Summer is here – and Vermonters are finally able to get out and enjoy the sunshine. However, when we are out in the sun, we risk damage to our skin from ultraviolet (UV) radiation if we do not take the proper safety precautions. Researchers have identified excessive UV light exposure as an important risk factor for developing melanoma, a particularly aggressive and potentially fatal form of skin cancer (Vermont has one of the highest rates of melanoma). This includes long-term exposure to sunlight, frequent sunburns, and use of tanning beds.

Unfortunately, many people still underestimate the risk of UV light exposure, especially when it comes to tanning beds. In 2009, the International Agency for Research on Cancer (IARC) classified the cancer risk of UV-emitting indoor tanning devices as Group I – “carcinogenic to humans”. Indoor tanning before the age of 30 increases a person’s risk of melanoma by at least 70 percent. Tanning is never safe; it damages the skin, causing early wrinkling and it increases an individual’s risk of all types of skin cancer.

What makes melanoma particularly tragic is that it affects people of all ages, and melanoma rates among young persons are rising significantly. Melanoma is now the most common cancer among young women aged 25-29 and is the second most common cancer among those aged 15-29 years.

Focusing on wellness and preventing disease before it occurs will save lives. No tan is worth dying for. Melanoma is a potentially preventable cancer and keeping our children out of indoor tanning beds is a powerful step in the right direction.  

More on Skin Cancer Risk Factors

Skin damage from UV radiation is the most important risk factor for skin cancer. Some other known risk factors include fair skin, blonde or red hair, significant freckling, and a family history of skin cancer.

A recent study found that people with two or more of the following factors had a higher risk of developing malignant melanoma:

  • A family history of a first degree relative with melanoma
  • Having 3 or more blistering sunburns before the age of 20
  • Having naturally blonde or red hair
  • Actinic keratosis (the presence of a rough, scaly patch on the skin that develops from years of sun exposure)
  • A history of 3 or more years of an outdoor summer job as a teenager
  • Significant freckling on the upper back

Depending on the number of risk factors present, your personal risk of melanoma may be as high as ten times the normal risk; however, it is important to know that risk factors only estimate your chance of getting skin cancer. Having one or more risk factors does not mean that you will definitely get melanoma. Conversely, many people who get skin cancer may not have any known risk factors. Regardless of your risk, it is important to avoid unnecessary sun exposure, perform regular self-skin checks and see your physician for full skin exams. Melanoma, although potentially fatal, can be cured if it is detected early.

Fortunately, protecting the skin from damaging UV light is a risk factor that one can control. Using sunscreen is an important part of a protection regimen but sunscreen alone is not enough. Additional skin cancer prevention tips include the following:

  • Do not tan or use UV tanning booths.
  • Do not burn.
  • Avoid unprotected sun exposure especially between 10 AM and 4 PM.
  • The best protection is to cover skin with clothing, including a broad-brimmed hat and UV-blocking sunglasses.
  • Uncovered skin should be protected with a broad spectrum (UVA/UVB) sunscreen with an SPF of 15 or higher.
  • For extended outdoor activity or during times of intense sun exposure, a sunscreen with an SPF of 30 or higher should be used.
  • Apply sunscreen 30 minutes before going outside and reapply every two hours or immediately after swimming or excessive sweating.
  • Keep newborns out of the sun. Sunscreens should be used on babies over the age of six months.
  • Examine your skin head-to-toe every month.
  • See your physician every year for a professional skin exam.

Early Recognition is Critical

The ABCDE guideline for moles is a commonly used method to help find suspicious moles.

  • Asymmetry: most early melanomas grow at an uneven rate resulting in an asymmetrical appearance (if you imagine a line through the mole the two don’t match)
  • Borders: moles that are melanoma tend to have irregular and uneven borders
  • Color variation: the irregular growth pattern of melanoma can cause the skin lesion to become darker or have a variety of colors including shades of brown, tan, black, red or blue.
  • Diameter: moles which are larger than 6 mm (the size of an eraser on the back of a pencil) are at greater risk of being a melanoma
  • Evolving: Any change in a mole (e.g. size, shape, color, elevation, symptoms) should be reason for concern.

Another technique for recognizing melanoma early is the ‘ugly duckling’ method. This method is based on the concept that malignant melanoma may look different from normal moles (i.e. they are “ugly ducklings” compared to the other surrounding moles). The normal moles each resemble one another, while the melanoma stands out as an outlier- it looks or feels different.

It is important to remember that not every melanoma will fit these criteria. For example, although quite rare, some melanomas are not pigmented and look like pink spots on the skin. Also, a mole that itches or bleeds is often at risk of being a cancer. Any suspicious mole or mole that changes in anyway should be assessed by a health care professional.

Fortunately melanoma is often curable if it is identified early. We recommend that anyone who is at elevated risk for melanoma be seen by a dermatologist for skin cancer screening. Also, anyone with a concerning mole should schedule an appointment with their primary care physician and/or dermatologist. Early assessment and management can make a significant difference in outcomes.

So have fun this summer, and stay safe.

Ted James, MD, is a surgical oncologist and Director of the Skin and Soft Tissue Surgical Oncology program at the University of Vermont Medical Center. He also serves as Vermont State Chair for the Commission on Cancer and is an Associate Professor of Surgery at the Larner College of Medicine at UVM.

Todd Holmes, MD, is a dermatologist at the University of Vermont Medical Center. He is also assistant professor at the Larner College of Medicine at UVM. 

Ted James, MD, is a surgical oncologist and Director of the Skin and Soft Tissue Surgical Oncology program at the University of Vermont Medical Center and is an Associate Professor of Surgery at the Larner College of Medicine at UVM.

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