St. Petersburg Times
TOO MUCH EXPOSURE?
ILLUSTRATION AND TEXT BY TERESANNE COSSETTA OF THE TIMES

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Coverup dos and don'ts
The sun's UV rays are most intense between 10 a.m. and 4 p.m. If your shadow is shorter than you, seek protective cover.

Do apply sunscreen SPF 15 or higher to exposed areas 15 to 30 minutes before going out. Give your skin time to absorb the active ingredients.

Do apply sunscreen liberally, and reapply as needed.

Do wear a wide-brim hat to shade face, ears and neck.

Do apply SPF lip balm or lipstick. Lips do not tan, but they will burn.

Do wear sunglasses that have 99 to 100 percent UV protection. UV absorption can cause cataracts and cancerous growths.

Do wear SPF clothing or tightly woven fabrics that you cannot see through when held up to the light. Darker colors seem to screen out more harmful rays.

Do wear lightweight long-sleeve shirts and long pants.

Do apply sunscreen to forgotten places such as kneecaps, shins and toes.

Don't get a false sense of protection from using sunscreen. Take a break from the sun when the UV rays are most intense.

Don't put sunscreen on children younger than 6 months. It is best to keep them out of the sun.

Don't expect waterproof sunscreens to provide all-day protection.

 One in five people will get skin cancer in his or her lifetime, the American Academy of Dermatology says. Each year more than 1-million Americans are diagnosed with skin cancer, the most common of all cancers in this country. 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.

 Where it starts

The sun is a vast resource for the Earth, but its ultraviolet, or UV, radiation can cause severe damage to human tissue.

Types of radiation:

  • UVB rays are short-wave solar rays. They are the main cause of sunburn, premature aging and cancer. They are more abundant at midday.
  • UVA rays are long-wave solar rays. They are not as powerful as UVB but can penetrate without signs of sunburn. Long-term exposure is what causes damage.

Premature aging conditions caused by long-term exposure to UV rays include:

Wrinkles
Cataracts
Dark patches
Loss of skin elasticity
Precancerous lesions

Three ways UV rays induce skin cancer:
1. DNA is directly damaged by the UV light, causing mutations.
2. Activated oxygen molecules are produced; they damage DNA and other cell structures.
3. The body's natural anticancer defenses are blocked by localized immunosuppression.

UV index

The Environmental Protection Agency and the National Weather Service post the daily UV forecast for 58 cities. Here's what the numbers mean:

chart

Tampa Bay area UV forecast: www.wtsp.com/weather/uvindex.asp

Who is at risk?

Everyone is at risk. African-Americans, for example, can get melanomas on the palms of their hands, soles of their feet and under their nails. People of any skin type who get excessive UV exposure should use precautions. Here are other risk factors:

  • Fair skin, light hair and eyes.
  • Burns easily but does not tan.
  • Multiple moles or freckles.
  • Anyone who had severe sunburns as a child.
  • Family history of skin-related cancers.

Skin cancers
Pay attention to moles and precancerous lesions (actinic keratosis) that could become one of these forms of skin cancer:

  • Basal cell carcinoma is the most common form. It appears as a small bump, open sore or reddish patch on the face, ears, neck, scalp, shoulders or back. It is caused by prolonged exposure to sun and can result from severe sunburns during childhood. There is a 95 percent cure rate when correctly treated by a dermatologist. This form rarely spreads to other parts of the body.
  • Squamous cell carcinoma typically appears on the rim of an ear or the lips, or on the face as a red, scaly patch or elevated growth. It is caused by a cumulative pattern of low doses of sun exposure. It destroys tissue, spreads to organs and can be fatal if left untreated.
  • Malignant melanoma can appear or begin in or near a mole or dark spot. It is the most virulent form of skin cancer, affects all skin types and has the highest rate of mortality if left untreated. Warning signs include oozing, bleeding, spreading of pigment or change in sensation.

 To tan or not to tan?
Not all people can tan; some burn or freckle instead. For those who do tan, the skin produces a natural substance called melanin that gives color to skin and hair in response to UV radiation. Melanin becomes minor protection against UV rays, but the damage to the skin must have been done to create a tan. Though a tan does not last, the effect can be permanent.

