Interview with Dr. Sommerville
SKIN CANCER MELANOMA AND REDUCING YOUR RISK
- Are there regional differences in the U.S. in terms of level of awareness about the damaging effects of sun exposure as it relates to the developments of skin cancers?
- That is the most deadly form of skin cancer and how common is it?
- Is excessive exposure to the sun responsible for this alarming increase in the incidence of malignant melanoma?
- Are doctors doing enough to diagnose melanomas at its earliest curable stage?
- How to effectively diagnose an early melanoma?
- Is frequent tanning addictive?
- Do tanning beds increase the risk of melanoma?
- What about children and melanoma?
- How do you balance the need for sun protection against the new findings of widespread deficiency of vitamin D in U.S. and consequent health risks?
- Are all sunscreens created equal especially if they bear the same Sun Protection Factor (SPF) number?
- Does one need to wear sunscreen in the winter and does the window glass protect us from the damaging effects of the sun rays?
- How should one use the sunscreen to maximize its benefits?
- What is the most important message that you would like to convey to your patients?
Q. Is frequent tanning addictive?
Dr. Sommerville: We as dermatologists frequently see relatively young patients with wrinkled, discolored, leathery skin who tell us that they have no plans to stop tanning every chance they get! When we ask why, they say that it “makes them feel good”, or is “relaxing”. There is in fact growing evidence that tanning has addictive qualities. Ultraviolet light can cause skin cells to release endorphins. When given narcotic blocker naltrexone, approximately half of the frequent tanners develop symptoms expected to occur in those dependent on narcotics.
Q. Do tanning beds increase the risk of melanoma?
Dr. Sommerville: A working group of the International Agency for Research on Cancer, a branch of World Health Organization, found a strong association between tanning bed use and melanoma risk. People who first use a tanning bed before age 35 increase their risk of melanoma by 75%. Approximately 47% of 18-19 year old American girls report having used tanning beds. Certain states prohibit the use of tanning beds by minors. There is no merit to Tanning Proprietors’ claims that sun beds offer health benefits because they provide a “base tan” that helps avoid sunburn. Most if not all dermatologists agree that there is no such thing as “safe tan”.
Q. What about children and melanoma?
Dr. Sommerville: Melanomas in children though extremely rare especially before puberty, appear to be especially dangerous since they do not tend to exhibit the typical diagnostic signs and therefore may be diagnosed late. They may appear as non-pigmented, red, eroded raised lesions which can be confused with benign growths such pyogenic granulomas.
In terms of protecting children from damaging effects of the UV rays, from birth to 6 months, infants should not be in direct sun. When outside, they should be shaded by an umbrella or stroller hood and be covered up in clothing whenever possible. Once the baby reaches 6 months of age, sunscreen should be applied to all exposed areas before every outing.
Q. How do you balance the need for sun protection against the new findings of widespread deficiency of vitamin D in U.S. and consequent health risks?
Dr. Sommerville: Adequate levels of Vitamin D are increasingly shown to decrease the risk of cancers such as colorectal, breast and prostate cancers; decrease the risk of serious chronic diseases such as multiple sclerosis; maintain and improve bone health, and reduce the need for pain killers in patients with chronic pain. Most cells express a vitamin D receptor and need adequate levels of active vitamin D for normal healthy function. The blood test for 25 hydroxyvitamin D (the measurement for vitamin D status in the body) can be ordered by doctors in order to determine vitamin D deficiency. Recent study form American Journal of Clinical Nutrition showed that women taking 1,100 units of vitamin D a day for five years reduced their risk of developing all cancers by 60%. Women who live in northern latitudes may be lacking vitamin D, particularly if they are nonwhite. Diet is seldom sufficient to provide adequate levels of vitamin D and supplementation especially in the winter months is necessary. 1,000 IU of vitamin D supplementation per day is what many physicians now recommend. Appropriately applied sunscreen absorbs about 99% of solar UVB radiation which is necessary to produce vitamin D in the skin. Therefore, it is important to assess patient’s level of vitamin D and supplement adequately.