It’s good to be outdoors in the summer sun, staying active and enjoying a vigorous lifestyle. Just do it in a healthy manner. And know the risks.
By Steve Kaufman | Illustration By Adam Kleinert
Oh, the things we tell ourselves when the summer sun begins to blaze.
I’ll only be out for a little bit. I’ll wear a hat.
I have sun screen.
It’s just golf.
I never burn.
The problem is, this isn’t about falling asleep on the beach, getting a bad burn and being in pain for a few days. This is about cancer.
Skin cancer is like any other cancer. Abnormal cells grow and multiply, often ignited by the ultraviolet rays of the sun.
Not all skin cancers are the same. Not all are potentially fatal. Not all skin pigmentations are as susceptible to sun-related skin cancer as others. There are all kinds of factors related to skin cancer, as to other cancers: health history, family health history, age, lifestyle.
But why would you want to roll the dice?
There are risks because there are so many things people don’t know or don’t understand, said Dr. Jae Jung, oncologic dermatologist at the Norton Cancer Institute. “There are right and wrong ways to apply sunscreen,” she said. “There are right and wrong clothes to wear. And there are right and wrong ways to evaluate the marks and moles on your skin so you know the proper actions to take.”
As an oncologic dermatologist, Jung is used to seeing patients who already have a diagnosed issue. So maybe she seems more cautious than others might be. But her advice is an excellent roadmap to avoiding problems and addressing common mistakes, like these:
My sunscreen has a 30 SPF. That’s the recommended level by the American Academy of Dermatology. I’m good!
Not necessarily, said Jung. “The academy’s recommendations are based on the testing it does. But they tend to lather it on in thicker amounts during their tests than most people do. At thicker amounts, it’s messy, or sticky, or uncomfortable, especially on the face – or it becomes expensive when you use so much at one time.”
As a result, she said, people use thinner amounts. And that’s less effective.
“I recommend an SPF of 50 or above. And even then, layer it on thickly. And cover everything that’s exposed – hands, feet, ears.” Any exposure to the sun – playing golf, going fishing, even just walking your dog – can be problematic.
“Cover whatever is expos e d,” Jung recommended.
I’m only going out for a drive.
Most cars’ front windshields are tinted to block out UV rays. Not so the side windows. Jung has even written prescriptions for certain patients to get tinted treatments on all their car windows.
“One of the most common incidents of skin cancer are on truck drivers’ left sides,” she said. “They roll the driver’s side window down and hang their arm out. But even with the window closed, their left arm and hand and left side of their face are exposed.”
I’ll be wearing a hat.
“The average baseball cap won’t protect your ears or the back of your neck,” said Jung. “Even those nice, wide-brim sun hats are designed more for fashion than for protection. They have an open weave, which of course invites the sun’s rays right in.”
It’s not a sunny day.
Then there are fewer UV rays in the air, said Jung, but they’re still there – and they’ll still burn your skin.
“They’re especially dangerous because if you don’t feel so hot, you’re inclined to stay outside longer.”
It’s cool out.
“Air temperature is not the issue if the sun’s out,” Jung noted. “Skiers get horrible sunburns.”
I’ll be wearing clothes – head to foot.
First of all, Jung said, few people cover themselves head to foot on a hot summer day. And while clothing is a much better screening agent than sun block – for one thing, you don’t have to keep reapplying it – she said not all clothing will protect you in the same way.
“Some clothing lines are specifically treated with a UV protectant and also woven in such a way as to keep UV light from getting through. They’re specifically designated as UPF 50.”
UPF is a rating that indicates a garment’s effectiveness against UVA and UVB rays. By comparison, an average T-shirt has a UPF rating of 7.
Jung said hunters and fishermen knew about this a long time ago, so these lines of clothing have been available for a while at specialty outdoor sporting goods stores like Dick’s, Cabela’s, Bass Pro and REI.
A variety of web sites specialize in these clothing lines, too – www.coolibar.com, www.uvskinz. com, www.cabanalife.com, www.shedolane. com and www.sunprecautions.com are just a few of the sites that come up by Googling “sun protective clothing.”
These are full lines of clothing, from robes and shifts to swimwear. Coolibar claims it is “the first company to receive the Skin Cancer Foundation’s Seal of Recommendation for sun protective clothing.”
I’ve never gotten a sunburn.
Jung acknowledged that there is a range of skin pigmentation rated on its risk of becoming cancerous. It’s called The Fitzpatrick scale, Jung explained, “and it runs from 1, always burns, never tans – albinos would be the most extreme example – to 6, never burns, always tans – the darkest-skinned person from sub-Sahara Africa.
“Everybody else is in between. The average Caucasian of Irish ancestry would probably be a 2 – pretty much always burns, never really tans.”
However, Jung said, never having burned is no guarantee of healthy skin.
“We believe the amount of UV damage you get in childhood actually affects your risk of melanoma at an older age,” she said. “The risk of all skin cancer will increase with age and with UV damage. Every time ultraviolet radiation hits your cells, there’s a chance it can mutate. Accumulate enough mutations and you’ll get a cancer.”
My doctor said I need sunlight to get my Vitamin D level up.
“That makes me crazy,” said Jung. “Someone decided that 80 percent of the U.S. population has decreased Vitamin D levels, and low Vitamin D leads to disease. More and more, though, there’s research that says having a disease leads to low Vitamin D levels, not vice versa.”
However, she said, there are lots of other sources for Vitamin D. “Your body can’t tell the difference between Vitamin D from a chewable supplement and Vitamin D that’s absorbed by your skin from sunlight – but your skin can tell the difference.”
I’m in my 60s. I spent years in the sun and never had a problem. I imagine I’m immune by now.
If only. Jung said the dry, leathery skin so many people get after years in the sun is all evidence of skin damage “and likely pre-cancerous.”
There’s also, she pointed out, the lifestyle nature of people who grew up in the 1940s, 50s and 60s, feeling it was okay to lather on baby oil or iodine and sit for hours with a reflector under their chins. “Those people did untold damage that may only now be coming back to haunt them.”
So, I’m doomed. Not necessarily at all, said Jung.
“The ‘beauty’ of skin cancer is that you can see it,” she said. “Going to a dermatologist regularly and getting a thorough skin exam is the best way to deal with skin cancer. If you catch it early, it’s 100 percent curable.”
Self-examinations are an excellent way to evaluate your risk, but while a melanoma is relatively easy to spot, Jung said [a] people don’t always know what to look for; or [b] they know exactly what to look for but are in denial and don’t seek treatment.
Unfortunately, she said, you can’t count on your general practitioner to do a thorough skin exam. It’s not a billable service. “The American Academy of Dermatology is working hard to get skin exams coded, like mammograms and colonoscopies, to prove that a general skin screening would lead to a reduction in patient deaths.”
Then I’m locking my door and drawing my drapes until November.
Don’t do that, Jung said. There is much to be gained from being outdoors when the weather is nice. Your mood elevates. You generate endorphins. You get good exercise and stay active. You swim and run, walk and play tennis or golf. You socialize with others much more during the summer months.
Just know your risks and how to protect yourself. Understand that white surfaces – sand, concrete, the bottom of swimming pools – are more intense sun-reflectors. Rethink the things you thought about protective hats and clothing.
Put all that medical and cancer research to work for you. And make your dermatologist a part of your life.