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Bernard Gordon, MD and Ernest Rosenbaum, MD

For decades, the promise of the sun's bronzing powers has sent people flocking to beaches and tanning salons, all in the name of looking good. Even those who burn easily have gladly endured chronic sunburn just to achieve that fashionable glow so long associated with a healthy body and lifestyle. In recent years, however, dermatologists have found that sun exposure is not as beneficial as many people think. In fact, they've concluded that sun damage causes nearly 90 percent of the cosmetic changes associated with aging -- such as wrinkling, a leathery appearance to the skin, irregular pigmentation, and age spots. This photo-damage may also cause other problems in the skin that can eventually lead to skin cancer. It's estimated that using sunscreens on a regular basis during the first 18 years of life could reduce the incidence of skin cancer by about 70 percent.

The Power Of The Sun
The sun's radiation is made up of up infrared, visible, and ultraviolet (UV) rays. It's the ultraviolet rays -- UVA and UVB -- that affect the skin. UVB rays, in particular, penetrate your skin's epidermis, or outermost layer, and are the principle cause of sunburn and skin cancer. They also contribute to premature aging. They are strongest, and thus most potentially damaging between the hours of 10 am and 3 pm.

For a long time, UVA rays didn't receive much attention because they weren't thought to be as dangerous as UVB. recent studies show that UVA rays penetrate the skin even more deeply, reaching into the connective tissues. There, .they aggravate the effects of UVB radiation and also play a major role in aging. Unlike the UVB rays, however, UVA rays are strong all day long, all year long.

When your skin absorbs UV rays, the exposure triggers the production of melanin, a natural sun screening pigment. This creates what we know as a tan. People with light hair and complexions have less natural protection from melanin, so they burn quickly But even a tan doesn't prevent long-term harm, because the skin remembers each exposure. With every burn, it can grow weaker in its ability to protect itself. Over years, damage to the skin's basic structure from sunlight can lead to premature aging and even skin cancer.

Sun Hazard 1: Premature wrinkling
Dermatologists now have overwhelming evidence that almost all wrinkles can be attributed to sun exposure, and not to aging itself. During a normal aging process, the skin becomes thinner - - but when it gets too much sun it permanently thickens. If the skin on your face never saw the sun, it would resemble the relatively smoother skin on your buttocks and the back of your arms, and dryness would be much less severe as you get older.

Just how does sunlight cause wrinkles? The most recent studies put the blame on a process known as photo aging. When UVA rays reach into the dermis, the skin's lower layer, they cause abnormalities in the proteins that keep your skin flexible and resilient. The result: Your skin sags, wrinkles, and looks aged.

Sun Hazard 2: Precancerous skin lesions
Excessive sun exposure can lead to the growth of actinic keratoses or solar keratoses -- rough, scaly skin lesions that can be a precursor to cancer. Years ago, it was unusual to find these skin anomalies in folks under 40, but today, they are commonly seen in patients in their 1ate teens. People who work in the sun a lot -- as farmers and seamen-are most likely to develop them, and studies suggest that anyone exposed to sunshine over a long enough period of time will get them as well.

Age of exposure also plays a role in shaping your risk of developing skin lesions. The number and type of lesions that occur depend on how much sun people got during their childhood. Over sunning early in life is more dangerous than it's later in life.

Symptoms Skin lesions usually show up in areas chronically exposed to the sun: the face, lips, ears, the back, forearms, and hands. Typical symptoms are listed below:
- Scaly and rough texture.
- Slightly raised or puffy if on the arms, hands, or other extremities, but usually flatter if on the face, head, or neck.
- Usually three to six millimeters in size, though some lesions can be as small as a pinpoint.
- A sharp boundary, though in many cases, some of the edges blend into the background.
- Present in more than one site.
- Color can vary greatly, from flesh-colored to darkly pigmented or tan.

Early Recognition and Treatment If you think you've got a skin lesion, it's important to have ,your doctor look at it right away. Studies suggest that solar keratoses can evolve into cancer. Some experts estimate that approximately one in 1,000 lesions will at some point evolve into a squamous cell carcinoma, the second most common skin cancer. Fortunately, these lesions do not spread, and even the carcinoma that may arise from them metastasize. Whether a lesion will grow into cancer seems to depend on time. In other words, the younger the age at which a skin lesion develops, the greater the risk it'll evolve into carcinoma over time. With that in mind, people with skin lesions should be careful not to overexpose themselves to the sun.

