How Dangerous Is Sun Exposure at My Age

It's easy to get burned. Just stick an uncovered hand into a 550°F
oven for a second or two. That's why we use pot holders.

The sun is 20 times hotter than a broiling oven. Sure, it's 93 million miles away, but in just 10 minutes it can toast you more thoroughly than a marshmallow over a campfire. And even after age 60, a rich brown tan or charring burn can ignite cancer-causing skin damage.

That's why doctors urge you to use sunscreen and take other precautions.

"At this age, people want to live an active lifestyle. And I don't blame them. You don't have to live in a cave, but there are certain measures that you can take to protect yourself while you are enjoying the outdoors that will drastically reduce your risk of skin cancer," says Craig Eichler, M.D., a dermatologist at Cleveland Clinic Florida in Fort Lauderdale.

The Bronze Age Is Over

For years, our heroes were bronze: Burt Lancaster, Cary Grant, Mickey Mantle, Natalie Wood, and Racquel Welch. Tans were in. Pale was out. But all that sun worshiping has sparked an epidemic of skin cancer, Dr. Eichler says. Skin cancer is the most common type of cancer in the United States. Americans over age 65 were expected to account for about half of the 838,000 new cases of skin cancer in 1996. In the same year about 9,400 Americans—more than one an hour—were expected to die of some form of skin cancer, according to the American Cancer Society.

Almost all of this is unnecessary because without sun damage, skin cancer, wrinkles, and liver spots would be virtually nonexistent, Dr. Eichler says.

To get an idea of how this damage accumulates, imagine sun exposure on a 100-point scale. When you're born, you have 0 points. When you reach 100 points, you get skin cancer, says Michael Kaminer, M.D., assistant professor of dermatology at Tufts University School of Medicine in Boston.

Every time you expose your unprotected skin to sun, it damages the skin a bit, and you add on points. One bad sunburn in your teens, for instance, might add 50 points to your lifetime total. Even tanning, which is really the skin's reaction to sun exposure, is a sign that harm has been done and more points are piling up, Dr. Kaminer says.

So if you are age 60 and your sun exposure score is 90, wearing sunscreen and taking other precautions may stop you from getting those last 10 points that would push you irreversibly toward skin cancer, Dr. Kaminer says.

The problem is that you never really know where you are on that imaginary scale. You can look perfectly fine but could be getting close to topping 100 points and developing a skin cancer. That's why it is important to start or continue taking sun precautions after age 60, Dr. Kaminer says.

"A lot of my patients in this age range say, 'Well, I'm old and it doesn't matter how much sun I get anymore.' The point is that it does matter very much at that age," says Nancy Silvis, M.D., assistant professor of dermatology at the Arizona Cancer Center in Tucson.

How the Sun Does Its Damage

Sunlight contains two types of harmful ultraviolet rays: UVA, a long-wavelength ray that penetrates deep into the skin; and UVB, a medium-wavelength ray that is absorbed by the upper skin layers. Both scramble DNA, the genetic code that cells use to reproduce, and increase the likelihood that your skin will form abnormal cells. At the same time, these rays suppress the immune system so that your body will be less able to defend itself, says Kevin Cooper, M.D., chairman of the Department of Dermatology at Case Western Reserve University and University Hospitals of Cleveland.

Over years or decades, these skin changes can develop into one of three types of cancer. Basal cell carcinoma, the most common type, is also the least serious form of skin cancer and rarely spreads to other organs. Squamous cell carcinoma is a bit more aggressive than basal cell and is more likely to spread to the lymph nodes and other parts of the body. Both of these types of skin cancer are usually easily cured but can leave disfiguring scars when removed. Melanoma is tougher. The most tenacious of all skin cancers, melanoma can quickly spread to the lungs, brain, and other vital organs if it isn't corralled early. It was expected to kill more than 7,300 in 1996.

