SUN STRUCK

Basking in the rays can domore than burn you. Here's how to enjoy yourself and keep safe, if notnecessarily cool, this summer

    U.S. News & World Report

    June 24, 1996


Blame it on Coco Chanel, who in the 1930s returned to Paris from thesouth of France with her skin a shocking golden bronze. That fashion statementmarked the beginning of the end of milky skin as the American standardof beauty and led to dermatologists' least-favorite oxymoron, the "healthytan." Blame it on the thinning ozone layer that wrenched open theatmospheric door to larger doses of ultraviolet rays. And blame it on ayen for sun-drenched pleasure coupled with Americans' knack for overindulgence.

The sun has betrayed its worshipers. It is almost solely responsiblefor nearly 1 million cases of skin cancer that U.S. doctors are expectedto diagnose this year. Most of those cancers will be the generally non-life-threatening,though often disfiguring, forms of basal cell carcinoma (800,000 cases)and squamous cell carcinoma (100,000 cases). But malignant melanoma, themost deadly form of skin cancer, will strike 38,300 people, about halfof them under the age of 50; 7,300 will die. One in 87 Americans will getmalignant melanoma at some point, up 1,800 percent since the 1930s. Andthe fastest-growing group of those sacrificing themselves to the sun godare young women. Melanoma is the most frequent cancer in women ages 25to 29 and runs second only to breast cancer in women 30 to 34.

Researchers are working on cures and skin cancer vaccines, with a breakthroughannounced in major journals just last week (Page 68). For the present,many of those burned by a cancer scare, like Cindy Katri, 34, have rejectedthe sun's hot seduction. Katri's diagnosis with malignant melanoma fouryears ago jolted her into seeking the shady side of the street forevermore."I'm as white as a sheet. People who don't know I've had skin cancersay, `Oh, you need a tan,' " says Katri, at which point her voiceturns icy as she responds: "No, I don't."

But not everyone feels that way. Nearly 60 percent of under-25 adultsadmit to working on a tan, flinging themselves in the path of UVA and UVBrays for the sole purpose of toasting their skin, according to a 1995 surveyby the American Academy of Dermatology.

A million to 2 million people have a serious tanning habit, payinggood money to cook in tanning salons as many as 100 times a year, accordingto the academy. Such salons, which remain popular despite moves to regulatethem in 26 states, bathe patrons in ultraviolet A, which tans rather thanburns, and plays less of a role in skin cancer than UVB rays do. But mostresearchers believe that UVA rays multiply the effects of UVB or acceleratethe growth of existing cancer cells. Moreover, UVA exposure prematurelywrinkles and withers the skin, leading to a prunish look. The AmericanMedical Association has urged the Food and Drug Administration to ban thenonmedical use of tanning equipment. The FDA is monitoring studies exploringthe link between UVA and skin cancer. For now, tanning salons must postwarning signs about UVA risks.

Risk takers. Perhaps most astonishing, the dermatologists' surveyshows that only about 1 sunbather in 3 bothers with UVB-thwarting sunscreenlotion. The sun's rays are most potent between 10 a.m. and 3 p.m., primerecess and play time for children. In early morning and late afternoon,the sun's intensity is one quarter of its noon power. "We tell peoplethat if they're going to jog or play tennis, do it in the morning or lateafternoon," said David Buller, director of the Arizona Cancer Center'sbehavioral science section.

Buller has good reason to keep the hazards of sunning on his mind.Arizona's latitude, about 10 degrees closer to the equator than, say, Maine,puts it in a position to receive a stronger dose of UV, and Tucson averages310 days of sunshine a year. Sun Belt states have the country's highestskin cancer rates. "We see people here in their 40s and 50s whoseskin looks 70 or 80," says Norman Levine, chief of dermatology atthe University of Arizona and author of Skin Healthy (Taylor, 1995,$12.95).

It doesn't help that the ozone layer has thinned by 6 percent to 7percent in the mid-latitudes of the Northern Hemisphere, which includesthe United States, since 1979. That lets 6 percent to 14 percent more UVBrays through the Earth's protective atmosphere.

