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Skin Cancer Special: Stay Safe in the Sun

When was the last time you had that mole on your back checked? Or that tiny pink bump on your arm that won't seem to go away? What about that scaly rough patch on your scalp? If never, our advice: get yourself to a dermatologist now — and every six months to a year for a full-body mole check. Some insurance plans will cover it, and it's an appointment you can't afford to skip, say experts. Here's why: skin cancer has more than doubled over the past three decades, particularly for young women like you. The American Cancer Society estimates that more than a 1.1 million cases of skin cancer will be diagnosed this year, the Atlanta-based group predicts, as many as prostate, breast, lung, colon, uterine, ovarian and pancreatic cancers combined.

The most surprising part of this rise: skin cancer is not solely linked with suspicious moles as many people think; it's also about other often-flesh-colored abnormalities that are less obvious, and at the outset, deceptively normal looking. While abnormal moles are a sign that you might be at risk of melanoma (the most well-known of the three common skin cancers and also the most fatal), it's often the lesser-known signs of other skin cancers like basal cell carcinoma and squamous cell carcinoma that are catching women like you off guard.

"No one knows your body like you do," says Leslie Christenson, M.D., a dermatologist at the Mayo Clinic in Rochester, Minn. "Chances are, you do notice (and will notice) when something isn't right." Caught early, there's close to 100 percent cure rate for skin cancer. The key is to move quickly by showing anything suspicious to your doctor.

What's your risk?
Knowing your chances of getting skin cancer can help you be even more vigilant. In fact, researchers have found new clues that can shed light on who needs to be on high alert for skin changes that can signal a developing skin cancer. Caught early, they can be removed easily, and are close to 100 percent curable.

> It runs in your family Genetics may predispose you to being more sensitive to the sun's ultraviolet (UV) rays, which explains why skin cancer is more common in some families and not others. Or how a lifelong sun-exposed surfer may never develop it while someone who keeps exposure to a minimum may. A recent study from Durham, N.C.-based Duke University, for instance, found that when exposed to UV rays, redheads are more susceptible than other hair hues to sun damage regardless of skin tone. Also, don't be fooled into thinking that if you have darker skin, you're more protected against skin cancer. Research from the Keck School of Medicine at the University of Southern California in Los Angeles, discovered a rise in melanoma rates among Hispanics. This study disputes prior thinking that darker skin tones are less prone to damage due to their skin's extra melanin, naturally sun-protective pigment that give skin its color. "All of this suggests that besides time spent in the sun -- a key factor for sure -- there is something else at play that makes some people less resistant to UV, and research points to a genetic link," explains Carol A. Rosenberg, M.D, assistant professor of medicine at Northwestern University Feinberg School of Medicine in Chicago, Ill.

> You're a true sun lover It was always thought that women did most of their skin damage -- with regard to the sun -- before age 18. But now it's not just your teenage beach time or that one bad burn at summer camp that matters; it's everyday exposure throughout your life that counts, too. That includes any fresh-air activities at home or on vacation -- from outdoor workouts, to gardening -- time away from a beach chair when you may not realize that sunscreen is crucial. In fact, a study from the University of Cincinnati, in Cincinnati, OH found that most team athletes don't use SPF during workouts. "When you think about the time they spend outside without protection, it seems likely that means they are at higher risk for cancers later in life," says Brian B. Adams, M.D., MPH, a sports dermatologist who led the study.

> You've already had skin cancer -- or suspicious moles/marks removed. A new study co-authored by Northwestern's Rosenberg suggests that women with a single incidence of non-melanoma cancers -- regardless of skin type or past sun history -- have an elevated risk of melanoma later in life. It's a clue that you're genetically more at risk. "We found that melanoma rates more than doubled for those people," says Rosenberg, a lead researcher for the study.

> There's ovarian cancer in your family. A surprising chromosomal link between this cancer and melanoma seems to exist (scientists are currently looking at a breast cancer link, too). Rosenberg says, "women who have had nonmelanoma skin cancer, and have a family history of cancer, particularly ovarian, should be more vigilant about monthly skin self-exams and annual exams, including doctor-supervised mole checks."

