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Skin Deep

Dealing With the Dangers Of Basking in the Sun

Daniel Krall

Sizzlin Summer 2006

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By Kate Leventhal | Posted 5/24/2006

As a typical Caucasian-American, my background is an assortment of European nationalities: Lithuanian Jew, Irish, Swedish, and French-Canadian. My ancestors were not a sun-loving people. The five days a year that they actually had sun were more of an annoyance, because it created an uncomfortable glare off the land as they dug up root vegetables for the bland recipes they passed down for generations. When these ancestors came to the United States, they immigrated through Canada, because Ellis Island was too tropical. From there, they settled as far south as balmy Minneapolis, Milwaukee, and Chicago.

Considering my ethnic heritage and the fact that my own skin is so ghostly white that I can use my forearm as a night-light, it would be crazy for me to lounge in the sun all day trying to bake some color into my otherwise translucent skin. Not that I haven’t tried. And the generations before me tried as well. My mom is even fairer skinned than I am—she’s mostly Irish, with red hair, pale blue eyes, and skin that freckles and burns rather than tans. Most of the summers of her youth were spent on a lake in northern Wisconsin, boating, water-skiing, swimming, and lathering up with baby oil in hopes of a tan. People just didn’t know about the lasting damage the sun could cause back then, and her practices led to more than one blistering sunburn. So when my mom called me from Wisconsin shortly after I moved to Baltimore in 2000 and told me she had skin cancer, I was more terrified than surprised.

She had been diagnosed with basal cell carcinoma, the most common form of skin cancer and the easiest to cure. It can look like small spots or blisters that most often appear on the face, ears, shoulders, and back. There are a variety of treatments, ranging from topical creams to laser surgery. My mom underwent excisional surgery, one of the more common treatments. Her dermatologist cut out the cancerous spot and a small layer of healthy skin surrounding it and sent them to a lab for tests.

Fortunately, the cancer had been caught in the early stages, and this procedure was all my mom needed. But she still has to return to the dermatologist twice a year, and, more often than not, she has to have more skin removed. She’s grateful, of course, that she hasn’t been diagnosed with melanoma, one of the most serious forms of skin cancer. But she’s a shy woman, and dealing with stitches and scars on her face has been difficult.


Sunscreen is available at drug stores and cosmetic counters, in bottles, sticks, sprays, and gels, ranging from SPF 4 to 75. But according to the Skin Cancer Foundation web site, “One in 5 Americans and one in 3 Caucasians will develop skin cancer in the course of a lifetime.” More than 90 percent of these cancers are caused by sun damage.

Dr. Nanette Liegeois, a skin-cancer specialist in the Johns Hopkins Department of Dermatology, says that the incidence of skin cancer is increasing dramatically, and not just in adults. “The increase [in melanoma] in children is extremely alarming,” she says. According to the Maryland Cancer Registry, melanoma cases in the state have risen 34 percent since 2003, to over 1,000 cases. No data has been recorded for nonmelanoma cancers.

“There’s a mentality that if you’re truly living a nice life, then part of that life needs to prove that you’ve been outdoors at the beach,” Liegeois says. Not that the beach is a bad place. “There is a mental-health benefit to being at the beach,” she says. People do relax near the water, and “that’s fine and good if you take appropriate measures to protect your skin.”

Skin cancer isn’t just a concern for the fair-skinned, either. “It’s a myth that dark-skinned people are at lower risk for skin cancer,” Liegeois says. There is actually a higher death rate from skin cancer among dark-skinned ethnicities such as African-Americans and Latinos, she says, because patients from these demographic groups are less likely to show up for routine dermatologic screenings than people with lighter skin.

Acral lentiginous melanoma accounts for about 10 percent of melanoma diagnoses and is almost exclusive to Asians, Latinos, Native Americans, and African-Americans. The cancer looks like a flat, black spot and often appears on less-pigmented parts of the body such as palms, the bottoms of feet, and underneath fingernails and toenails.

