We all know that spending too much time in the sun increases the risk for melanoma, the most serious form of skin cancer. But sun exposure is not the only cause of melanoma.

What you may not know: Genetic factors may play a significant role in the development of skin cancer. Melanoma can develop on parts of the body that get little or no sun (for example, on the palms of your hands or soles of your feet ...between the fingers, toes and buttocks...and on the genitals). Melanoma also can develop under a fingernail or toenail...in the eye..and, in rare cases, in the nose and mouth.

People with a family (or personal) history of melanoma or pancreatic cancer must be especially vigilant about checking their skin for changes even if they spend little time in the sun. (Pancreatic cancer has been linked to melanoma via a mutation in a particular gene.)

Even though we cannot change our genes, we can control our sun exposure and be vigilant about skin exams. My advice...

UV Dangers

Ultraviolet (UV) radiation, produced by the sun and tanning beds and lamps, is a carcinogen (cancer-causing agent) that increases risk for all types of skin cancer. Specifically, sunshine contains UVB radiation, which causes tanning and sunburn, and UVA radiation, which damages deeper skin layers. Tanning beds produce primarily UVA radiation and should be avoided.

Important: UVA skin damage can occur even if your skin does not appear red.

Better Sunscreens

The most effective sunscreens are "broad spectrum--they protect the skin against both UVA and UVB radiation. Within the next few years, virtually all sunscreens will be broad spectrum. Until then, you must read the label.

Avobenzone (Parsol 1789) or oxybenzone, both of which absorb UV radiation, are compounds that are commonly found in high-quality broad-spectrum sunscreens.

Titanium dioxide and zinc oxide are broad spectrum sunscreen ingredients that prevent all of the sun's rays from reaching the skin by reflecting the rays back. Products that contain at least 5% of titanium dioxide or zinc oxide are recommended for people who burn easily or work outdoors, those with a history of skin cancer or those who take certain medications that increase sun sensitivity, such as certain antihistamines, diuretics and tetracycline and sulfa antibiotics.

What you may not know: The FDA has proposed a new one-to four-star rating system to alert consumers to a sunscreen's protective effect. The FDA is finalizing this rule and plans to implement it within the next few years.

Other advice…

  • Don't spend more for ultra-high SPF sunscreens. I recommend using a sunscreen with a sun protection factor (SPF) of 30.

Exception: A sunscreen with an SPF higher than 30 should be used by people with extremely sun-sensitive skin, a history of skin cancer and/or a photosensitivity disease, such as lupus.

  • Apply a sufficient amount of sunscreen. Most people apply only a thin layer. It takes about one ounce of sunscreen-approximately two tablespoons-to protect the average-sized person's face and all exposed areas of the body (including the hands and feet)

Also important: Apply sunscreen at least every two hours and reapply immediately after getting out of the water and drying off. Also, apply it 30 to 60 minutes before going outside to allow the active ingredients to penetrate into deeper layers of skin.

  • Protect your scalp and eyes. Wear a hat with at least a three-inch brim and UV-blocking sunglasses.

Tea Extracts

Many skin care products, including some sunscreens, now contain tea extracts. Reliable studies have shown that both green and black tea (applied topically) reduce inflammation caused by sun exposure. Tea contains antioxidants that reduce free radicals, harmful molecules released in the skin during excessive sun exposure. Controlling free radicals protects skin DNA and can help reduce the risk for skin cancer.

A Sunscreen You Swallow

The dietary supplement Heliocare (available online or by special order at your pharmacy) contains an extract of Polypodium leucotomos, a tropical plant, which improves the skin's resistance to UV radiation. Studies published in the Journal of the American Academy of Dermatology found that the extract significantly reduced sunburn as well as cell damage-both can increase cancer risk.

How to use: Take one 240-mg capsule in the morning on a day when you're planning to spend time in the sun. Take a second capsule at noon if you will be exposed to intense sunlight (such as that in a tropical climate). The extract has no known side effects.

Caution: Heliocare should be used in conjunction with—not as a substitute for-sunscreen.

Improved Exams

A monthly self-exam of the skin is one of the best ways to identify signs of melanoma anywhere on the body. Most skin cancers, including melanoma, can be cured when they are confined to the outermost layer of skin.

Use a mirror to look at hard-to-see areas—and don't forget to part the hair and examine the scalp. If necessary, ask another person, such as your hair stylist or barber, to examine your scalp. A thorough self-exam also should include the back of the neck and behind the ears—like the scalp, these areas sometimes are missed, allowing a melanoma lesion to reach an advanced stage before being detected.

Everyone should see a dermatologist for a full-body exam each year-especially people who burn easily or have a personal or family history of skin cancer.

What you may not know: A relatively new technology known as epiluminescence microscopy (ELM) allows a doctor to detect cancers or precancerous changes that would get missed during a routine skin examination. With digital ELM, the doctor uses a handheld device to examine and photograph large areas of the skin. The images are magnified and stored electronically.

The equipment is expensive, so only certain dermatologists in private practice--for example, those who specialize in the treatment of melanoma-use ELM. However, many large hospitals and academic medical centers now utilize the technology.

New Rule For Detection

Melanoma deaths could be curbed by 60% if everyone performed monthly self-exams. Patients have traditionally been advised to see a doctor if a mole or other growth can be described by the "A, B, C, D" guidelines--that is, it is Asymmetric, in which the two halves are different... has an irregular Border...has variations in Color and/or has a Diameter greater than the size of a pencil eraser.

What you may not know: "E" for Evolving has been added to the guidelines. If a mole or other growth changes in appearance, sensation (itching and tenderness) or size, see a dermatologist. Lesions that change, particularly over a period of a few months, are far more likely to be melanoma than areas that stay the same over a period of years.

Warning: It's unusual for patients to develop new moles after age 40. To be safe, if you develop a new mole after age 40, see a doctor right away, particularly if you have melanoma risk factors a personal or family history of melanoma, a large number of moles (more than 20) or fair skin that burns easily.

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