The best prevention tactics
Take these steps to keep a cancer from developing in the first place:

> Use sunscreen religiously Look for this key wording: broad-spectrum protection (read the label to be sure), which means it protects against ultraviolet A (UVA) and ultraviolet B (UVB) rays. UVA is thought to be responsible for premature aging of the skin (which shows up as fine lines, wrinkles and age spots) and UVB for changes that can lead to skin cancer. Until recently, lotions have not been able to supply lasting protection for UVA: avobenzone (also called Parsol 1789), a key chemical sunscreen for UVA seems to lose its effectiveness quickly in the sun. "After two hours, the protection was gone," explains Darrell S. Rigel, M.D., a clinical professor of dermatology at New York University Medical Center in New York City, and a member of Shape's editorial advisory board. Now, stabilizers and other laboratory tinkering have made the skin-saver last longer, up to four hours or maybe more, he estimates. Reapplying sooner helps ensure you're covered.
Physical sunscreens titanium dioxide and zinc oxide also block both UVA and UVB, and do it as well as ones with avobenzone and oxybenzone, another common UVA sunscreen. Formulas that contain only one or the other of these natural minerals as active ingredients are gentler and good choices for sensitive skin including rosacea (or for small children) but they don't adhere to skin as well as chemical sunscreens do. This means they must be reapplied after contact with water, no matter what the label says, explains Robert Weiss, M.D., associate professor in the department of dermatology at Johns Hopkins University School of Medicine in Baltimore, MD. "Chemical sunscreens bind to proteins in the top, dead layers of skin, making them more water and sweat resistant."

> Be extra diligent if you workout outside A German study showed that sweat increases skin's likelihood of burning. "Perspiration makes skin more photosensitive," explains Adams. "Outdoor athletes should use SPF 30 or higher, and reapply after 30 to 40 minutes of intense exercise even if the product is labeled sweat resistant," he advises.

> Choose your best formula A creamy lotion, a double duty SPF self-tanner, a fast-drying spray, a goes-anywhere compact -- is the one you're most likely to use, often, so trust your instinct when you scan the shelves. Choose at least SPF 15 for intermittent sun exposure and SPF 30 when you'll be out longer, says Adams.
Protect skin after the sun Even with the best sunscreen, it's impossible to block out 100 percent of UV rays. The little that gets through still harms skin, setting off a deep-reaching inflammatory response that breaks down collagen and contributes to premature skin aging. "Antioxidants help stop inflammation that leads to collagen breakdown," says Weiss. But no one antioxidant can zap all the damage; a multi-pronged approach is your best defense. Weiss suggests choosing daily skincare for face and body with polyphenols, which are also anti-inflammatory (green tea is one with best research behind it), vitamin C and a form of vitamin A (like retinol).

Making sense of skin cancer
When you do your monthly skin self-exam, the ABCDs (Asymmetry, irregular Borders, unusual Color variations and Diameter greater than the size of a pencil eraser) will help you spot them. (Consider also "E" for evolving -- be concerned if a mark changes over time.) Alert your doctor right away about any suspicious findings. Here's a closer look:


Basal Cell Carcinoma:
Shows up at the bottom of the epidermis (the outer-most layer of skin). These slow-growing cancers tend to develop on sun-exposed areas like the face, lips, ears, chest and hands. They often appear as a small red or pink or pearly bump, or a sore that won't heal.

Squamous Cell Carcinoma:
Occurs in the top layer of the epidermis. Like basal cell cancers, these tend to show up on sun-exposed areas and can look like crusty reddish patches. It's more aggressive than basal cell and can spread to other areas of the body, including the lymph nodes.

Melanoma Cancer:
Begins in melanocyte cells (which create color pigment for skin and hair) in the top layer of the epidermis. Uneven, irregular moles could be a sign. They are usually brown, black, bluish but some are flesh-toned or pinkish, or simply look like cuts that don't heal. Only about four percent of skin cancers are melanoma but it's the most deadly of the three because it spreads quickly.

For more information: Visit the Skin Cancer Foundation (; the American Academy of Dermatology ( or the American Cancer Society (; all offer comprehensive information about skin cancer, including what to expect from a biopsy, and treatment options. - Maureen Connoly


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