Despite recent advancements in many areas of medicine, skin-cancer treatments have changed little. “There have been no recent breakthroughs or therapies to prevent a patient from going through the ordeal of skin cancer,” Liegeois says, with remedies frequently requiring surgical removal and even chemotherapy for advanced melanoma cases.

Governments have started getting involved in promoting sun safety. Gov. Robert Ehrlich officially proclaimed May as Melanoma/Skin Cancer Detection and Protection Month in Maryland. The Coalition for Skin Cancer Prevention in Maryland helped organize the kickoff event at Meyerhoff Symphony Hall. Established in 1997 through a grant from the federal Centers for Disease Control and Prevention and currently funded by the state Department of Health and Mental Hygiene, the organization is the first and only state coalition for skin-cancer prevention in the United States. “Sunburns are the leading cause of skin cancer and melanoma,” says Roberta Herbst, the coalition’s project coordinator. “Our group is specifically targeting children to prevent skin damage.” The kickoff event included a children’s poster contest promoting sun safety.

The coalition has supported several legislative efforts introduced by state Del. Anne Healey to mandate safe skin care. Earlier in May, the Prince George’s County Democrat introduced a bill requiring every county to have a health-service programmer to establish consistent, centralized health services in public schools across the state.

The bill also requests that children be allowed to bring sunscreen to school. In the past, some schools have viewed it as a medication that children have to receive from a school nurse or health-care worker, or have written permission from a parent or guardian to carry it. “People are getting the message, slowly,” Herbst says. But she is pleased with the strides the coalition has made in educating young children and families. “I see people and parents that are proud that their child has never had a sunburn,” she notes.

The coalition is also supporting Healey in drafting a tanning-bed licensing and regulation law that would prohibit children under 13 from using artificial tanning booths. “In my opinion, that is not even stringent enough,” Herbst says.

Tanning beds use ultraviolet radiation to create an artificial source of sunlight. The U.S. Department of Health and Human Services has declared UV radiation to be a known human carcinogen. According to a 2002 article in the Journal of the National Cancer Institute by Dr. Martin Weinstock of the Brown University Medical School, people who used artificial tanning lamps were 2.5 times more likely to develop squamous cell carcinoma and nearly twice as likely to develop basal cell carcinoma than those who did not. The article stated that the younger people are when they use tanning devices, the more likely they are to develop these types of skin cancers.

The bill has been introduced before, Herbst says, but lobbying groups from the tanning-bed industry have rallied against it. Healey has withdrawn the bill but plans to introduce a retooled version next year.

Smart Tan has been lobbying for the tanning-bed industry for nearly 20 years; the group publishes Tanning Trends magazine, which is geared toward tanning-salon owners. A recent issue addressed the loss of customer base due to changing attitudes toward artificial tanning. The article encouraged better marketing to increase customer numbers and “encourage the customer to feel good about tanning.”

Both Herbst and Liegeois condemn using tanning beds as a way to get a base tan before hitting the beach, reiterating that there is no such thing as a safe tan. “I’m frankly surprised that [tanning lobby groups] are not held liable for some for some of the misinformation they’ve given,” Liegeois says.

Teens are one of the most difficult groups to talk out of tanning, and Liegeois is not optimistic about efforts to get through to this group: “We’ve made no headway at all. People are still tanning, and not avoiding the sun as they should be.” Human skin does not self-repair, and tanning and burning in one’s younger years may have lasting effects. “Just like your brain, your skin does not forget,” she says.


I know my skin will not forget the frequent burns I faced as a child, and it will most definitely not forget the spring day during my junior year of high school when I skipped class with my friends, threw on a two-piece, and paddled around in an inner tube on the river for four or five hours. That night, I had blisters all over my back and chest and stood shivering with chills and a fever, while my mom angrily sprayed me with Solarcaine for 10 minutes—doing so in our garage, fearful that the fumes would kill our cat.

Ten years later, with my mother’s ordeal weighing on my mind, I’m more careful about skin exposure. And it’s not easy. Vanity, though I hate to admit it, does play a role—I’d like to make it to August without at least one person asking me why my skin is see-through. But it is this same vanity that could literally be the death of hundreds of people as the numbers of skin-cancer diagnoses continue to climb.

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