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The Sun Vs. Your Skin: A Survival Guide

By now you've probably heard the warnings: The American Cancer Society expects that 600,000 new cases of skin cancer will be diagnosed this year, mostly caused by overexposure to the sun. One out of every six Americans will eventually develop some form of skin cancer. For fair-skinned people, that rate increases to one in three. And in April, the Environmental Protection Agency announced that a shrinking ozone layer could lead to 200,000 Americans dying from skin cancer by 2050.

This is sobering news for those of us who slathered on baby oil, aimed reflectors at our faces, and blithely basked for hours. Will the indiscretions of our past necessarily doom us to skin cancer? The answer, say experts, is that with extra precaution now, maybe not. And the good news is that over the past decade or so, major advances have been made both in spotting skin cancer early and treating it effectively.

DEEP DAMAGE. The sun's danger is invisible to us, existing in the form of ultraviolet light. The short rays that are responsible for a stinging sunburn and are thought to be the primary cause of photo-aging and skin cancer are called ultraviolet B (UVB). But research is revealing that its longer-wavelength cousin, UVA, may also cause damage. These longer rays produce a tan by reaching into the deeper layers of the skin and stimulating the production of melanin, a brown pigment.

There are three types of skin cancer, the most common type being basal cell carcinoma. Showing up mainly on the face, this type of skin cancer is slow-growing and rarely spreads to other parts of the body. Less common are squamous cell carcinomas, which grow faster than basal cell tumors and can sometimes spread to other parts of the body if not treated early. These rarely arise on normal skin but seem to grow on obviously sun-damaged skin. The deadliest and rarest of skin cancers, comprising just 5% of all skin cancers, is malignant melanoma. Although it's uncommon now, doctors say that melanoma has been increasing by 7% annually over the past decade and will kill 7,000 people this year.

Skin cancer most often occurs on areas exposed to the sun: the face, nose, ears, neck, and the back of the hands. It is slightly more common in men and is most likely to occur in middle age. People with light skin and light eyes are at greatest risk for skin cancer; darker-skinned people have an extra degree of protection because they have a greater amount of melanin in their skin.

According to Dr. Perry Robins, a skin surgeon at New York University Medical Center and president of the Skin Cancer Foundation, the best defense against all types of skin cancer is vigilance. That's because the biggest gains against the disease have been made in spotting carcinomas early and treating them before there are complications. Even melanomas, if caught early, are curable. That means visiting a dermatologist to have all suspicious moles, dark patches, or long-lasting "pimples" checked.

SURGICAL STRIKE. Doctors usually treat early-stage skin cancer with surgery performed in the office under just a local anesthetic. Cancerous spots can also be burned, scraped, or frozen Melanoma is slowly on the rise: It will kill 7,000 people this year off. A newer technique called Mohs micrographic surgery allows doctors to take a thin layer of the affected site, view it under a microscope to determine exactly where the cancer cells lie, and remove the cancer with great precision. According to Robins, who has trained about 300 surgeons in the technique, this surgery has higher cure rates and there is less scarring because only the cancerous tissue is removed.

If you don't have skin cancer, the burning question is how to stave it off. One area of progress has been in treating the precancerous spots called solar keratoses. These are scaly, flat, red or tan patches that form, usually on the face, back of hands or on a bald pate. They aren't dangerous as such, but if neglected can develop into squamous carcinomas. To treat these, doctors freeze or cut them off, or use harsh chemicals such as 5-fluorouracil that are applied to the skin in the form of a cream. These chemicals cause the skin to redden and peel extensively--and may have other potentially serious side effects if applied incorrectly. But there are a few other promising treatments in the works, including a new drug called Actinex that in a recent study reduced the number of solar keratoses by 71.4% in one month without the extreme skin irritation common to today's chemicals.

Retin-A, the acne-drug-turned-wrinkle-cream, may help reduce solar keratoses, but because it can take six months to a year to show results, "it has lost some of its glitter," says Robins. In the next couple of years, he adds, light-skinned people will probably be able to use a cream with a chemical that can safely stimulate the production of protective melanin before they are exposed to the sun.

IN THE SHADE. For those of us who worshiped the sun, believing it to be a benevolent deity, skin cancer is not inevitable. One dermatologist at Beth Israel Hospital in Boston says there is little evidence to support reports that a few bad sunburns as a child put an adult at serious risk for skin cancer. But the benefits of protection are undeniable. According to Robins, by age 55, the likelihood of getting skin cancer rises to 27,000 cases per 100,000 for those men who spent a lot of unprotected time out in the sun. But for those who avoided the sun, only 1,614 per 100,000 suffer the consequences.

That leads back to the advice doctors have been dispensing for the past decade: The best way to prevent skin cancer is to take refuge from the sun. One weapon is a good sunscreen that blocks out UVA as well as UVB and has a sun protection factor of at least 15 (box). Wearing a broad-brimmed hat and staying in the shade between 11 a.m. and 2 p.m. can also help. And remember that exposure to the sun just doesn't happen when you're stretched out on a towel. Long walks and volleyball games count, too.

And as you huddle under a beach umbrella and wipe the sting of sunscreen-laced sweat from your eyes, take solace in the fact that the deeply tanned surfer and his bronzed, bikini-clad companion next to you on the beach are anachronisms from the days when few people knew how dangerous the sun could be.

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