There are a number of effective treatments for eradicating actinic keratoses. Not all keratoses need to be removed. The decision on whether and how to treat is based on the nature of the lesion, your age, and your health. Actinic keratoses is skin cancer's warning signal.

Heed That Signal! - Sun Hazard 3: Skin Cancers
Estimated new cases and deaths from skin (non melanoma) cancer in the United States in 2009:
- New cases: more than 1,000,000
- Deaths: less than 1,000

Estimated new cases and deaths from melanoma in the United States in 2009:
- New cases: 68,720
- Deaths: 8,6501
Skin cancer ranks as the most widespread cancer among Americans, but fortunately, 90 to 95 percent of people with the disorder can be cured. Skin cancer can occur in all races and skin colors. There are three types of skin cancer:

Basal Cell Carcinoma
This the most common malignant tumor of any kind, affecting more than 600,000 people annually in the United States. Basal cell cancer usually develops in sun-exposed areas of the face and body and looks like a pale, wax-like, or pearly nodule (lump) that may ulcerate.

Who's at risk -- The development of basal cell carcinoma has been directly linked to ultraviolet radiation exposure and other factors. The odds of developing it are greater in:

- Fair-skinned people, especially those who sunburn easily but tan poorly
- People who live in a warm, sunny region, or who frequently take outdoor vacations

Odds of survival -- Most basal cell cancers are treated effectively. The real danger lies in the potential for local tissue destruction that might lead to disfigurement or functional impairment, since a majority of the tumors occur on the head and neck. Tumors that have been neglected for a long time and have grown relatively large, as well as those that have recurred after initial therapy, may be more aggressive and especially difficult to cure. Consequently, they may lead to more tissue destruction and other bad side-effects.

More than 95 percent of basal cell cancer patients are cured if their tumors are treated early. Long-term follow-up is essential because of the possibility of recurrence; a person's most likely to get skin cancer if he or she's already had it. Thus it's important for patients to use sunscreen and keep a vigilant eye for new lesions.

Squamous Cell Carcinoma
This type of skin tumor, also malignant, takes root in the cells that produce the protective keratin of the epidermis. It may occur anywhere on the skin -- whether or not the area's been overexposed to sun -- as well as on mucous membranes. The cancerous growths usually appear as red, scaly, raised lesions that arise sun-damaged skin or at sites of previous burns, scars, or chronic sores. They may be also be wart-like or cauliflower-like in shape, most typically if they're on the hands, feet, or the linings of the mouth or genitals. In some cases, they show up as a hard nodule with or without ulcerations.

Who's at risk -- Squamous cell cancer is usually related to too much ultraviolet light exposure. People run a higher risk for getting it if:

- They have fair skin and burn easily but tan poorly.
- They've developed precancerous lesions such as solar keratoses.
- They've got preexisting dermatological problems, such as scars and ulcers.

Odds of survival -- Despite the high numbers of new squamous cell tumors that appear each year, most are cured effectively. However, in addition to the danger that these tumors may destroy local skin tissue, they may also metastasize.

Melanoma -- meaning black tumor -- is a potentially deadly tumor. It's the most malignant type of skin carcinoma-and more than that, it's one of the lethal cancers of any kind. The disorder arises frequently in the pigment-producing cells -- melanocytes -- of the epidermis, and can spread quickly to melanoma to every part of the body. It is rare before puberty, and most cases are non-familial. Some pigmented lesions may be precursors to melanomas.

Who's at risk -- The chances of getting melanoma are increased with these risk factors:

- A family or personal history of the cancer
- Light complexion
- Tendency to freckle
- A tendency to sunburn
- Many moles or birthmarks
- Unusual moles or birthmarks

Symptoms to look for -- Melanomas may develop in normal looking skin or in dark or flesh colored moles. While most pigmented spots are not melanoma, see your physician straight away any mole or lesion -- old or new -- shows the following signs:

- A change in color-- a lightening or darkening, reddish, bluish or grayish tinge.
- A growth or change in size, shape, or thickness.
- Irregularity of the margins of the growth.
- Itching, crusting, bleeding, erosion, or ulceration.
- Personal or family history of melanoma an or dysplastic nevi, unusual moles that look like melanoma under the microscope.