"Once melanoma spreads to a vital organ, it is resistant to radiation and chemotherapy. At that point, there is really nothing you can do. But if it is caught at the start, there is virtually a 100 percent cure rate," says James Spencer, M.D., a dermatologist and director of Mohs Micrographic Surgery at the University of Miami School of Medicine.

Lighten Your Risks

Most of the skin damage that leads to skin cancer occurs before age 20. But even if you have never taken one precaution in the sun, there are still plenty of reasons to start doing it now, Dr. Kaminer says.

Sun exposure, for instance, can increase your risk of certain skin cancers after age 60, according to researchers at the British Columbia Cancer Agency in Vancouver. In a study of 586 men up to age 79, the researchers found that those who reported spending 24 hours or more a week outdoors during the summer months were twice as likely to develop squamous cell carcinoma in the next 10 years than men who got less sun exposure.

But taking preventive measures even at a late stage may help repair seriously damaged skin before it turns cancerous, Dr. Silvis says. For six months, Australian researchers tracked 588 people up to age 93 who had precancerous skin lesions called actinic keratosis. Those who began using sunscreen developed fewer new precancerous lesions and were 53 percent more likely to have existing actinic keratosis disappear.

"Studies like this have shown that patients over age 60 who use sunscreen are actually helping their skin recover," Dr. Silvis says. "But among patients who don't use any protection, the skin isn't doing the needed repair work because it is continually being damaged."

Here are a few ways to lower your risk of skin cancer yet still enjoy the warmth of the sun.

Make 15 your lucky number. Use a sunscreen with an SPF (sun protection factor) of at least 15, Dr. Kaminer says. That means it will protect your skin in the sun for about 150 minutes, or 15 times longer than if you didn't wear it. Although sunscreens with SPFs up to 50 are available, a 15 should do the job. It will block out 93 percent of the sun's harmful rays. In comparison, an SPF of 35 only gives the skin about 4 percent more protection. If you really want 100 percent protection, choose a sunblock that contains either zinc oxide or titanium dioxide.

Make it a daily routine. Sunscreen is easy to forget unless you make it a part of your morning ritual. After you bathe and dry off, apply sunscreen to every part of your skin that will be exposed to the sun before you dress for the day, Dr. Cooper suggests. Allow at least 20 minutes for the lotion to soak into your skin before going out in the sun so that the sunscreen will stay on better once you swim or start sweating.

Don't let the clouds fool you. Wear sunscreen even on overcast days, since the sun's rays penetrate clouds and can still damage your skin, Dr. Eichler says.

Smear it on. Many people, particularly in this age group, spread sunscreen on much too thinly, Dr. Kaminer says. Put at least one heaping teaspoon on your face and neck together, another heaping teaspoon on your chest, and yet another heaping teaspoon on your back. Then use a half-teaspoon to cover both hands, another half-teaspoon to cover both feet, a half- to a full teaspoon for each leg, and a half-teaspoon for each arm and shoulder, he suggests. For men with lots of body hair, more might be needed on the arms, chest, and legs because the sunscreen is absorbed by the hair before reaching the skin.

Do the hands, neck, and ears first. "Three places where older people often forget to put sunscreen on are the neck, ears, and the back of their hands," Dr. Kaminer says. "So I tell my older patients to apply sunscreen to those areas first. It's important, especially on the back of the hands, because a lot of skin cancers develop there."

Start all over again. Reapply sunscreens at least every 2 hours to maintain maximum protection, Dr. Kaminer suggests. If you are swimming or perspiring heavily, you may need to do it every hour that you are in the sun. Some sunscreens are water-resistant or waterproof, but even these should be rubbed into your skin every couple of hours, he says.

No matter your color, beware. People who have naturally dark skin pigment develop fewer skin cancers than fair-skinned individuals, Dr. Spencer says, but it isn't perfect protection.

"African-Americans rarely develop skin cancers because their dark skin provides natural sun protection," he says. "Hispanics can and do develop skin cancers, so they should use sunscreen if they're going to be out in the sun for extensive periods, like fishing on a boat all day."

