Radiation exposure is probably not high on anyone's list for vacation travel plans, but a local doctor says that's just what many people experience.
“The thing to remember is: The sun is radiation,” Johnstown plastic surgeon Dr. Paul Rollins said. “If you have radiation exposure that is sufficient for the skin to be injured – which is sunburn – that is actually a radiation injury to the skin.”
Exposure to the ultraviolet radiation – either from the sun or from indoor tanning equipment – is the leading cause of skin cancer, which kills more than 8,000 people a year in the United States, the American Cancer Society reports.
It's never too early to take precautions and protect the skin, Rollins said at Conemaugh Physicians Group – Plastic Surgery offices in Conemaugh Medical Park.
“It's a gradual process,” Rollins said. “The radiation injury changes the genetic material in the skin, so it's slightly abnormal. As the abnormal cells reproduce, they become more and more abnormal and may become a skin cancer.”
Older patients are often surprised when he gives them the diagnosis of skin cancer.
“They haven't been in the sun for years, but I tell them it's what happened when they were teenagers or in their 20s,” Rollins said.
'Watching for change'
The three most common types of skin cancer are basil cell carcinoma, squamous cell carcinoma and melanoma.
Although cancers of the skin are the most common types of cancer by far, most are basal and squamous cancers – which are less dangerous than melanoma. About 5.4 million basal and squamous cell skin cancers are diagnosed each year, affecting about 3.3 million Americans, the Cancer Society website reports, noting that some patients have more than one cancerous lesion.
Only about 96,000 melanomas will be diagnosed in 2019, but that type of cancer will cause the most deaths – about 7,200 this year.
Deaths from basal and squamous cancers are not common and have been declining in recent years. One estimate puts the total at about 2,000 a year, with most involving individuals who have not seen a doctor until the tumor is quite large or patients with compromised immune systems, the Cancer Society reports.
Just to be sure, experts urge everyone to be aware of changes in their skin – especially changes in moles and dark patches.
“Watching for change is the most important thing,” Rollins said. “Most of the melanoma are dark moles. If they change size, color, texture or shape, or start bleeding, those are some of the things that can be suggestive of a cancerous lesion.”
Sunscreen is 'important'
A primary care doctor or dermatologist can examine the suspect mole to determine if further testing is advised. Diagnosis requires minor surgery – usually by a plastic surgeon, Rollins said.
“It is not just about scraping the skin,” he said. “The issue is, how deep it penetrates into the skin.”
Tissue removed by surgery is analyzed in a lab. If it is basal or squamous cancer, treatment is usually limited to removing the lesion and starting a regular schedule surveillance exams.
If it is melanoma, the plastic surgeon consults with a medical oncologist for the next course of treatment.
The type of cancer and extent of invasion determine treatment, which may include surgical examination of nearby lymph nodes to see if the cancer is spreading through the body's lymphatic system, Rollins said.
Skin cancer prevention begins with ultraviolet radiation protection, Rollins said.
“The important thing is not to be burned,” he said. “That's where sunscreen becomes important. We all need sunlight exposure, but it should be in a way that you are not going to get injured from that.
"Everybody is capable of being burned.”
Tips and warnings
The Centers for Disease Control and Prevention offers these tips:
• Stay in the shade, especially between 10 a.m. and 4 p.m.
• Wear clothing that covers the arms and legs.
• Wear a hat with a wide brim.
• Wear sunglasses with ultraviolet protection.
• Use sunscreen with an SPF of at least 15.
• Don't use indoor tanning systems.
It's not just skin cancer. Sun exposure also causes the skin to age faster, Rollins said.
“It destroys the collagen in the skin, so it becomes thin and loses its elasticity,” he said. “That is part of the aging process, but the sun tends to accelerate that process.”
It's a good idea to develop the habit of putting on sunscreen with an SPF factor of at least 15 every time you are going to be outdoors, he sad.
And don't think a tan is safe or will protect from the cancer risk from burning, he added, noting that some people go to tanning parlors for a “base tan” before going to the beach or other vacation spot.
“Tanning booths have much more radiation than the sun,” Rollins said. “It would be better not to do the tanning (and instead) use lots of sunscreen to protect themselves that way.”