Here Comes the Sun --
Do You Know What to Do?

As spring takes hold, many of us will be spending more time outdoors, taking advantage of the warmer weather. But enthusiasm for the new season shouldn't cloud our judgment about sun safety, experts warn.

"It's good for people to be out and exercise and be active, but when you are out, be careful to protect yourself," said Martin Weinstock, MD, a professor of dermatology at Brown University Medical School in Providence, RI, and chairman of the American Cancer Society's Skin Cancer Advisory Group.

Protecting yourself means following ACS's "Slip! Slop! Slap!" advice, he said: When you're going to be outdoors, slip on a shirt, slop on sunscreen, and slap on a hat. Sunglasses that screen out ultraviolet rays can protect eyes and the delicate skin that surrounds them.

Too much exposure to the sun can raise the risk of skin cancer, including the deadliest type, melanoma. Rates of melanoma have been increasing in the US over the past 20 years, and ACS estimates that some 55,000 new cases will be diagnosed in 2004. Nearly 8,000 people are expected to die from melanoma this year.

Although anyone can get melanoma and other skin cancers, they are most common in people with fair complexions who sunburn easily. A recent Scandinavian study published in the Journal of the National Cancer Institute (Vol. 95, No. 20: 1530-1538) found that women with blond hair had about twice the risk of developing melanoma as women with dark brown or black hair, while redheads had 4 times the risk.

The investigators, who studied more than 100,000 Swedish and Norwegian women, also found that getting sunburns -- particularly as a youth -- raised the risk of melanoma. This finding is in line with those of several other studies that have linked excessive childhood sun exposure to skin cancer.

"In general, for most people who are susceptible to sunburn, you should definitely stop the exposure long before you get red," Weinstock said. "That's why it's a good idea to put sunscreen on before going out." Beachgoers must be especially careful, he noted, because the sunlight reflects off water and sand, and bathing suits provide very little coverage.

The ultraviolet rays in sunlight, UVA and UVB, can cause damage to the DNA in skin cells that may eventually cause them to become cancerous. In fact, a study published online in the Proceedings of the National Academy of Sciences suggests that UVA rays may be even more harmful than previously believed because they penetrate into deeper layers of skin where cancers begin to form. For this reason, it's a good idea to use a sunscreen that protects against both types of UV radiation.

But sunburn isn't the only danger. Even tanning can expose the skin to damaging amounts of UV radiation, Weinstock said, whether the tan comes from the sun or a tanning booth.

"We have good reason to think that tanning in tanning salons increases your risk of certain types of skin cancer," he said, "because we know those types of skin cancer are induced by the kind of UV radiation you get from tanning lamps."

Some studies have found an association between tanning booth use and skin cancer risk, Weinstock noted. The Scandinavian study, for instance, found that women who tanned in a salon once a month or more at any age had a 55% greater risk of melanoma than women who didn't visit tanning salons.

Findings like that worry many skin cancer experts, because tanning booth use is popular in the US, especially among young people. Researchers at Case Western Reserve University, in Cleveland, Ohio, recently reported in the Archives of Pediatrics and Adolescent Medicine (Vol. 157, No. 9: 854-860) that more than 28% of white teenage girls and 6% of white teenage boys in the US have visited tanning salons repeatedly. Among Americans as a whole, roughly 10% will visit a tanning salon at some point during the year, according to the Indoor Tanning Association, an industry group representing tanning salons.

So what about getting a "base tan" in a tanning booth to protect against sunburn from being outdoors? Not a good idea, said Weinstock.

"That philosophy gets you a huge amount of radiation," he said.

Although a tanned person won't burn as quickly as someone who isn't tan, a tanned person is likely to stay out in the sun longer than someone who is worried about getting sunburned. It's that double whammy of radiation from the initial tan and the prolonged outdoor exposure that can be problematic, Weinstock said.

And what about vitamin D? This nutrient is crucial to good health, and exposure to sunlight is one of the best ways to get it. But that's no excuse to sunbathe, Weinstock cautioned.

The typical American of European background would get enough vitamin D from about 5 minutes of midday sun on the face and arms, a few times a week for 6 months, he noted. And that's in a northern city like Boston; people who live in the Sunbelt may need even less exposure to meet their vitamin D needs. People with naturally darker skin may need a bit more. The nutrient is also found in foods like dairy and fish, and can be taken in vitamin supplements.

"For most people, vitamin D won't be an issue, even if they're using sunscreen, because you need so little of the noonday sun to generate it," Weinstock said. "You get it walking to your car."

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