Lifelong Health by Dr. David Lipschitz

I believe that too much sun exposure accounts for the increasing incidence of malignant melanoma.

While I was a teenager, not a summer went by without at least one severe and painful sunburn, which significantly increased my risk of melanoma, the most dangerous of all skin cancers. Fortunately, I have been spared, but my sister and mother were not so lucky. Each had a change in a mole that was recognized early enough to only require removal.

The volume of ozone in Earth's stratosphere — the ozone layer — appears to be declining every year. Meanwhile, the incidence of melanoma has increased. From 1970 to 2009, melanomas increased by 800 percent in women and 400 percent in men. The American Cancer Society estimates that 76,690 new cases of invasive melanoma will be diagnosed in 2013 and 9,480 people will die of the disease.

The National Cancer Institute, part of the National Institutes of Health, estimates that Americans developed more than 2 million new cases of non-melanoma skin cancer in 2012 (basal cell and squamous cell cancers), but these cancers caused fewer than 1,000 deaths. By comparison, the institute estimates that in 2013, melanoma will be diagnosed in 76,690 Americans and it will cause 9,480 deaths. Despite accounting for only 5 percent of all skin cancers, this disease causes more than 90 percent of skin cancer deaths.

Although it seems unlikely, of the seven most common cancers in the United States, melanoma is the only one whose incidence is increasing. Between 2000 and 2009, incidence climbed 1.9 percent annually. New evidence published in the journal Pediatrics suggests that rates of melanoma are significantly increasing in children.

If melanoma is diagnosed when limited to the most superficial layers of the skin, the cure rate is 98 percent. If, however, it has spread to distant organs, the chance of surviving more than five years after diagnosis is only 15 percent.

The lighter the skin and the more frequent the sunburn, the greater the risk of melanoma. Anyone at high risk must be vigilant and have their skin examined by a physician frequently. A melanoma should be considered if a change in the size, shape or color of a mole has occurred or if a mole is more than one color, has irregular margins or starts bleeding or forms an ulcer. A newly pigmented spot or one under the nails, between the toes or on the genitalia is suspicious and should never be ignored.

Once the diagnosis is made, the melanoma can be excised surgically.

The entire cancer is removed with a wide margin of normal tissue around it. The extent of the incision depends on the size of the melanoma and whether it has spread to tissue beneath the surface of the skin. In some cases, the incision may be so large that a skin graft is required. Deep growths usually require further testing to assure that cancer has not spread to lymph nodes and distant tissues. If it has, surgery to remove those lymph nodes and chemotherapy may be needed.

To prevent melanoma as well as the far more common basal and squamous cell skin cancers, and to avoid ugly blotches, wrinkles and skin lesions that can be precancerous, dermatologists advise us to avoid sunburns and wear sunscreen. Most importantly is sun avoidance during the heat of the day. Exposure to dangerous UVA and UVB rays occur whether the sky is cloudy or clear.

The Food and Drug Administration allows sunscreens that protect against UVA and UVB rays to claim they are broad spectrum. The strength of a sunscreen is determined by the SPF value. While many offer values of 70 or more, there is no evidence than an SPF of greater than 30 offers any more protection. Under new labeling rules that took effect in summer 2012, only broad-spectrum products with an SPF value of 15 or higher can claim to reduce the risk of skin cancer and early skin aging, if used as directed with other sun protection measures.

Sunscreen should be applied to chest, back and all sun-exposed areas even if you wear a shirt all day. The average T-shirt provides only SPF 7 protection. A non-oily, water-resistant spray is the best way to provide liberal coverage to all areas including the scalp. (Under FDA rules, sunscreens must not claim to be "waterproof" or "sweat-proof " because all products eventually will wash off and thus should be reapplied routinely.) During the summer, apply every two hours if outdoors, and continue use during the winter. Stay in the shade during the heat of a day and wear a hat whenever possible.

Despite compelling evidence that sun avoidance and sunscreens prevent melanoma, research presented at the American Association of Cancer Research Society meeting showed that 25 percent of melanoma survivors did not use sunscreen and 2 percent reported using tanning beds.

Sun damage and all skin cancers are preventable. Lying in the sun and tanning beds can be relaxing, but they are taboo. If you absolutely have to look tanned to feel healthy, consider a spray tan; it is harmless, and they can look quite natural these days.

Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at: www.drdavidhealth.com

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