How can the glorious warmth of the sun be unhealthful? How can somethingthat feels so good be so bad? Edward De Fabo, a research professor of dermatologyat George Washington University Medical Center in Washington, D.C., andchair of the International Arctic Science Committee investigating the consequencesof ozone depletion on human health, says scientists have known for decadesthat radiation causes skin cancer. Now they know it also compromises theimmune system. He and his research partner and wife, Frances Noonan, helpedunravel the way that the sun inhibits the ability of the immune systemto fight cancer cells.

Solar radiation is doubly taxing, both causing tumors and promotingexisting ones. When the sun burns the skin, perhaps triggering the mutationof a healthy cell into a cancer cell, the body's immune defenses identifythe burned tissue as foreign and poise to mount an attack. But the UV raysalso transform urocanic acid, found on the surface of the skin as a byproductwhen the outermost layer of skin is formed. Until the 1983 discovery byDe Fabo and Noonan of the chemical's role in the immune system, it hadno known function.

The urocanic acid molecules twist and bend under the sun's rays. Intheir altered state, they switch off the immune system's attack on theskin. That is not necessarily bad; it keeps the immune system from attackingthe body's own skin and gives the burn time to heal itself. But if a malignantcell is hidden among other skin cells, the switched-off immune responsegives it free rein to grow and multiply.

If you come from a fair-skinned line who passed on a propensity toburn rather than tan, your chances increase that UV rays will spark a malignancy.As a professor of history and humanities at Hawaii Pacific University,Daniel Binkley, 54, couldn't believe his good fortune at being able tobuild a life in sunny paradise. "I wanted to be as brown as everyoneelse," he said. But his Irish ancestors did not possess appropriategenes. Binkley's sun-induced brownness was confined to a mole on his rightarm that was diagnosed as malignant melanoma about 20 years ago. It wastreated successfully, and he no longer seeks a tan.

Looking for moles. Binkley was fortunate. At the time he heardthe words "malignant melanoma" in the late 1970s, the likelihoodthat it was a death sentence was far higher than it is now. In the early1960s, 60 percent of melanoma patients survived five years; today the rateis about 90 percent. "That's entirely due to early diagnosis,"said Arthur Sober, head of the melanoma clinic at Massachusetts GeneralHospital in Boston. The key is that more people seem to be recognizingunusual moles and having them removed early (box, Page 65).

Basal cell and squamous cell carcinomas, while much less deadly thanmelanoma, can be a recurring annoyance, showing up most commonly on face,ears, neck, arms, hands and legs as warty bumps or scaly patches. Surgeryto pluck them out can also be disfiguring if they've grown deep into skin,and can require extensive reconstructive surgery. Even an open car windowcan take its toll, as evidenced by contrasting statistics from two sidesof the Atlantic Ocean. In Americans, skin cancer is more common on theleft side of the face, since the driver's window is on that side; in England,it's the right side. (Closed windows and windshields absorb most of theharmful rays.)

Strategy for life. Damage done cannot be undone. Sunburns andsuntans accumulate, ultimately resulting in premature wrinkles. For childrenwho have suffered a sunburn before age 20, the consequences are more serious--ahigher lifetime risk of skin cancer. The dermatologists' survey found that30 percent of parents with children under 13 reported that their childrenhad suffered at least one sunburn. Babies should be kept out of directsunlight for the first six months of life, when their skin is thinner thanthat of older children. Sunscreens are not approved for babies youngerthan six months--not because of demonstrable danger, but because the lotionshave not been tested on such young children. Lawrence Schachner, directorof the division of pediatric dermatology at the University of Miami Schoolof Medicine, says all other children should be protected with a water-resistantsunscreen, which will hold up against sweating as well as swimming, ofSPF 15 or higher.

Beyond such universal advice, personal preference can help map outa protective but realistic regimen. Of the two basic types of effectivesunscreens, the most popular kind relies on chemicals to absorb UV rays.The other sunscreens, called physical blockers and sometimes marketed aschemical free, use titanium dioxide or zinc oxide--the white-nosed, lifeguardlook. SPF ratings apply to both types of sunscreens, but a rating lowerthan 15 may allow for some tanning among individuals who tan but don'tburn. If your skin type says SPF 4 will give you an hour in the sun, afteran hour your time is up. Don't make the mistake of thinking that puttingon another layer will get you more time in the sun. If you want more timein the sun, use a higher SPF. Most dermatologists prefer to insist on SPF15 or higher, however, believing that no tan is a safe tan.

