It’s the summer of 2015 here in the US and hopefully you’ve been in the water and have surfed some great waves by now. Perhaps you’ve ventured down the coast from your home break or gone on a surf trip. I’ve been lucky to travel to Nicaragua and Tavarua with the SMA this year. Wherever you live, whether the water or weather is cold, warm or hot, I hope you’ve thought a bit about protecting your skin from the sun.
UVA and UVB
The sun emits radiation towards earth and our atmosphere filters out some of the more harmful rays. The rays that do reach us are the longer wavelength UVA at 320-400 nanometers and the shorter wavelength UVB at 290-320 nanometers. UVA is responsible for causing DNA damage, which causes skin cancer, premature aging, wrinkling, and dark sun patches on the skin. UVB is also responsible for causing skin cancer as well as sunburns and eye damage. Water will reflect back UV light to the skin and is often called “second-hand sun.” Additionally, water has the property of convergence, which acts to further concentrate the UV rays
3 Skin Cancers
There are three main types of skin cancer: Basal Cell Carcinoma (BCC), Squamous Cell carcinoma (SCC) and Malignant Melanoma (MM). Fact: One in five Americans will develop skin cancer in their lifetime. (1)
Basal Cell
Basal cell carcinoma is the most common skin cancer and is more of a locally destructive cancer. It may present as a painless, waxy pearly spot or growth on the nose, ears, face or other sun exposed area. However what you see on the surface may be just the tip of the iceberg. It usually doesn’t metastasize but it often destroys extensive tissue beneath the surface. I see these everyday in my practice. We excise A LOT of these cancers, which often leaves significant disfiguring scars on the face and body. I’ve had many patients in their teens and twenties with basal cell carcinoma.
Squamous Cell
Squamous cell carcinoma is the second most common skin cancer. It may presents as a scaly, rough, or warty appearing growth on sun-exposed areas, especially on the face, lips, head, neck, arms, hands, back and legs. It may bleed. It might be painful or it may not. It may grow slowly or rapidly. SCC’s are easily treatable and curable when caught early but about 2% metastasize. In 2012 between 3,900 and 8,800 died from this skin cancer in the US. (2) We are seeing patients in their 20’s and 30’s developing SCC’s.
Melanoma is the most dangerous of the three kinds of skin cancer. Melanoma may present as a growth or mole, flat or elevated anywhere on the body from the top of the scalp to the bottom of the feet. The lesion may have one or more of the “ABCDE” characteristics of melanoma: A-Asymmetrical, B-Borders are uneven, C-multiple Colors, D-Diameter larger than 6mm and E-Evolving or changing in size, shape or color.
Melanoma has a high cure rate when caught early and with extensive surgical removal. However, MM can metastasize rapidly to lymph nodes and vital organs. In the US, one person in 50 will develop melanoma and one person dies every hour of every day from this cancer (every 57 minutes). (3) Australia and New Zealand have the highest rates in the world, about one person out of 17 will develop melanoma. (4) No surprise, but surfers are three times more likely to develop melanoma according to a 2015 study out of Bond University in Australia.
More than 90% of adult melanomas are due to the sun. In a study published in March 2015, dermatologists also found that more than 90% of pediatric melanomas had genetic changes consistent with UV-caused damage. (5) A study in 2013 showed the incidence of pediatric melanoma is on the rise. The largest increase of pediatric melanomas was amongst teens ages 15-19. (6) My youngest patient with melanoma was a 7-year-old girl where it showed up on her forearm. In fact, recent data reveals that 40-60% of children with melanoma do not present with conventional ABCDE criteria. (7) My little patient had a small spot on her arm that wasn’t particularly striking but her mother thought it had changed “a little bit.” After a sobering diagnosis followed by a wide excision, and many tears, we both agreed- mom’s intuition saved her life.
Prevention
As surfers, we can to do better at sun protection. We can try to avoid or limit our exposure from the sun between 10am and 4pm when UV rays are strongest. Morning and evening sessions are going to be the best bets. But optimal tides, trips to the tropics (Tavi and Nica), endless pumping swell, and every excuse imaginable put us in the water and in the sun at all hours.
Wear protective clothing in and out of the water. Wetsuits and long sleeve rash guards block a lot of sun. Rash guards and wetsuits are available that have pullover hoodies for extra coverage. I’ve seen them being worn at both SMA surf trips this year- way to go guys! Surf hats that have a chin or neck strap can also help save your scalp, forehead and ears from direct UV light while surfing.
Sunscreens
In 2011, the FDA set new rules changing sunscreen labeling in the US. You want to look for “broad spectrum” on the label because it means that the sunscreen blocks both UVA and UVB rays. The SPF label is still there but it is a measure of UVB blockage only. I look for SPF of 30 or higher. The old “waterproof” label is gone. Now we have water resistant 40 or 80 minutes. No guess there which is the better for surfing.
