1 sunburn = 1 melanoma?
December 19, 2010 2:10 AM   Subscribe

How much sun damage do I have to do to my skin to doom me to skin cancer? I'm a white male in an ozone-free country.

I live in New Zealand, where there is a large ozone hole. In the summer the air is clear and the light is very strong. Sunblock ads, school infotopics, newspaper articles, government agencies - all cry out at us, warning us to protect our skin. The idea seems to be that any sunburn, any skin damage, is too much - staying cancer free means staying sunburn free.

I'm a white male, of Danish/English/Greek decent, and I'm pale. My skin does tan a bit, so I'm not insanely pale. My hair is brown/blond. I find it pretty hard to remember sun block every time I'm in the sun - my days can be lazy and long, and unlaced and adventurous. So I tend to get some sunburns, usually not nasy ones (rarely peeling), a couple of times a year. If I was to believe my government-friendly newspapers (something most good new zealanders do), I would believe that I was doomed to spending a good part of my golden years have cancerous bits carved out of my ruined skin.

Is this true? How much does one sunburn cost you? Just how big are these risks? And how else am I supposed to build up a bit of a tan - or am I supposed to just be pale and shrouded all my life? How do celebrities get away with their lifelong perma-tans?
posted by schmichael to Health & Fitness (21 answers total)
Any exposure is a risk, if you want to look at it purely statistically. How much exposure will result in cancer depends on so many variables that the only consistent advice is that which you're already getting.
posted by dougrayrankin at 2:18 AM on December 19, 2010 [1 favorite]

Cancer council advertising here in southern Western Australia suggests that if you have a tan, you've gone too far. Here's their info page.
posted by Ahab at 2:19 AM on December 19, 2010 [1 favorite]

Here are the ads. Male. Female.
posted by Ahab at 2:23 AM on December 19, 2010

Data point: I'm a moderately pale guy of European descent, not a sun worshiper by any stretch of the imagination though I do like gardening, cycling and the occasional fishing trip. I got a splotch of basal cell carcinoma on my face in my mid-30's. This particular cancer is not terribly dangerous and is relatively easy to deal with, but still -- 2 minor surgeries, a scar and a lot of expense, plus I'm now required to strip for a dermatologist once a year.

I don't think they've pinned down exactly 'how much one sunburn costs you.' Vulnerability is somewhat genetic, so a given degree of sunburn doesn't cost everyone equally.

At the very least, get yourself a nice, wide-brimmed hat to shade your face. There's no sense wallowing in anxiety over this but it's easy to make the problem less bad, and dumb to not do so.
posted by jon1270 at 2:25 AM on December 19, 2010 [1 favorite]

Don't go by the perma-tanned celebrities. They're wearing expertly-applied fake tan, although sometimes they get it wrong, providing fodder for the gossip websites and magazines.
posted by hazyjane at 2:37 AM on December 19, 2010 [2 favorites]

Here are some medical papers about the correlations.

As you can see, the correlations seem to be quite complex (for some types of skin cancer, sunburn even seems to be protective!) But melanoma is the one to worry about, and sunburn clearly seems to increase your chances of it. But even the highest effect mentioned in these three papers seems to be a bit more than 2 times the relative risk for people who experienced a few bad sunburns vs those who had never been burned. (If I'm reading these abstracts right.)
posted by lollusc at 2:53 AM on December 19, 2010

I would believe that I was doomed to spending a good part of my golden years have cancerous bits carved out of my ruined skin.

I'm the only person in my entire, extended family to NOT have had cancerous bits carved out of my skin. (Yet.) I bet if you asked most people who grew up in Aus and NZ before sunscreen use was prevalent, they've had something removed. Like a lot of carcinogens, you can't know the exact risk because so many other factors (genetics, luck) come into it. Some people have a perma-tan and never get melanoma, the same way some smokers won't get lung cancer. (And some people get skin/lung cancer despite avoiding the sun/smoking).

You need to evaluate for yourself how much effort you're willing to put into avoiding sunburn, versus how worried you are about sun damage, versus how much you like looking tanned. I know people who have died from melanoma, but I still don't remember to wear sunscreen as often as I should.

tl;dr: One sunburn does you as much damage as one cigarette, or one binge drinking episode. That is: nobody knows exactly, but use your common sense.
posted by jaynewould at 3:07 AM on December 19, 2010 [1 favorite]

Also: Come middle age, it's pretty easy to see who liked to keep a tan in their younger years. If you're at all vain about your skin, you probably realise that even if you don't get cancer, you might well look like an aged leather handbag. (Ahhh, the people you see when you spend summers in Queensland...) Truth be told, this is what I have in mind when I choose to cover up in the sun.
posted by jaynewould at 3:12 AM on December 19, 2010 [5 favorites]

On one hand, there's me, a fair-skinned redhead who regularly got sunburnt to blistering stage too many times to count, before I got common sense and started wearing long-sleeved cotton shirts in summer. Still alive at 42. Got a couple of spots that don't seem to concern my doctor.

On the other hand, there's the kid who starred in a DVD we watched at a school council meeting, when they were trying to convince us that hats are crucial. Malignant melanoma at 16, dead by 17, I think. He did a kinda crusade thing, going around Sydney beaches and showing sunbakers the massive scars from melanoma-removal-surgery on his back, and telling them that he will die soon because he surfed without sun protection. (Google isn't helping here, but I'll plug in my old hard drive and see if I can find some info about him.)

It's the luck of the draw, I reckon.

