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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Page 82 of 115

Congratulations. You've survived life's slings and arrows, and made it to your senior years. It took some brains. It took common sense. Now is not the time to abandon those assets. Many older people seem to feel that after navigating past decades of life's pitfalls, they can cast caution to the winds – especially when it comes to sun exposure. The thinking may go like this: "I've never had skin cancer. It takes decades for skin cancer to develop, so I'm never going to get it. I'm moving to Arizona and reveling in the sun." THE DOWNSIDE OF LONGER LIFE The first flaw in that thinking is that none of us know how long we will live; Mickey Mantle, who died of cancer at age 63, famously said, "If I knew I was going to live this long, I'd have taken better care of myself." We need to keep taking care of ourselves to extend our lives and stay strong and healthy as long as possible. The average lifespan in the industrial world has been rising steeply. By 2020, 25% of the US workforce will be composed of older workers 1 — sometimes called the Silver Tsunami—and epidemiological, biolog- ical and molecular data all point to skin cancer as predominantly a disease of the elderly. Between 40% and 50% of Americans who live to age 65 will have skin cancer at least once. 2 Caucasian men over age 65 have had a 5.1% annual increase in melanoma incidence since 1975— the highest annual increase of any gender or age group. 3 It has also been reported that more than half of skin cancer-related deaths occur in persons more than 65 years old. 4 The longer people live, the more likely they are to develop skin cancer, and the greater their chances of dying from it. There are many reasons for this. First, most skin cancers result from sun damage over the course of our lives, and seniors have lived longer; they have had the most sun exposure and sustained the most damage from ultraviolet (UV) light. Both sunburns and suntans damage our skin's DNA, breaking down the skin's tissues so that it ages before its time, and producing genetic defects that can lead to skin cancer. Suffering just five sunburns over your lifetime more than doubles your chances of developing melanoma, and each successive tan or sunburn raises the risks further. 5 We never know exactly how much damage will trigger a skin cancer, but studies show that one bad burn in older age may be the straw that broke the camel's back. 5 DIMINISHED DEFENSES Making matters worse, as the damage mounts, our ability to stave it off keeps diminishing. As we age, our skin undergoes changes that weaken our defenses against skin disease: reduced immune systems, poorer healing capacity, thinner skin, and damage from bodily as- saults from smoking to pollution. 6,7 These changes all contribute to accelerated skin aging and increase our risk for skin cancer. 8 INTRINSIC VS. EXTRINSIC AGING Two types of skin aging exist: intrinsic, or normal chronological aging, which occurs in all individuals, and extrinsic aging, caused by external factors such as ultraviolet (UV) light exposure (both sunlight and tanning beds), industrial chemicals, human immunodeficiency virus and environmental pollutants. 8 Both play a part in skin cancer. Intrinsic Aging: In our advanced years, our skin loses fat and water content and becomes thinner, allowing UV light to penetrate more deeply. Compounding the problem, the body's natural ability to re- pair damaged DNA diminishes, increasing the likelihood of abnormal cell growth that can cause mutations leading to skin cancer. The over- all natural decline in our immune systems not only may allow prior DNA damage to progress to cancer, but leaves us more susceptible to cancers from future DNA damage. Many diseases and conditions related to aging contribute to this immune decline. Atherosclerosis, diabetes mellitus, and congestive heart failure, for example, are known to impede blood flow and decrease immune responses, re- ducing the skin's ability to heal. Extrinsic Aging: If all that's not bad enough, we regularly expose our skin to agents that further weaken our defenses. Above all, many older individuals vastly increase their UV exposure, moving to sunnier climes and engaging in more outdoor activities like golf, fishing, and tennis. Since UV light itself suppresses the immune system, this exacerbates our natural immune decline and facilitates the development of skin cancer. UV light also breaks down elastic tissue (elastin) in the skin over time, leading to wrinkles, sagging, discoloration, and blotchiness. 81

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