If you are African-American, keep an eye on lighter portions of your skin such as scars and the palms of your hands, which are often less resistant to sun damage, Dr. Spencer suggests. No matter your skin coloration, see your doctor if you develop any unusual spots or growths on your body.

Check the weather. Look for the UV Index in your local weather report, Dr. Silvis suggests. It is a forecast from the National Weather Service of how much ultraviolet light will reach the ground in your area at midday. It will help you decide when and for how long you may want to go out that day. The index ranges from 0 to 15. Zero to 2 is minimal risk, meaning 1 hour of unprotected sun exposure may cause skin damage in sun-sensitive people.

At high noon, take cover. When the sun is directly overhead, its rays are traveling through less atmosphere than when it is on the horizon. That is why sunlight is considered more intense and damaging at midday than at sunrise or sunset, Dr. Eichler says.

"I suggest that my patients only go out in the sun when they cast a shadow that is longer than they are tall. It is an easy rule of thumb to remember, and it will protect you from the most damaging ultraviolet light," Dr. Eichler says.

Put a lid on it. Hats are essential in the sun to cover your scalp and shade your neck and ears, particularly if you are over age 60, Dr. Kaminer says. Wear one that has at least a 3-inch brim all the way around the base.

Reapply sunscreen regularly. Certainly, long-sleeve shirts and pants offer more protection from the sun than bare skin, Dr. Silvis says. But not much more—a dry T-shirt provides an SPF of 6 to 8, and only 2 to 3 when wet.

"Most people think that their clothing is enough to protect them from the sun," Dr. Spencer says. "But if you hold a white T-shirt up to the sun, you can see right through it. And if you can see through it, that means light is going through it."

So be sure to regularly apply sunscreen every couple of hours underneath your clothes. Some mail-order clothing manufacturers such as Sun Precautions, however, do make tightly woven clothing with an SPF of 30 even when wet. For a free catalog, write Sun Precautions, 2815 Wetmore Avenue, Everett, WA 98201.

"Sun-protective clothing is an excellent option," Dr. Silvis says. "The clothing provides a broad range of protection from both UVA and UVB light."

Soothe the sizzle. If you do get a sunburn, only time will really relieve your symptoms, Dr. Spencer says. Your best bet? Take a 325-milligram aspirin every 4 to 6 hours and apply cool-water compresses to the burn as needed. You also might try over-the-counter moisturizers such as aloe vera to mollify the burn.

Pore over your skin. Conduct a self-exam of your skin once a month and see a dermatologist at least once a year for a professional evaluation, Dr. Spencer recommends.

"It's so simple to do a head-to-toe. It doesn't take long, it doesn't hurt, and you can save yourself a lot of trouble," he says. "Remember that most skin cancers are very easy to cure if they're detected early."

Look for any new growths and changes in size, shape, color, texture, or thickness of existing moles, freckles, and birthmarks on any part of your skin. If you do find a suspicious spot, have it checked out by a dermatologist promptly, Dr. Spencer says.

Prescription for Prevention

Americans over age 65 account for more than half of all new cases of skin cancer. Skin damage accumulates as you age. The more unprotected sun exposure you have, the greater your risk of skin cancer. But even after age 60, you can stop this process and reverse some skin damage if you begin taking precautions in the sun.

Do:

* Use a sunscreen with an SPF of at least 15. Apply it to your skin 20 minutes before sun exposure. Reapply every 2 hours when outdoors.

* Look for the UV Index in your local newspaper. It will help you decide when and for how long you may want to go out that day.

* Wear a broad-brim hat in the sun.

* Conduct a self-examination of your skin once a month. Look for any new growths or changes in moles, freckles, and birthmarks. See a dermatologist if you have any suspicious growths.

Don't:

* Let clouds fool you. Sunlight penetrates clouds, so wear sunscreen even on overcast days.

* Forget to apply sunscreen to your ears, neck, and back of the hands. These spots are just as vulnerable to sun damage as other parts of your body.