The Skin Cancer Foundation Journal

MAY 2015

The 2012 edition of The Skin Cancer Foundation Journal features medically reviewed, reader-friendly articles such as tanning, the increasing incidence of skin cancer diagnoses among young women, & the prevalence of melanoma among white males over 50.

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M any parents today diligently protect their children against the sun during a day at the beach or poolside. But kids need sun protection every day. They are exposed to a surprising amount of ultraviolet (UV) radiation daily, which can add up to serious skin damage over time. Just five sunburns during childhood raises the lifetime risk of melanoma by 80%. 1 The damage mounts not only from obvious lengthy outdoor exposures on weekends and vacations, but also from frequent, briefer exposures you may not even be aware of during their everyday activities. SNEAKY RAYS ON SCHOOL DAYS Let's look at a typical school day for your child. It starts safely enough, as he wakes up, dresses, and rushes through a bowl of cereal. But in a sense, the trouble starts before he walks out the door: he has no sunscreen on, no hat, and no sunglasses. The truth is, he was late, but since it's a cloudy day, you didn't feel too worried when he ran out before you could put sunscreen on him. In any event, sunscreen is a daily struggle, because he doesn't like the way it feels; he often slips away without that protection, or with a hasty dab or two swiped across his face. Later in the day, when the clouds clear up and the sun comes out full bore, he will be especially vulnera- ble. But since about 80% of UV rays go through clouds, he will actually be vulnerable all day. 2 You'd give him a hat to wear, which would help protect his face, eyes, and ears, but he doesn't want to be the only student wearing one. Even if he did, his school has banned hats from the playground. Few kids wear sunglasses, and yours is no exception, though the sun's UV rays and HEV (high-energy visible) light contrib- ute over time to conditions ranging from cataracts and macular degen- eration to eyelid and ocular cancers. 3-5 The problems are magnified when he sits down at his assigned desk in school – near a large window. While window glass does a fine job of keeping out the sun's UVB rays, it lets in 50% or more of the sun's equally damaging UVA rays. 6 These rays contribute to all three major skin cancers as well as premature aging. Your son will endure several hours of UVA exposure that way, much of it between 10 AM and 4 PM, the sun's peak hours of the day. It is 10:00 AM, in fact, when he goes out for morning recess, play- ing for 20 minutes on the playground with no sunscreen, hat, or sun- glasses. Like hats, sunscreen bottles and tubes are banned from the playground, except with a doctor's note, because of potential "tox- icity." Amazingly, one fear expressed by school officials is that some children may eat the sunscreen. 7 To its credit, the school's PTA recently raised the funds to install a shade structure – a large canopy – over all the playground equip- ment, covering about a third of the playground. But as your son plays a game of tag with classmates, he dashes outside the borders of the shade cover again and again, exposing himself repeatedly to substan- tial amounts of UV rays. HIGH HEAT At 11:30 AM, as the clouds dissipate and the sun approaches its zenith, it has heated up considerably when your son goes out for his half-hour physical education class. The kids do exercises and run an obstacle course, sometimes under the shade structure and sometimes outside it. Even when they are anywhere near the edges of the struc- ture, the sun's rays are reaching them on a slant from above, as well as reflecting off the asphalt and hitting their skin a second time. At lunchtime, he finds a seat at an outdoor picnic table with friends. It's only 12:30 PM, but already his skin is reddening from hours of inter- mittent exposure. By 1:30 PM, at afternoon recess, a last 15 minutes in the playground sun has accentuated the sunburn. And yet the day isn't done. At 3 PM, he packs his book bag to go home, waiting outside in the sun to board the school bus, then sits by the window going home, for another 20 minutes of UVA exposure. After a quick snack at home, you shuttle him to Little League prac- tice, where he at least wears a baseball cap (which covers only part of the face and neck), while catching not only balls, but a last hour and a half of the late afternoon sun. Grand total for the day: About 5 hours of sun exposure. Maybe this was a worst case scenario, maybe not. But if your child gets half that much unprotected exposure, it's a frightening amount of skin damage, when every minute adds up over time. See that little mole on his cheeks that he wasn't born with? That's sun damage. See those cute freckles on the bridge of his nose? That's sun damage. The more moles a child develops, the greater his lifetime odds of skin cancer. 8 The more freckles, the more he is at risk for premature aging and skin cancer. Freckles are often a warning sign of sensitive skin that is highly vulnerable to sun damage. 9 (Continued on next page.) References on pages 105-107. CYNTHIA J. PRICE, MD, a dermatologist and pediatrician who is fellow- ship-trained in pediatric dermatology, is in private practice at Linder Dermatology & Skin Cancer Surgery Center in Scottsdale, Arizona. She specializes in adult, pedi- atric, and cosmetic dermatology. Dr. Price served as chief resident at the University of Miami, one of the top dermatology training programs in the country. Her multi-center research trial on hemangiomas achieved national recognition. She is a national educator for Botox, Juvederm, and Voluma. Dr. Price has been quoted in Parenting, American Baby, JAMA, Archives of Dermatology, Skin & Aging, E-Medicine, and Medscape. She has more than 40 publications in dermatology and is a frequent speaker at national conferences. 73

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