper."
Lindstam did not sunbathe as a child, but he did spend time fishing, racing bikes and playing sports. Although he didn't wear sunscreen, he doesn't remember burning. Tanning, he admitted, was a benefit of being outdoors.
"I used to take my shirt off and try to get a tan while fishing," Lindstam said. "Now, my shirt never comes off."
Lindstam has had two surgeries to remove his cancer. The first time doctors found basal cell, the most common skin cancer. The second time they found basal cell and squamous cell, the second most common form.
Doctors had to excise his right ear to remove all the cancer. Lindstam now wears a prosthetic ear and has no hearing on that side.
For the next two years, doctors will take MRIs of Lindstam's neck and head every six months to make sure the cancer doesn't recur. After two years, he will have the MRIs once a year, he said.
Similarly, Marohnic will have annual checkups with an oncologist and dermatologist every six months for the rest of his life, he said.
Both Lindstam and Marohnic were in at-risk groups for skin cancer. They both had family members who had precancerous spots removed. They both have fair skin and light eyes.
Still, at risk or not, everyone needs sun protection, doctors warn.
The Skin Cancer Foundation encourages parents to apply and frequently reapply a sunscreen with a sun protection factor of 15 or higher on children. It should protect from UVA and UVB rays. Babies younger than 6 months should avoid the sun, doctors strongly urge, because they are not adequately protected by melanin, a natural substance that gives color to the skin, hair and irises of the eyes.
Sunscreen isn't enough. Children should wear protective clothing, such as long sleeves and hat flaps for the back of baseball caps, Norman said. It's also a good idea to significantly reduce sun exposure time between 10 a.m. and 4 p.m., when the sun's ultraviolet rays are most intense.
"The single most important factor is that parents instill sun protection to kids as infants and children," Fenske said. "They get used to it and it becomes a habit."
As a rule of thumb, you should not put insect repellent over sunscreen because the repellent weakens the sunscreen, the Skin Cancer Foundation reports. Instead, look for insect repellents that have SPF 15 protection.
Fenske warns that using sunscreen and other sun protection methods doesn't mean it's safe to stay in the sun all day. He recommends parents with preteens and teenagers "appeal to their vanity."
"Tell them that the sun will make their skin look leathery and wrinkly. People don't believe they'll get skin cancer," he said.
Early skin cancer detection increases survival chances.
Marohnic will graduate in December from the University of Florida in Gainesville. He plans to go to a police academy.
Lindstam owns Hi-Tech Assembly Inc., a mechanical parts business. He's a husband and father of three. Despite his bouts with skin cancer, he continues to participate in fishing tournaments and other outdoor activities.
"You can't hide from it (the sun)," he said. "You can only protect yourself from it."
To protect your skin, follow these tips:
Do not put sunscreen on children younger than 6 months. It is best to keep them out of the sun.
Try to avoid the sun between 10 a.m and 4 p.m., when the sun's UV ray are most intense.
Apply sunscreen SPF 15 or higher to exposed areas 15 to 30 minutes before going out.
Wear a wide-brim hat to shade face, ears and neck.
Apply SPF lip balm or lipstick. Lips do not tan, but they will burn.
Wear sunglasses that have 99 to 100 percent UV protection. UV absorption can cause cataracts and cancerous growths.
Don't get a false sense of protection from using sunscreen. Take a break from the sun when the UV rays are most intense.
