Stay safe in the sun

the integrative approach to total well-being Skin cancer affects 1 in 5 Americans. Catch it early to cure it. Or take the right steps to prevent it

yOU DON'T have to get burned to increase the risk of skin cancer. So if you store all your sunscreen in your beach bag, do yourself a favor and get an extra tube for when you drive to the mall or walk the dog.

"The damage caused by the sun is incremental," says David J. Leffell, M.D., professor of dermatology and surgery at Yale University School of Medicine in New Haven, Conn., and author of Total Skin. "It accumulates over your lifetime." In other words, your risk increases one sunny (or cloudy) day at a time.

With more than a million cases each year, skin cancer accounts for a majority of all cancers in the United States, according to the American Cancer Society. Most cases can be cured if detected and treated early. However, skin cancer does kill: About 10,000 people are expected to die from it in 2006.

Three of a Kind
Sunlight induces skin cancer in several ways, according to the Skin Cancer Foundation. First, ultraviolet light damages DNA, leading to mutations that can contribute to cancer; second, it produces activated oxygen molecules that harm DNA and other structures in the cells; and third, it suppresses immune function around the area of the sun damage, which impedes the body's own natural defenses against cancer.

Actinic keratosis is considered the first step in the development of some skin cancers. It refers to small, scaly spots — commonly found on the face, ears, neck, lower arms, and back of the hands in fair-skinned people who have had significant sun exposure — which may become cancerous if not treated or removed. To prevent an actinic keratosis from turning into cancer, some doctors prescribe topical treatments like diclofenac (Solaraze), imiquimod (Aldara), and tretinoin (Retin-A).

With rare exceptions, cancers of the skin can be classified as one of three variations:

Basal cell carcinoma (75 percent of cases) generally appears as raised, translucent lumps. While it usually doesn't spread to other body parts, it can be disfiguring.

Squamous cell carcinoma (20 percent) develops in the upper layer of the skin, most often in places that have been exposed to sun. It tends to manifest as raised reddish bumps or growths. Squamous cell can spread to other parts of the body; once this happens, it is more difficult to treat.

Melanoma (4 percent) is the most dangerous kind of skin cancer; it can spread throughout the body via the bloodstream and the lymph system. It also shows up in younger patients — half of all cases occur under age 57. Symptoms include irregularly shaped brown or black blemishes.

Check it Out
If you have a cancerous lesion, you're just as likely to find it as your doctor is. That's why dermatologists recommend doing a monthly home skin-cancer check; you'll want to monitor freckles, moles, and birthmarks for any changes over time. Position yourself before a full-length mirror in a well-lighted room, and use a hand-held mirror to inspect hard-to-see areas. (In men, one-third of melanomas occur on the back.) If you notice anything suspicious, call your doctor (see "Treating Skin Cancer," page 50). To learn what you're looking for, just memorize your ABCs, D's, and E's:

Asymmetry Skin cancers often have irregular shapes.

Border Trouble spots can be indicated by ragged and poorly defined edges or rolled borders.

Color Lesions can be very dark, multicolored, or mottled with shades of black, brown, or tan, or even white, gray, red, or blue. Basal cell may be indicated by pink growths or pale yellow or waxy scarlike areas.

Diameter Watch for spots greater than ¼ inch, about the size of a pencil eraser tip. Basal cell can show up as larger reddish patches, which may or may not crust, itch, or hurt.

Et cetera Other warning signs of skin cancer include a sore that doesn't heal or a change in how a mole feels (it begins to hurt, show tenderness, or itch) or behaves (it starts to bleed or ooze).

Screen Savers
Staying out of the sun is by far the most effective way to prevent skin cancer. Using sunscreen is the next-best strategy, and you should never wander far from your trusty bottle of SPF 30. (The number refers to the level of sun protection factor against UVB radiation.) "Just like you brush your teeth every day, you should use sunscreen every day," advises dermatologist Joshua Fox, M.D., director of Advanced Dermatology P.C. in New York and a spokesman for the American Academy of Dermatology "Even on a cloudy day, up to 80 percent of the sun's rays get through."