The Food and Drug Administration, the Centers for Disease Control and Prevention and the Skin Cancer Foundation caution against the use of artificial tanning devices. Here are some of their findings:

  • One 15-30 minute session exposes the body to the same amount of UV light as a day at the beach.
  • Blood vessels are damaged.
  • The skin ages prematurely.
  • There is a risk of adverse reactions to certain drugs such as ibuprofen, antibiotics and birth control pills.

According to the Skin Cancer Foundation, "sunless tanning" products are a safe alternative to indoor and outdoor tanning, but sunscreen is still needed:
Lotions contain dihydroxyacetone, or DHA, a colorless sugar that interacts with dead skin cells, staining and making them darker. Some lotions contain a sun protection factor, or SPF, but the protection lasts only a few hours, not the length of the tan. DHA provides minimal protection from UV rays, an equivalent of SPF 2 or 4.

Sun protection factor
Sunscreen is the first step to protect skin from the sun's rays. Dermatologists recommend an SPF minimum of 15. Look for UVA and UVB protection. Regardless of the skin shade, some level of SPF is needed.

Burn factor
SPF ratings determine how long you can stay in the sun before there is a chance of minimal sunburn. For example, it might take 5 minutes for a sun-sensitive person not wearing suncreen to redden. But remember, just because you reapply sunscreen does not mean that you should increase the amount of time you remain in the sun. Here's a formula for calculating exposure times:

Exposure time before burning SPF 15 When to reapply
5 minutes
5 x 15 = 75
1 hour and 15 minutes
10 minutes
10 x 15 =150
2 hours and 30 minutes

Exposure time before burning SPF 30 When to reapply
5 minutes
5 x 30 = 150
2 hours and 30 minutes
10 minutes
10 x 30 = 300
5 hours

More than sunscreen
Clothing with sun protection is becoming increasingly popular. These clothes have SPF mechanically added to the fabric and give protection for more than 100 laundry cycles and 100 days of sunlight. Sun-protective clothes can start at SPF 30; a white T-shirt provides SPF of 5 to 9.

Clothing:
Sun Precautions Inc. (toll-free 1-800-882-7860, www.sunprecautions.com) is among the companies that offer clothing with sun protection. For others, search online under SPF clothing.

Do-it-yourselfers should consider:
Rit Sun Guard. Sun Guard goes into your wash cycle and won't change the color of your clothes. One treatment is good for up to 20 additional washings. Check stores.

Treatment
Most skin cancers can be cured if detected in the early stages. Advanced stages require surgery.

Precancers should be treated by a board-certified dermatologist. Two options include:

  • Cryosurgery: freezing the lesion.
  • Chemotherapy cream: can be used for some types of skin cancer. It is used on the affected area regularly for several weeks.

Forms of treatment for skin cancer:

  • Excision: surgical removal.
  • Mohs surgery: microscopically controlled surgery.
  • Radiation therapy: treatment with high-energy waves.
  • Laser surgery: intensely powerful beam of light.

ABCDs of early detection
Most moles are harmless, but check with a board-certified dermatologist if you notice one of these warning signs:

Asymmetry
One half does not match the other.
  Border
Edges are blurred, ragged or irregular.
Color
Mottled appearance. Color is not uniform; there are shades of brown, black and sometimes dashes of red, blue or white.
Diameter
Area is larger than 6 millimeters (about the size of a pencil eraser) or is growing.

Stop it by spotting it
The sooner skin cancer is detected, the better chance you have for effective treatment. Make an appointment to visit your dermatologist annually. Use these self-examination methods to look for changes in moles, unusual new growths and dark patches, and to monitor sores that do not heal:

 Blow dryer:
Part hair and inspect scalp

Sitting:
Legs and feet

Heels and soles

Toenails and spaces between toes
 Full-length mirror:
Front and back of body

Raising arms, check right and left sides

Both sides of arms

Tops and palms of hands

Fingernails

Face, head and neck
 Hand mirror:
Shoulders

Back of neck and ears

Buttocks

Back

Legs

Upper arms

Find out for yourself
Lists of board-certified dermatologists and the latest information can be found through these organizations:

The Skin Cancer Foundation
toll-free 1-800-754-6490
www.skincancer.org
American Academy of Dermatology
toll-free 1-888-462-3376
www.aad.org
American Cancer Society
toll-free 1-800-227-2345
www.cancer.org

Sources: American Academy of Dermatology, Skin Cancer Foundation, American Cancer Society, AmeriPath Inc., Sun Precautions Inc., Sun Safety Alliance, National Weather Service, HBOC National Health Call Center Group and CancerBACUP.