Odds of survival -- Of all diseases that arise from the skin, melanoma causes the most deaths, more than 8,000 per year. When a melanoma is caught and treated early, most patients do very well. By examining your skin regularly, you become a responsible partner in your own health care.

Diagnosing and treating skin cancer
In all three types of the disease, skin biopsies are necessary to confirm a diagnosis of cancer. For treatment, a wide variety of options are available. Choice and success of therapy depends upon the patient, the tumor type, and the doctor's skill. Long-term follow up is essential because of the potential for recurrence spreading of the cancer, or development of new lesions.

Staying On The Alert For Skin Cancer
Here are our recommendations for skin cancer screening:

l. Have your skin checked during your physical examination once every three years if you're between the ages of 20 and 40, and every year if you're older.
2. If you're at a higher risk for cancer, ask your physician for specific recommendations.
3. Examine your skin periodically for changes. Pay specific attention to moles. Ask a friend to check areas you can't see, or use a mirror.
4. If you're fair-skinned, avoid excessive exposure to the sun by using a sunscreen or protective clothing.

Enjoy The Great Outdoors And Protect Yourself From Skin Damage
It's clear that the sun's rays lead to skin damage, but a few easy steps of prevention can allow you to safely enjoy outdoor activities:

Avoid the midday sun. Nobody can totally avoid the sun, nor do we advocate that you do, but consider scheduling your time outdoors before or after 10am to 3pm, when UVB rays are most intense. Also remember, the UVA rays responsible for premature skin aging are strong all day, all year, so wear protective clothing whenever you're outside.

Cover up. Light, long-sleeved shirts and long pants can help shield you from the sun without becoming too warm. Umbrellas may also help, but light reflected off the beach or water can be as strong as direct sunlight.

Use sunscreen. Suntan lotions are designed to moisturize the skin and permit tanning without sun protection. A sunscreen, on the other hand, absorbs or reflects ultraviolet energy from the sun, protecting the skin from its harmful effects. Try a broad-spectrum sunblock; unlike conventional sunscreens, which filter out only UVB rays, broad-spectrum products screen out both UVB and UVA rays.

According to dermatologists, you can greatly reduce sun damage to your skin by using a sunblock with a Sun Protection Factor of l5 or higher. With an SPF of 15, a person who would normally start to sunburn in ten minutes can go for 150 minutes before turning pink. Some people may be bothered by PABA which is an active ingredient in sunscreens. You can now buy PABA-free sunscreens.

Apply your sunscreen once a day in the morning and reapply after swimming and heavy exercising. Products that are water resistant or waterproof continue to exert their photoprotective properties for up to 40 and 80 minutes, respectively, after you've immersed yourself in water.

If skin cancer runs in the family, sunscreen use should begin in childhood, especially you've got fair skin. There is evidence that sunscreens effectively prevent sunburn, and they probably also reduce wrinkling and skin cancer.

Avoid tanning salons. The idea of a year-round tan appeals to many people. But the use of tanning salons may have serious effects on both your skin and eyes, some of which are irreversible. For. one thing, the intensity of the UVA rays received in a tanning parlor is twice what you'd get while sunbathing at noon on the beach in the summer. Not only might this increase your risk of skin cancer and cataracts, but it may also trigger photosensitive reactions in clients who take antibiotics, birth control pills, and other drugs. Public education and new regulations on the operations of tanning salons are needed to ensure the health and safety of clients.

The best cure for skin cancer remains early detection and,prompt treatment. Recognize the warning signs of the disease through regular skin self-examinations. Even more important however, is to protect yourself from the sun's rays. By avoiding the peak hours of ultraviolet radiation, and by wearing sunscreen and protective clothing, you can keep skin cancer from happening to you.

The prevention of skin aging and cancer can make your life healthier and longer.
