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"HERE COMES THE SUN " Summer 1998: An Update on Sun Exposure by IHOR MAGUN, M.D. The long sunny and warm days of summer are upon us. Even the thought of a ray of warm sun is enough to lift the spirit. It is human nature to love light and the warmth of sun encourages us to spend time outdoors enjoying a variety if summer activities. Coincidentally, it is also a time period when we are most vulnerable. Exposure of our skin to the sun produces vitamin D (healthy) and at the same time can result in sunburn leading to skin cancer (not healthy). Not everyone gets sunburn because the population can be divided into skin types and skin sensitivities. There are actually six different types: 1) always bum, never tan; 2) always bum, sometimes tan; 30 sometimes bum, always tan; 4) never bum, always tan; 5) darker pigment; 6) darkest pigment. The sun's energy encompasses a vast range of radiation. One is the ultraviolet (UV) spectrum and is divided into A, B, and C. The stratospheric ozone absorbs certain energy wavelengths of solar radiation that are more energetic and potentially more harmful to humans. These harmful wavelengths are the reason for global concern about substances released into the atmosphere that reduce the protective nature of the ozone layer. Because more damaging ultraviolet rays penetrate the atmosphere, due to the decreased the amount of protection from the ozone layer, greater damage may be done to the skin. The mechanism of sun injury appears to be due to exposure to UV-A and UV-B. UV-A appears to be strongest at midday, but is less potent than UV-B in producing sunburn. Chronic exposure to these rays leads to both visible and microscopic changes. Visible changes include wrinkles, rough skin and a skin thickening which resembles leather. A major consequence of chronic skin exposure is skin cancer. This is the most common type of cancer and can be classified as nonmelanoma (e.g. basal cell or squamos cell carcinoma) and melanoma. Most nonmelanoma cancers appear in the exposed areas of the body with the nose and the cheeks as the most commonly affected sites. Individuals with fair complexions are most at risk. The incidence of nonmelanoma skin cancer is constantly rising despite education and rising awareness of the problem. Melanoma is also on the rise, faster than any other cancer in America. At the current rate, it is estimated that by the year two thousand, one of every seventy-five Americans will develop melanoma. Approximately 10,000 people will die each year from the disease. Melanoma is a tumor that is derived from the pigment cells in skin. The prognosis is good when it is detected in the early stages, but when the tumor is deeper, it can spread to various parts of the body and result in multiple, serious complications. Sun exposure is a major risk factor for skin cancer. Intermittent, short bursts of sun exposure during vacations are notorious for causing problems. It is very harmful to go away in the middle of the winter for a week in "paradise", for example, and get a quick suntan. Multiple moles present since birth, changing shapes of moles, family history of melanoma, fair complexion, blond or red hair, light colored eyes, freckles, and previous history of skin cancer are all additional risk factors. The signs to watch for are known as the ABCD factors of melanoma: Skin lesions that have Asymmetry (one half is different from the other half), Border irregularity, Color (not uniform and/or shades of different colors), Diameter (a size that is greater than six millimeters or any change in size of any lesion). Reducing sun exposure risks can be achieved in numerous ways. The first and foremost is to limit sun exposure, especially in the summer and between the hours of 10 to 3 in the afternoon. Sunscreen with an SPF (sun protection factor) of 15 or greater should be applied. Sunscreen should be used even if we plan on sitting in the shade. Sand, water, and even snow reflect sunrays. Proper hats, long sleeved shirts and proper UV sunglasses are also helpful. It is important to reapply sunscreen after bathing, even if you are using a water repellant sunscreen. Remember to use a sunscreen on overcast days too, as the sunrays are still damaging despite the obvious cloud cover. Sunscreen for children and infants is especially important. Avoid tanning salons. These claim to be safe but do cause sunburn and pose a risk of skin cancer. Lotions that promote tanning without the sun are reported to be safe, but this writer recommends avoiding such products. Extensive and prolonged testing has not been done and these lotions may prove harmful in the future. It is, however, safe to apply bronzing make-up that is extensively used in Hollywood Staying outdoors can be fun and safe. Proper protection is easy and inexpensive and can keep skin youthful and healthy.
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