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When you get tan, doctors see red

Skin cancer is on the rise and the use of sunscreen is declining. It's all enough to make a dermatologist broil.

By LISA GREENE, Times Staff Writer
Published September 11, 2005

ST. PETE BEACH - Pam Paine is a dermatologist's nightmare.

On a recent Thursday, she was on the beach at high noon, in a green tan-through suit that highlights her very blond hair and her very dark tan.

Usually, the St. Pete Beach resident stays inside during the hottest part of the day, but even when she doesn't, she avoids sunscreens - "because who the heck knows what's in them?" - and she values the way sunshine lifts her spirits.

"Are you going to be old and pale and sickly looking, or are you going to be tan and fabulous and knock off a few years?" Paine said with a grin. "I'd rather be tan and fabulous."

To most dermatologists, skin cancer is simple. It comes from too much sun.

"It's ultraviolet light. End of discussion," said Dr. James M. Spencer, a professor of clinical dermatology at Mount Sinai School of Medicine who practices at St. Anthony's Carillon Outpatient Center in St. Petersburg.

But Americans find it hard to listen.

In June, a survey found that Americans have become less likely to use sunscreen just in the past year. The percentage of sunscreen-users in the survey dropped from 72 percent to 60 percent, according to the Sun Safety Alliance, a nonprofit group funded by skin care companies. Indeed, along Paine's stretch of beach, beachgoers talked about a "healthy tan" and admitted they were sunscreen-free.

Meanwhile, the number of Americans with skin cancer is rising. The prevalence of melanoma, the deadliest form, has more than doubled in the past 30 years, according to the National Cancer Institute.

Those cancers also are showing up earlier. Skin cancer rates among people under 40 have almost doubled in the past 30 years, according to a Mayo Clinic study published in last month's Journal of the American Medical Association.

More than 1-million new cases of skin cancer are diagnosed each year, including more than 100,000 cases of melanoma, the deadliest form. Nearly 8,000 U.S. residents die from melanoma each year. The number of U.S. melanoma cases is projected to increase 10 percent this year over last year, according to the American Academy of Dermatology.

People with fair skin are most at risk, although doctors caution that people with darker skin tones get skin cancer too.

Adding to people's confusion about sun and cancer, a few doctors argue that some people need to get more sun. That's because they think vitamin D, which the skin makes from the sun's rays, may help prevent at least four kinds of cancer.

But the evidence isn't conclusive, and the theory is controversial. Even its strongest advocates recommend "safe sun" of only about 15 minutes without sunscreen a few times each week - an amount some dermatologists say is almost impossible to avoid in Florida, where the sun's rays are more intense.

"The vitamin D issue has really skewed things," said Dr. Susan Weinkle, a Bradenton dermatologist who is on the board of directors for the American Academy of Dermatology and an assistant clinical professor at the University of South Florida. "You get so much vitamin D so easily here. The risk of the UV rays causing skin cancer is so much greater."

The problem with the "safe sun" advocates is that, even though they aren't actually recommending much sun, the message the public hears is that it's okay to skip sunscreen, said Dr. Philip D. Shenefelt, associate professor at USF and chief of dermatology at James A. Haley VA Medical Center in Tampa.

"Information like this vitamin D thing gives people an excuse not to use sunscreen," Shenefelt said. "They may regret that 10 or 15 years later."

But for now, there's a profound disconnect between what doctors say and what people do. It's one that sometimes puzzles Spencer. After all, it's harder to stop smoking, or overhaul a lifetime of poor eating and exercise habits.

"This appears to be a simple message," he said. "The cardiac message, it's pretty hard. For sedentary people to start exercising is difficult. Putting on sunscreen is pretty easy."

But so is forgetting it. The threat is remote, while an afternoon under the sun or in a tanning bed promises an immediate boost in sex appeal.

Paine, who says she's over 45, said she's careful to eat healthy foods and avoid the hottest hours of the day. But a tan is a gamble she's willing to make.

"I wear Hawaiian Tropic oil (without SPF) and I keep my fingers crossed," she said.

On the same stretch of beach, Brandon resident Danielle Giordanella, 21, was reading the new Harry Potter book. She wore a bikini, with a baseball cap to shield her face from the sun. Most days, she said, she wears sunscreen, even to go jogging.

Just not today.

Spencer has heard it all.

"Our desires, our emphasis on physical appearance is so strong, it trumps health," he said. "Ultimately the answer will be for a tan not to be seen as beautiful."

Yet there are stars who show off alabaster skin. Think Gwyneth Paltrow or Nicole Kidman.

But more display bronzed limbs, shot back Spencer. Try Britney Spears and Charlize Theron.

Weinkle thinks it's not only glamor. It's also forgetfulness.

"It's analogous to the seat belt," Weinkle said. "I always wear it, but I didn't happen to be wearing it today."

She tries everything. Scolding. Calling tanning beds "aging machines." Shock therapy: "This week I cut off half a man's nose," she said.

People don't realize they're not protecting themselves, Weinkle said. People think they can stay outside for several hours without re-applying sunscreen. And she would like more people to wear clothing treated to block UV rays.

At St. Pete Beach, British tourists Grace Haworth, 2, and her big sister Olivia, 4, both wore UV-protective suits. And hats. And SPF 50 sunscreen.

The Haworths' parents, Kent and Emma, have special reason for their precautions: blond Grace is an albino. With no protective melanin in her skin, she burns easily. But the whole family covers up.

"That's crazy," Emma Haworth said, when told that many on the beach skipped sunscreen. "Everybody knows."

She grew up in Australia, which has the highest skin cancer rate in the world.

"I can remember as a child being so burned I blistered," she said. "It was hard to get sunscreen when I was a little girl."

These days that's not the problem, Spencer said.

This is: "We can't get people to wear it."

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