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Second Opinion: Paying the price of sun exposure
Going away soon? Lucky you. Some days in the office I think that come January there will only be a few of us left rambling around Vernon. Very large contingents of mostly retired local residents are heading south: Yuma, Mexico, Palm Springs and Phoenix are some of the popular choices. The goal is the endless summer and a lower cost of living. At the risk of sounding like sour grapes, there is a price to pay for all that sun and I see it on the faces of many who attend the office.
Skin cancer is the most common cancer doctors treat. It represents one third of all new cancers diagnosed. In 2007 Canada had 74,000 new cases. All skin cancer is directly related to time spent in the sun. Each of us has what I refer to as a UV bank account, UV being the abbreviation for ultraviolet radiation. The most important deposits that we make to the UV bank account are in the form of sunburns in childhood. Skin has a long memory, and those overdoses of ultraviolet radiation are accumulated over a lifetime in the form of gene changes in the skin cells. As we age, we continue to make further UV deposits, sunning in the summer, skiing in the winter, working outside, gardening, driving to work and just hanging around outside. Those episodes all add to our accumulated UV bank account and add further gene changes in the skin cells. Eventually in the fourth or fifth decade those changes manifest as sun-damaged skin where eventually precancers or cancer can develop.
Many people come to the office worried about melanoma but the vast majority of the skin cancer that doctors see is non-melanoma skin cancer. This often starts as a precancer referred to as an actinic keratosis or will appear directly as a basal cell or squamous cell cancer. Actinic keratosis are scaly red patches that resemble eczema and often appear on the face and other exposed areas. They represent a cancer confined to the upper millimeters of skin. Others will present with slow growing round nodules or scaly patches on the face, back or extremities. Some will bleed or ulcerate but they do not go away. These are the basal cell cancers and they have a complex root system that extends beyond their borders. Still other individuals will have squamous cell cancers on the face, ears or lower arms and legs. These are more dangerous as they can metastasize to other parts of the body. Squamous cell cancers on the lips, nose or ears are potentially high risk. Men develop non-melanoma skin cancers at a rate of two to one when compared to women.
The bottom line is that all unusual or nonhealing skin lesions need to be attended to. Skin cancers on the face are of particular concern. If not treated early, extensive surgery may be required. We cannot take back the childhood deposits that we have already made to our UV bank account, but we can slow down the changes associated with excessive UV exposure by wearing sunscreen. Buy the sunscreen with both UVA and UVB protection with an SPF or sun protection factor of at least 30. Apply it every four hours when outside. Wear a hat and protective clothing over high exposure areas. As well, there is no logic in getting a tan before going to the lower latitudes. Avoid the direct sun between 11 a.m. and 3 p.m. If you have scaling lesions on your skin that do not go away or if you have new growths on the skin, have them looked at by your doctor.
Dr. April Sanders is a physician, with Sanders Medical Inc. Vein and Laser in Vernon, B.C.