It's worse at the beach or on the slopes. Water reflects 20 percent of the sun's rays, while sand and snow boost them by 80 percent. "It's like being hit from both sides," Fox says.

Sunscreen and sunblock are not the same. In sunscreens, chemicals like benzophenones, cinnamates, salicylates, and para-aminobenzoic acid (PABA, a compound linked to allergic reactions in some people) prevent sun damage by chemically absorbing radiation before it reaches the skin. Pick a product that works on both UVA and UVB radiation; Leffell likes the brands Ombrelle, Sundown, Water Babies, BullFrog, and PreSun.

Sunblocks contain ingredients like zinc oxide or titanium dioxide that lie on top of the skin and physically obstruct UVA and UVB radiation. "Blocks are less likely to cause allergic reactions and are sometimes called 'chemical-free,'" says Leffell. "You can't get more natural than zinc oxide." Sunblocks with zinc oxide or titanium dioxide are also "photo-stable," which means they do not change in the presence of light; many products combine the two agents, such as Jason Family Block, SkinCeuticals Physical UV Defense, and Aveeno Continuous Protection Sunblock Lotion.

Don't spend a fortune for sun protection, but choose something with an appealing texture; otherwise you'll never use it. It takes about 1 teaspoon to cover the face and neck and 1 to 3 tablespoons for the body. Apply 30 minutes before sun exposure; it's best to reapply frequently, though no SPF allows you to stay out in the sun all day.

Active Wear
If you run out of sunscreen, don't presume that throwing on a shirt will defend you from the sun. "The average white T-shirt has an SPF of four to six," notes Leffell.

Loosely woven garments that are light in color, thin, or stretchy (which describes most warm-weather fabrics) offer little safety. "Very fair people and those who have had skin cancer should wear broad-brimmed hats and use sun-protective clothing," Leffell advises.

Several companies sell clothing with substantial sun protection factors, including the following:

Solar Eclipse 800-878-9600 or solareclipse.com

Solartex Sun Gear 877-476-5789 or solartex.com

Sun Precautions 800-882-7860 or sunprecautions.com

Sun Clothing, Etc. 866-713-9352 or sunclothingetc.com

SunGrubbies.com 888-970-1600 or sungrubbies.com

Coolibar 800-926-6509 or coolibar.com

Tea for You
Evidence suggests that nutrition may play a part in reducing the risk of skin cancer. Toward that end, diets rich in anti-inflammatory nutrients (such as alpha-linolenic acid, an omega-3 fatty acid found in flaxseed oil or in supplements) and antioxidants (like vitamins A, C, and E) are often recommended. In an animal study published this year in the journal In Vivo, vitamin C, green tea, and the amino acids lysine and argenine suppressed melanoma tumor growth in mice. (Beans, soybeans, lentils, and meat are rich in lysine; good sources of arginine include meat, poultry, dairy, and fish.)

Green tea has previously shown anti-carcinogenic potential. Various animal studies have found that the polyphenols in green tea (and, to a lesser extent, black tea) consumed as a beverage or applied to the skin appear to prevent skin cancer induced by ultraviolet radiation.

While vitamins and tea are no substitute for the shielding effects of shade, it makes sense to use them along with sunscreen. The following botanicals may also protect the skin from UV-related harm, reports Santosh K. Katiyar, Ph.D., a skin disease researcher at the University of Alabama at Birmingham:

Apigenin A flavonoid found in herbs (endives, cloves), vegetables (beans, broccoli, celery, leeks, onions, barley, parsley, tomatoes), fruits (apples, cherries, grapes), and beverages (tea, wine).

Curcumin A yellow pigment that's obtained from the turmeric rhizome.

Proanthocyanidins Antioxidants found in grape seeds.

Resveratrol A compound found in grape skins, peanuts, red wine, and mulberries.

Silymarin A flavonoid extracted from the seeds of milk thistle.

"Consumption of these dietary botanicals may provide efficient protection against the effects of solar ultraviolet radiation," says Katiyar, who due to quality concerns recommends whole foods over supplements when possible. It's easy to pair green tea with meals; look to Indian cookbooks for ways to use turmeric. The suggested dose for standardized milk thistle supplements is 200 to 400 milligrams per day.

