Welcome to summer! Goodbye rain and short days, hello sunshine and flowers! Bring on the barbecue, pool, and camping! For Oregonians, emerging from hibernation and enjoying longer daylight hours is a much-anticipated time of year filled with making great memories with family and friends. It’s almost as if you can feel your mood and energy improving, like being plugged into a solar charging station. And if a little is good then more is better, right? And for once, the medical opinion agrees. Studies have shown that Seasonal Affective Disorder (SAD) can make depression worse, and with decreased Vitamin D levels comes decreased resilience and coping skills for daily stressors.
Just wear your sunscreen. Consistently. SPF 30 or greater, water and/or sweat resistant for swimming or vigorous physical activity. And a hat. And long sleeves if it is not too hot. And sunglasses. Reapply sunscreen every two hours. No whining. But why, you ask? What about that bronzed sun-kissed skin tone I was looking forward to all winter? The short answer is that skin damage is cumulative and does not repair nearly as well as we once thought. Most of us have or will have an estimated 80 to 90-percent of our lifetime skin damage, mostly from sun exposure, before we are 21. This is partially because we think we are indestructible until about that age, and also because most of us spend more time in our youth at lakes, parks, beaches, etc. before we spend the rest of existence in an office staring at a computer somewhere.
So, what does cumulative mean? It all adds up, that time in the sun. It means be kind to your 45-year-old self if you are 21 because that beautiful tan today means more crow’s feet, wrinkles, and decreased skin elasticity in the future. And oh, by the way, increased risk for skin cancer.
Although much more common in fair skinned people, skin cancers-particularly melanoma-can show up at any age and with any skin type. Family history plays a role so if you have a mom, dad, brother or sister with history of melanoma specifically, you should have an annual skin survey with a dermatologist or family practitioner knowledgeable about skin conditions. Melanoma, while uncommon, is a fast-growing type of skin cancer that can metastasize elsewhere in the body quickly, even when the primary site is fairly small and innocent in appearance. Regular daily use of an SPF 15 or higher sunscreen reduces the risk of developing melanoma by 50-percent according to the American Cancer Society. Paradoxically and frustrating to clinicians, melanomas also have a slightly higher rate of occurrence on skin areas with no sun exposure at all such as the groin. And further, even though most people think of Florida and Hawaii as being high risk due to sun, demographics show that there is a significant risk in temperate climates despite less total sun exposure to the regions-with the Pacific Northwest showing one of the highest rates of new diagnoses. Treatment requires wide excision, as this form can have invasion margins far beyond the visible structure.
Although Melanoma is the most concerning, more common is Squamous Cell Carcinoma (SCC) of the skin-a slower growing type of skin cancer that exists on a continuum from premalignant dry red scaly plaques called actinic keratosis; an intermediate phase known as Bowen’s disease; and formal skin cancer. SCC is almost always related to radiation (sun) exposure, and can be treated in a variety of ways including removal, or destruction with liquid nitrogen or topical chemicals depending on how advanced it is. These skin changes tend to occur later in life.
The final type of skin cancer of frequent clinical significance is Basal Cell Carcinoma (BCC) and is also related to radiation damage from the sun or other sources. It tends to have shiny rounded margins, but this is not always the case. The good news with this type is that it almost never goes elsewhere in the body. Its main threat is that it frequently comes back unless excised with wide margins, because it also has more local site involvement than is typically visible to the clinician. BCC tends to be more of a cosmetic issue, cropping up frequently on the face, nose and ears.
So enjoy the summer, but forego the tan! Instead treat your skin to a good daily moisturizer and application of SPF 30-plus sunscreen. That way, your skin has a better chance to continue looking beautiful and doing its job for decades to come.
