As we begin another summer season, it is a good time to reflect on the dangers of overexposure to the sun and tanning beds. As many of my patients returned from spring breaks this last month, I was shocked at the number of people – adults and teens – with what can only be described as a “savage tan”- many shades darker than their un-exposed color and also many with pink, red or peeling skin from healing sun burn. Usually I was told “Oh, we just got back from the beach/Mexico/Carribean/a cruise” as if this made all the sun exposure safe and OK. Clearly the message is not getting through.
Skin cancer is the most common cancer with over 3.5 million cases each year in the United States. One in five Americans can expect to develop skin cancer in a lifetime. Basal cell carcinoma (BCC) is the most common skin cancer, followed by squamous cell carcinoma (SCC) and then malignant melanoma. Of people who live to age 65, 40-50% can be expected to develop at least one skin cancer. The numbers are staggering but the sobering data lies in skin cancer in young individuals under the age of 40.
Basal cell skin cancer incidence in women under the age of 40 has more than doubled in the last 30 years while the incidence of SCC increased 700% in this age group. Confirming what many dermatologists have already been seeing in their practices, a recent Mayo Clinic study showed an alarming increase in skin cancer – both melanoma and non-melanoma – in patients aged 18-39 years old. During the study period of 1970 – 2009, there was an eightfold increase in melanoma in women and a fourfold increase among men of this age group. Possible explanations include increase use of tanning beds, increased in tanning and intense intermittent sun exposure (think spring break).
Just one exposure to a tanning bed can increase an individual’s chance of skin cancer. People who have used a tanning bed once or more are 74% more likely to develop melanoma. The risk increases with increased exposure. Those who have used tanning beds for 10 years have double the risk of melanoma. A recent study showed that women who used a tanning bed four times a year between high school and age 35 were 15% more likely to develop BCC. An average one million Americans visit a tanning bed each day. Over 70% of tanning bed patrons are females aged 16-29 years.
Young adults are not the only ones at risk. The majority of people diagnosed with melanoma are men over the age of 50. One in 39 Caucasian men and one in 58 Caucasian women will develop melanoma in their lifetimes. National Cancer Institute data show that Caucasian men over age 65 have had an 8.8 percent annual increase in melanoma incidence since 2003 which is the highest annual increase of any gender or age group. Adults over the age of 40 have the highest exposure to ultraviolet radiation from the sun.
Ultraviolet radiation (UVR) from the sun or tanning beds is a well documented carcinogen. Protection from the damaging effects of UVR is essential to maintain healthy, cancer-free skin as we age. We are currently experiencing a skin cancer epidemic with no end in sight. There is no such thing as a safe amount of sun exposure.
What about Vitamin D? Incidental sun exposure is enough to reach the skin’s maximum Vitamin D production. A study of 93 frequent surfers in Hawaii (average age 24 years, average weekly sun exposure 29 hours) showed that over half had serum vitamin D levels under 30 ng/ml and almost all had levels less than 60 ng/ml which is the level currently considered a goal for normal level. Of this group, 40% never used sunscreen. If these surfers could not reach “normal” level of Vitamin D with an average of 29 unprotected hours in the sun per week, then it should be obvious that we need to rely on diet and supplements to maintain a healthy level of Vitamin D.