The D Debate
Is sun all bad? Well, it's important for the body's production of vitamin D, which maintains bone density. It might even offer protection against diseases like rheumatoid arthritis and multiple sclerosis, says Boston University School of Medicine professor Michael Holick, M.D., Ph.D., author of The UV Advantage.

Holick advises people to expose their arms and legs to five to 10 minutes of sunshine between 10 a.m. and 3 p.m. (depending on season, skin type, and latitude) two or three days a week. This allows the body to manufacture the vitamin D it needs without increasing skin-cancer risk, he claims.

But other dermatologists disagree, especially since you can get vitamin D through supplements. Responding to Holick's suggestion, the Skin Cancer Foundation notes that unprotected sun exposures of just two or three minutes can begin breaking down skin tissues. James M. Spencer, M.D., a clinical professor of dermatology at Mount Sinai School of Medicine in New York and a member of the foundation's medical council, suggests protecting bone health by drinking vitamin-D-fortified juice or milk, eating fatty fish, or taking a daily multivitamin containing 600 units of vitamin D. "It's a lot safer," he says.

Fox concurs: "I think it's better to wear sunscreen every day."

THOSE LIPS, THOSE EYES
The upper and lower eyelids are two of the most common places on the face that skin cancer can occur, according to the Skin Cancer Foundation; these cases can be hard to treat and account for about to percent of all skin-cancer deaths. Other than staying out of the sun, the best way to prevent skin cancer on the eyelids is to wear UV-blocking sunglasses, which can stop more than 99 percent of UVA and UVB rays from reaching the area. Wraparound sunglasses protect a wider section of skin than ordinary styles.

Other ways to guard your delicate lids include carefully applying sunscreen around the area — a sunblock stick makes this easier to do safely — and wearing a hat with a brim that is at feast 3 to 4 inches wide.

Another prime site for skin cancer is the lips (particularly the lower lip, which gets more sunlight). Protect your kisser with sun-blocking lip balms like Almay Pure Tints Protective Lip Care or C.O. Bigelow Lip Formula.

TREATING SKIN CANCER
If your doctor thinks a spot on your body looks suspicious, he or she will order a biopsy. If you do have skin cancer, your dermatologist or surgeon can treat it using one of the following procedures:

Chemotherapy Cancer-fighting drugs are applied to the skin. If the cancer hat spread, the drugs may be administered Into the bloodstream.
Laser surgery Cancer
cells are vaporized with Intense waves of light.

Surgery Cancerous tissue is cut away; the excision is then stitched closed. Large wounds may require skin grafts from other parts of the body.
Curettage and electrodesiccation
Cancer cells are scraped away with an Instrument that resembles a vegetable peeler. It may be followed by treatment with an electric needle to destroy remaining cancer cells. Both of these procedures are typically repeated a few times.

Cryosurgery Cancer cells are frozen and destroyed with liquid nitrogen.
Mohs micrographic surgery Cancerous tissue is cut or scraped away. During the procedure, the tissue is microscopically examined to determine whether more skin must be excised in order to remove the entire tumor.
Radiation High-energy rays or particles are beamed at the skin to destroy cancer cells. Up to 30 treatments may be required.
CAN THE TAN
Nearly 30 million Americans visit indoor tanning salons each year, and many of them believe what they're doing carries no danger. Not true. "Indoor tanning is simply not safe," says James M. Spencer, M.D., a board member of the Skin Cancer Foundation.

In a large-scale Scandinavian study, tanning-bed use was associated with a 55 percent increase in melanoma risk, especially in participants between the ages of 20 and 29.

"We know that tanning-parlor radiation definitely causes skin cancer," says David J. Leffell, M.D., professor of dermatology and surgery at Yale University School of Medicine. "Those are the same lightbulbs we use in the lab to cause skin cancer."

Since the damaging effects accumulate over time, indoor tanning is particularly dangerous during the teenage years. "In my experience, any woman in her 20s who has a skin cancer most likely says she used tanning parlors," Leffell reports.

PHOTO (COLOR): SUN DAMAGE is quick and cumulative. But protective strategies can keep those cancerous rays at bay.

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By Alice Lesch Kelly

Illustrations by Sarah Wilkins

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