In the US, we have 17 UV filtering ingredients approved by the FDA. More are hopefully on the way to our shelves in the next year or two. Sunscreens are referred as either organic or inorganic. Organic sunscreens absorb UV and convert it to red light wavelengths and the inorganic sunscreens basically reflect UV rays. The best sunscreens will usually have a combination of both. Turn the bottle over and look at the ingredients. I look for the two inorganic sunscreens, zinc oxide and titanium dioxide. Zinc oxide blocks UVA and UVB in the 290-400 nm range and titanium dioxide blocks UVA and UVB in the 290-350 nm range.
Let me give you one piece of advice that may change the way you think about sunscreen. If it doesn’t contain Zinc oxide, I absolutely will not use it for surfing. On a recent Nicaragua surf trip, one of our SMA physicians had used Neutrogena Ultra Sheer 70 water-resistant (80 min). Early afternoon, in the tropics, warm water, not too far from the equator. How’d it do? It failed him and he got sunburned! We talked about it and I recommended one with zinc. That particular Neutrogena sunscreen didn’t have zinc in it. I’m not advocating against Neutrogena because they do make great sunscreens with zinc and titanium dioxide. I want you to start looking at those ingredients on the back. His SPF 30 Zinc sunscreen worked much better on his next surf session. No burn.
Some sunscreens block better than others and some stay on in the water better than others. The vehicle of the sunscreen is important in how well it stays on in the surf. Gels and sprays tend to wash off faster. I’m a fan of “sticks” and creams as they stay on better for me plus sticks won’t run into my eyes and cause a burning sensation.
My face routine goes like this: I apply a thick amount of “broad spectrum” SPF 30+ water resistant 80 minute sunscreen “stick” containing zinc and titanium dioxide, to my whole face. I apply it up way up into the parts of my hairline as well because when my hair gets wet and the frontal part of the scalp gets exposed it can burn. (I’ve cut out way too many skin cancers on the upper forehead and scalp- especially in the “part” areas even in women with thick hair). I get some sunscreen cream with the same ingredients and labeling and thickly cover both ears- all over the backside, the rims, the whole bowl and all the crevices I can. Do not miss this area! I biopsy and cut out so many skin cancers on all sides of the ears almost daily in my practice. It’s a constant reminder to me to protect my ears especially surfing. I use that sunscreen on my neck and scalp/mastoid area behind the ears, another common area where I see a ton of skin cancers. My next purchase is going to be a surf hat to finish off my routine and I’m recommending one for you too.
Surfer’s Lip
Don’t forget your lips! I apply some thick lip balm SPF 30 chap stick as heavy as I can before surfing. Burns on the lips, especially in the tropics are all too common. Ask one of our SMA members here who ok’d the use of his picture for this article. His lower lip was swollen as big as a watermelon after his last surf session. Not really but pretty close. Lip cancer is no joke and tends to be more aggressive than in other skin areas. General sunscreens don’t stay on lips very well surfing so get some thick lip balm designed for your lips and coat it on.
After the face, scalp, and neck routine, put that rash guard or wetsuit on. Apply sunscreen to the areas of sun exposure on your legs and backs of your hands. Double your efforts, apply 30 min prior to surfing when you can for better absorption. And reapply at least every 1 ½-2 hours. Sunscreens break down in the sun and they get rubbed off and washed off in the water.
Skin Exams
Get to really know your skin by doing self-skin exams once a month. If you surf, please do not let this year go by without getting your skin checked by your health care provider. Ask your provider how often you should be checked since you are a surfer. A yearly checkup is a minimum for most patients but I often see patients more frequently and some a little less so. If you are worried about a mole or spot or notice any change or anything suspicious forming on your skin, get it checked. If your intuition is bothering you about a spot, push for a biopsy. Early detection and removal of skin cancer could save your life.
Author
Brian McArthur, PA-C, MPAS
In private practice, Dermatology Associates, Phoenix, AZ
bmcarthur5@yahoo.com
References:
1. Rogers, HW, Weinstock, MA, Harris, AR, et al. Incidence estimate of nonmelanoma skin cancer in the United States, 2006. Arch Dermatol 2010; 146(3):283-287.
2. Karia PS, Han J, Schmults CD. Cutaneous squamous cell carcinoma: estimated incidence of disease, nodal metastasis, and deaths from disease in the United States, 2012. J Am Acad Dermatol 2013 June; 68(6):957-66.
3. American Cancer Society. Cancer Facts & Figures 2015. http://www.cancer.org/acs/groups/content/@editorial/documents/document/acspc-044552.pdf. Accessed January 9, 2015.
4. Melanoma Institute Australia. Melanoma Facts and Statistics 2012. www.melanoma.org.au/…melanoma/melanoma-facts-and-statistics/
5. Charles Lu, Jinghui Zhang, et al for the St Jude Children’s Research Hospital–Washington University Pediatric Cancer Genome Project. The Genomic Landscape of Childhood and Adolescent Melanoma. J Invest Dermatol 135: 816-823; March 2015
6. Wong JF, Harris JK, Rodriguea-Galindo C, Johnson KJ. Pediatrics. 2013;131(5):846-854
7. Cordoro KM, Gupta D, Frieden IJ, et al. J Am Acad Dermatol. 2013;68