An average adult-size dose sufficient to cover all exposed skin isabout 1 ounce. Clothing provides some protection, so cover up what theheat will allow. "Cotton clothing is pretty good protection and it'slightweight, so wear longer sleeves, longer shorts and higher socks,"says Schachner. "And get out of the hip-hop mode of wearing the baseballcap backwards. Worn the right way, a billed cap will protect 70 percentof the face." A wide-brimmed hat is even better.

For anyone facing an unusual risk because of a family or personal historyof skin cancer, skin that easily burns or a weakened immune system, newlines of clothing block out almost all UV rays. A line cleared by the FDAcalled Solumbra, which includes articles from leggings and safari shirtsto toddler coveralls, has an SPF of 30 or more. (Call 800-882-7860 fora catalog.) Some dermatologists, like Levine, think of such clothing asextreme and unrealistic for most people and say that normal summer-weightclothing with a tight weave provides adequate protection.

Black- and brown-skinned people who don't sunburn have far less riskof skin cancer than do fair-skinned people who sunburn easily, but theystill benefit from SPF 15, says Perry Robins, president of the Skin CancerFoundation. Even the darkest-skinned people can get skin cancer--oftenon the lighter skin of their palms or soles or on previously traumatizedparts of their bodies, such as a vaccination scar or an area that has beenburned or scalded.

Far sighted. All eyes, regardless of skin color genes, are equallyvulnerable to sun damage. Sunlight stimulates cataracts, a clouding ofthe lens that results in 1 million surgeries annually to substitute anartificial lens for a damaged one. A 1988 study in the New England Journalof Medicine asked 838 Chesapeake Bay fishermen ages 30 to 94 abouttheir eye-protection habits since the age of 16. Those who wore no eyeprotection had three times as many cataracts as those who routinely woresunglasses or a brimmed hat.

The fishermen conscious of their eyes likely were wearing sunglassesless sophisticated than those now available, although all sunglasses offersome protection. To be fully protective, a pair of sunglasses should blockat least 99 percent of all UV light or provide UV absorption up to 400nanometers, which covers the range of harmful UV. Some sunglasses claimto block infrared rays, but research to date has found no reason to worryabout infrared. Polarized lenses cut glare but do not stop UV. Mirror-coatedlenses cut down on light, but unless they're also labeled as outlined above,don't assume they fully protect you. For those who have had cataract surgeryor who have macular degeneration, wraparound glasses are recommended.

The ultimate safe prescription, it might seem, is no sun at all. Butthe human craving for sunlight is basic, and not even the most stridentdermatologist advocates cave dwelling as a lifestyle. There's no doubtthat the sun lifts our moods, and those who live in northern latitudessuffer disproportionately from seasonal affective disorder, a rhythmicdepression that gears up as the days grow shorter and lifts as the summersolstice nears. SAD sufferers can be treated by exposure to high levelsof artificial light--special fluorescent bulbs in light boxes designedfor intensity.

Chemical engineer Herb Kern, now 79, was instrumental in steering researcherstoward evidence that the sun's energy could affect one's state of mind.For most of his life, Kern had felt his energy drain away during the falland winter, to return in the spring and summer. Ever the scientist, hekept a 14-year diary of his seasonal mood changes. In the early 1980s,the diary caught the attention of Norman Rosenthal, chief of environmentalpsychiatry and director of seasonality studies at the National Instituteof Mental Health; 1984 saw the first published paper on the disorder. Somescientists believe the light stimulates production of serotonin, a brainchemical known to affect mood. Kern now treats his illness with a lightbox during the part of the winter he spends in his New Jersey home. Thelight from the box is about 20 times brighter than normal room illumination,though still only one-tenth the brightness of a sunny day at the beach.

But it's the real sun that Kern finds most healing. Now retired, heheads for a second home in Florida from January to May. As much as hispsyche craves sunlight, his mind also respects the power of its rays. Hesplashes on sunscreen, dons wraparound sunglasses, puts on lightweight,long-sleeved and long-legged clothing, tops it with a brimmed hat, andheads out for an early morning or late afternoon dose of golden happiness.

BY SUSAN BRINK WITH CORINNA WU

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