Here Comes the Sun -- Watch Out!

Last week, I saw a teenager for a chief complaint of back pain. He was a very fair-skinned, young man with reddish hair and many freckles. When he removed his shirt for the examination, my eye immediately saw an odd-looking black skin lesion on his right shoulder. He is coming back today so that I can remove it. There is a very good chance that this is a melanoma - a malignant skin cancer.

My own brother visited a dermatologist last year because he was concerned about a mole. The dermatologist was not concerned about the mole, but he was worried about a dark pigmentation on his chest that my brother did not notice. It turned out to be a melanoma.

I have two red-haired grandchildren that spend a considerable amount of time in the sun. The nine-year-old plays baseball and the two-year-old is always outside or slowly cooking through the window of the car. In the last month, both of them sustained significant sunburns on their faces. While my daughter-in-law claims she puts sun block on them and insists on hats, it still happened. Fair-skinned, red-heads are considered the highest risk for sunburn. As little as thirty minutes of unprotected exposure can result in a significant sunburn.

The Southern hemisphere, particularly Australia and New Zealand, are leaps and bounds ahead of the U.S. in preventing sun-related cancers. Although topless or nude beaches are not uncommon in Australia, the vast majority of beach-goers are adequately protected from the burning rays of the sun. Children typically wear full-sun suits covering the torso and half of the arms/legs. They also were big hats that have a brim covering their necks. Hats are such a part of their attire that children may be excluded from school if they forget their hats. Many of the citizens of Australia and New Zealand are descendents of immigrants from England, Scotland, and other European nations who are noted for their fair-skinned people. A few generations is not sufficient time for evolution to develop sun-protective changes.

Nearly all cases of melanoma occur in people that report a severe sunburn in the past, perhaps even in childhood. Some recent studies show that there may be a five-times greater chance of getting melanoma after a severe, blistering sunburn.

Individuals who are prone to sunburn and those who have children who are in this same category need to be proactive.

• Stay out of the sun, especially from 10 AM to 2 PM when the sun is strongest. Although this sounds simplistic, you can't get sunburned inside (unless you go to those tanning salons).
• Remember that sun can reflect off of water or snow, doubling your exposure.
• The best sunscreens in the world are not as good as clothing - wide-brim hats and long-sleeve cotton clothing. Some people can even burn through clothing, however.
• Use a sunscreen that is at least 30 SPF (Sun Protection Factor) and re-apply it often. Use water-resistant sunscreens when swimming. Babies under 6 months old should not use sunscreen that contains PABA.
• Stay hydrated. Ultraviolet rays penetrate more on dry skin.

Inspect your own skin carefully and get a loved one to inspect the areas you cannot see. Any suspicious skin lesion, especially darkly-pigmented, spreading lesions in sun exposed areas, should be brought to the attention of your medical provider or dermatologist.

If you do get sunburned, what is the best treatment? One dermatologist recommended that medical providers not prescribe pain medications for preventable sunburn. She said that pain is important so that people remember NOT to do it again!

• Like all burns, cool it down. Cold compresses are helpful.
• Ibuprofen and aspirin are both anti-inflammatory and can be very helpful if given early and regularly during the painful phase of a burn. Many medical providers will even prescribe systemic prednisone, a potent oral steroid, for sunburn.
• Topical steroid creams, like hydrocortisone cream, are not that helpful according to the studies; however I often recommend that the creams be kept in the refrigerator and applied sparingly.
• Severe, blistering sunburn may need the services of a medical provider.

Severe sunburns can result in melanomas appearing years or even decades later. Promptly treated and monitored, melanomas can be managed, but often can result in deep, unsightly scars. Ignored, or untreated, melanomas are mostly likely fatal.

Related Topics:

• WebMD Video: Photosensitivity
• WebMD Video: Healthy Tanning

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