Not So Sunny Spots
You can still get skin cancer even if you haven't spent a lifetime outdoors
Erin Elovecky loves to feel the warmth of the sun on her body. Growing up, she spent many summer days on Long Island Sound, cruising around in her parents' boat and soaking up rays. Elovecky admired her mother, who could quickly develop a rich, brown tan, thanks to her Lebanese heritage. But Elovecky took after the Irish side of the family, with fair skin and green eyes, and got burned by the sun more often than not.
Hoping to give her skin a year-round sun-kissed glow, Elovecky started visiting a tanning salon near her Southbury, Conn., home a few times a week in her early 20s. She went for a couple of years. "It made me feel like I didn't need to wear a lot of makeup, and I thought I looked so much healthier with a tan," she remembers.
Two years ago, at the age of 27, Elovecky noticed a small red spot at the edge of her eyebrow. It itched, and the skin kept peeling off. She didn't do anything about it until her hairdresser said, "You have to get that checked out right away." One very painful biopsy later, Elovecky got the bad news: She had basal cell skin cancer.
Sun exposure. Cases like Elovecky's are becoming increasingly common. A recent study published in the Journal of the American Medical Association found that the incidence of basal cell carcinoma (a slow-growing tumor of the basal cells at the bottom of the epidermis) among women under the age of 40 more than doubled between 1976 and 2003, to 31.6 per 100,000. The rate for men increased only slightly during that time. The study also found that both women and men showed significant increases in squamous cell cancer, which occurs in the middle layer of the epidermis. Like basal cell cancer, squamous cell cancer typically doesn't metastasize and is rarely ever fatal. The reasons for the rise in skin cancer are clear, say doctors. "Either they're getting lots of chronic sun exposure because they're out all the time or using tanning beds, or it's these intense burns that they're getting," says Leslie Christenson, a dermatologic surgeon at the Mayo Clinic and one of the study's authors. Stepped-up screening for skin cancer and the thinning ozone layer, which allows more of the sun's ultraviolet rays in, may also play a role. The Indoor Tanning Association notes that the study didn't address whether the women tanned indoors or outdoors.
Basal cell carcinoma is the most common cancer in humans, with 800,000 new cases each year. Squamous cell cancer is the second most common skin cancer, with 200,000 new cases. Next in line is melanoma, a tumor that begins in the cells that produce the skin's pigment, which accounts for only about 100,000 new cases annually. But melanoma is much more lethal, killing 1 in 4 people who develop it. Ultraviolet radiation from the sun is a principal cause of all types of skin cancer, either from damaging sunburns or the cumulative effect of long-term exposure. Family history also plays a role, especially in melanoma. The typical sufferer used to be an older man who had either worked outdoors all his life or was an avid golfer or boat owner who spent long hours in the sun. But as the new study shows, that profile is changing.
Dermatologists who treat skin cancer aren't surprised. "A week doesn't go by that I don't see a woman in her 20s or early 30s with skin cancer," says David Leffell, a professor of dermatology and surgery at the Yale School of Medicine. And although basal cell and squamous cell cancers hardly ever kill, those who develop them are at higher risk for melanoma. Among 25-to-29-year-old women, melanoma is more common than any non-skin cancer, including breast and colon cancer.
When you're young, though, health concerns often take a back seat to more pressing worries, like having a tan for prom. That's how Erika Smith felt. Her grandmother died of melanoma, so Smith knew she was at higher risk for the disease, but that didn't stop her from sunbathing in the backyard of her family's home north of Seattle or going to the tanning parlor regularly. "I felt invincible," says Smith.
But then melanoma struck her family again. Her uncle's wife died of the disease last year at age 35, and Smith, then 19, was devastated. Because she wasn't a blood relative her risk didn't change, but her perspective did. She went to the dermatologist, who biopsied a mole on her calf that looked normal but for a tiny black speck on it. Diagnosis: melanoma, at a very early stage. Now she goes to the dermatologist every six months for a full-body skin exam and avoids the sun.
Leffell and other skin cancer experts believe tanning parlors are one of the major culprits in the rise of skin cancer among young women. A study published in the journal Pediatric s in 2002 found that 40 percent of 17- and 18-year-old girls reported visiting a tanning parlor in the past year (compared with just 11 percent of boys in the same age group). Twenty-three states now restrict minors' use of tanning beds in some way, according to the American Academy of Dermatology. Many states either require parental consent or restrict use to certain age groups.
Fewer scars. How skin cancer is treated depends on many factors, including the type of cancer, whether it's confined to the top layer of the skin, and how important it is to achieve the best cosmetic result. Superficial cancers on the trunk, arms, or legs can often be scraped and burned: The affected skin is gently scraped off with a sharp curette, and then the area is cauterized. Patients with more invasive cancer or with skin cancer on their face may choose to undergo a surgical excision in which the cancerous cells as well as some tissue surrounding the area are removed. This option is more precise than scraping and burning and scars less. Mohs micrographic surgery is the most thorough method for treating basal and squamous cell cancer and also yields the best cosmetic result. It involves removing the diseased tissue layer by layer and mapping the affected area to pinpoint cancer cells.
Even though most sun worshipers no longer aim for the deep, nut-brown tan that was popular in the 1970s, it's still fashionable to get a "healthy" tan in the summer. But there is no such thing, say dermatologists. People tan when the melanin in their skin darkens to protect it from the sun's rays. "The fact that you're making a tan is a sign that you've had an injury to your skin," says John Carucci, director of Mohs micrographic and dermatologic surgery for Weill Medical College at Cornell University.
Self-tanners are a safe alternative for people who want a golden glow that doesn't depend on radiation. These products contain a colorless sugar that stains the skin's surface cells darker, although most do not offer any protection from the sun's rays. Self-tanners were the fastest-growing sun care product between 1999 and 2004, according to Euromonitor International, a market research company.
The nonprofit Skin Cancer Foundation (skincancer.org) recommends that people who go out in the sun wear a broad-spectrum sunscreen with a sun protection factor, or SPF, of at least 15. This will block 93 percent of the sun's ultraviolet type B rays, which are primarily responsible for skin cancers. Sunscreen should be reapplied every two hours and right after swimming. In addition, sunbathers should wear fairly tight-knit clothing, sunglasses, and a hat. Try to stay in the shade between the hours of 10 a.m. and 4 p.m., when the sun is hottest.
Since most skin cancers, even melanoma, are curable if caught soon enough, early detection is key. Check your own body for new or changing moles, lesions, or other spots on your skin once a month, and visit a dermatologist for a professional skin check annually. Any lesion that changes size, shape, or color, or that begins to itch, doesn't heal, bleeds intermittently, or becomes worse over the course of a month should be examined right away. Shonda Schilling, 38, who has had five melanoma surgeries since 2001 and who founded the Shade Foundation to educate people about skin cancer, says some of her skin lesions didn't look bad at all. "It doesn't have to look nasty to be skin cancer," says Schilling. "If you wait until it's as nasty looking as the pictures in books, it's probably going to kill you."
This story appears in the November 14, 2005 print edition of U.S. News & World Report.