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PORTSMOUTH - Summer has arrived and, while we all love to

Portsmouth Herald - 6/3/2018

PORTSMOUTH - Summer has arrived and, while we all love to be outdoors, we should remember that sun safety now can reduce damage to the skin later, and the risk of melanomas, a dangerous type of skin cancer.

Dr. Nahid Vidal, a dermatologist and a dermatology oncology specialist at Dartmouth Hitchcock Medical Center, said there are several tips for playing safely in the sun.

"Most people think to be vulnerable to melanomas there has to be family history, or for the person to be red-headed and freckled and that is true," said Vidal. "Light skinned people are also more prone, but in actuality, all skin types can get melanomas."

According to the Centers for Disease Control, skin cancer is the most common cancer in the United States. Most cases of melanoma, the deadliest kind of skin cancer, are caused by exposure to ultraviolet (UV) light.

In 2014 (the most recent year numbers are available), 76,665 people in the United States were diagnosed with melanomas of the skin, including 45,402 men and 31,263 women. And, 9,324 people in the United States died from melanomas of the skin, including 6,161 men and 3,163 women.

Dr. Gary Proulx, medical director of radiation oncology at Exeter Hospital'sCenter for Cancer Care, said people should watch their skin closely because the outcomes for melanomas are greatly improved if the cancer is caught early.

"The size and the thickness are important," said Proulx. "Sometimes you can't tell the thickness because much may be below the skin. But with early detection, you can have a 90 percent better chance on the outcome and can live for many years."

Vidal said most people don't know that melanomas can form in the eyes and on eyelids. She said sunglasses that block UV light are the best protection.

"Using sunscreen is good, but choose the right one," said Vidal. "There are two types of sunscreen, those that physically block and those that are chemical blockers. The chemical blockers are most likely to break down, so we recommend our patients use physical blockers that contain zinc oxide or titanium oxide. The SPF should be 50 or higher. SPF 30 is slightly different because the way it is tested is different than how we use it in real life. It is applied much thicker in the lab than we are likely apply it to our skin."

Vidal said sunscreen should be reapplied every two hours, especially after swimming or heavy sweating.

"That's every two hours even if it says it is waterproof," said Vidal. "And seek shade whenever possible, particularly during peak sun hours of 10 a.m. to 4 p.m.

For those who are outdoors for long periods of time, like fishermen, people out on a recreational boat all day or outdoor construction workers, Vidal suggests adding clothing with good sun protection to the use of sunscreens.

Some people believe that if they get a base tan at a tanning salon they will not get a sunburn. Not true, and potentially dangerous, said Vidal.

"Avoid bed tanning," said Vidal. "Any machine like those that promise a quick tan are not good for your skin. They work with UV radiation. We see squamous cell and basal cell cancers from tanning beds. And there is no evidence that it will protect you from a burn."

"There is enough potential risk from the sun, for free," said Proulx. "Why seek further risk through a tanning bed. The warnings are out there. If you do use them, the same advice applies. Check your skin and take precautions. Injury with burns from a tanning bed is the greatest risk. I am not in favor of tanning beds."

So, why do people seek out the sun, even knowing the potential for harm?

"The sun can be addictive," said Vidal. "It gives you endorphins and makes you feel good. We get happy thoughts because it lights up our pleasure centers."

For people who will still play in the sun, Vidal has some advice.

"Family history can indeed play a part," said Vidal. "Know your own skin type. If you have freckles and/or lighter skin, you are at a higher risk. Watch your body, watch moles for changes. Some are just gifts from Father Time, but if they are changing, they should be checked out. It might not be cancer, but check anyway."

Proulx said people who spend time in the sun should watch their skin for new lesions. '

He said to also watch for changes in current moles.

"If they become irregular or angry looking, have it checked," said Proulx. "If there is a change in shape or color, and if they are bigger than a few millimeters, bring it to the attention of your health care provider."

People who get a bad sunburn, or who have had bad sunburns in the past are more prone to melanomas, said Proulx.

He said not all are cancer.

"Fair-skinned people can be prone to benign growths called Nevi," said Proulx. "If you are not sure, don't guess. That one mole, the one we call the ugly duckling, could prove dangerous."

Vidal suggests having a baseline skin exam, so your doctor can use it for comparison.

'Knowing what to watch for is helpful and the American Cancer Society lists a short alphabet of changes to watch for.

A: Asymmetry, meaning the left and right side of a mole do not match.

B: Borders that are irregular, not a circle, or are changing.

C: Color is not always dark. It can be lighter. If you have had it for years and it starts to change; check it out.

D: Diameter of most melanomas is 0.6 cm, about the size of a pencil eraser.

E: Evolution.

Does it look significantly different than it did three months ago?

The CDC guidelines to lower your skin cancer risk are to protect your skin from the sun and avoid indoor tanning. I

nstead, they recommend:

1. Stay in the shade, especially during late morning through mid-afternoon.

2. Wear clothing that covers your arms and legs.

3. Wear sunglasses that block both UVA and UVB rays.

4. Use sunscreen with both UVA and UVB (broad spectrum) protection.

5. Avoid indoor tanning.

"People should live life and enjoy the things under their control," said Vidal. "They should take care of things they can control to ease their minds and still live the best life they can."