A guy I once worked with - the first Aboriginal to be the Secretary of a federal government department, as I recall - told me that he firmly believed being pre-disposed to cancer was a genetic thing. He convinced me.

Don't risk it. It's better to be pale than dead.
posted by malibustacey9999 at 3:39 AM on December 19, 2010 [1 favorite]

Response by poster: If it matters, I have never heard of anyone in my family getting cancer. In fact, none of my aunts, uncles, cousins, or grandparents have died of anything yet.
posted by schmichael at 4:14 AM on December 19, 2010

Hate to tell you, but tanning is skin damage. You don't need to burn; a tan is increasing your cancer risk all by itself. (It's also going to make you look prematurely old.) Tans may help protect you from the pain of burning, but they're not protecting you from cancer; any color change on your skin is increasing cancer risk, whether it's tanning or burning. (And yeah, modern celebrities are spray-tanned, at least if they want to keep working past 35.

And, yes, if you want to avoid skin cancer, pale and shrouded is the way to go. I wear a big floppy hat and lightweight-but-tightly-woven linen overshirts so I don't have to constantly fuss with sunblock; I can just block up when I know I'll be outside.

I'm a pale redhead who's always been diligent about sunblock. I'm 32. No family history of skin cancer. I had my first dubious-looking spot dug out and biopsied (in that order; they were concerned enough about it that they just dug it out first) this year. Benign, luckily.
posted by Eyebrows McGee at 5:09 AM on December 19, 2010

Your question assumes that there is a fairly straight line of causation: if you venture out in the strong sun for too long you will get skin cancer and if you get skin cancer you are "doomed". Others have pointed out that the first link in the chain is not that simple. Nor is the second.

My dad died from melanoma - he quite possibly might be around today if he had gone to see a doctor earlier to get it checked out. Since he was my dad and we share the same complexion I am un-keen to share the same fate. To this end I limit my sun exposure but also keep a close eye on my skin for any changes or other problems. My dermatologist tells me that melanoma is probably not genetically linked: the main factors putting you are risk are your complexion and the amount of exposure you get to the sun.
posted by rongorongo at 7:16 AM on December 19, 2010

If it matters, I have never heard of anyone in my family getting cancer. In fact, none of my aunts, uncles, cousins, or grandparents have died of anything yet.

Neither had mine, until my 60 year old father was diagnosed with and quickly died from melanoma. It just doesn't make sense not to be careful. As jaynewould said above, a tan today is going to mean some ugly skin when you're old, anyway, whether you get cancer or not.
posted by something something at 7:18 AM on December 19, 2010 [1 favorite]

My mother died of melanoma when she was 45, first diagnosed at 35. Though her doctors presumed her damage was done in childhood, her 5 siblings (all older) have never had any suspicious moles or things. She had very fair skin with rosy, pink undertones, and grew up spending a lot of time outdoors in central Italy in the mountains - not explicitly tanning, but people just didn't think about those things much in the 50's, 60's, and 70's.

My personal philosophy is to live a life of balance. I try to stay in the shade, I don't actively slather myself in SPF before I go outside, but try to incorporate lotions, moisturizers and makeup with some SPF already built in. I avoid prolonged sun exposure, but don't freak out about 5, 10, or 15 minutes in the sun. I don't burn especially easily, but I had one sunburn on my back about 6 years ago that still sometimes worries me. I think (hope?) being mixed helps - I'm quite pasty with dark hair ("naturally goth"), but have very yellow undertones from my dad's Pakistani/Indian side of the family - I think those undertones make a difference - though fair, the melanin in my skin is markedly different.

Like many people mentioned above, there is no formula for getting (or not getting) skin cancer. I think the best thing you can do is be cautious about prolonged sun exposure, implement some SPF in your routine, and keep an eye out for suspicious skin changes and marks on your body. Even if total prevention is out of your hands, early detection can make a world of difference.
posted by raztaj at 7:47 AM on December 19, 2010

I was diagnosed with Melanoma last year. Fortunately, it appears (so far) to have not spread from the original excised mole. I have had 2 PET scans, a CT scan, a sentinel node biopsy, and have been palpated and examined every three months since then and this will continue into the indefinite future.

I grew up on the beach in California, and our MO as far as sun exposure was to get a bad sunburn in April or May or June, then let it peel off and then be "good" for the remainder of the summer. I have no doubt that this contributed to my skin cancer (I have also had two basil cell carcinomas removed but at this point those are just more a nuisance than anything else.)

A few things my oncologist told me:

1. My Northern European heritage is a huge risk factor.
2. It does not run in families.

Be sensible and consider yourself lucky that you are in a country where solar radiation has to go through more atmosphere, and that, more often than not, you can put on some high-SPF sunscreen.

I am still not as careful as I should be, but I always wear a hat, and if I am planning on being in the sun, I wear sunscreen and/or time it so it is not during the dead of mid-day.
posted by Danf at 7:58 AM on December 19, 2010 [2 favorites]

Nthing everything here, but adding since I don't think it's been mentioned, that I remember having heard or read that a severe sunburn in childhood can increase your risk. Doesn't mean that if you've already had a severe sunburns as a child that you are automatically fucked or if you spent your childhood doused in SPF 100 under a shade umbrella that you are now safe to tan with impunity. It is just one of the risk factors.

For example a friend of mine in her early 60s who grew up mainly in the Northern US, is very fair (mostly Norwegian ancestry) but spent a good deal of time in Bermuda as a young child where she suffered some severe sunburns. As an adult she's been fairly diligent about sunscreen, although I'm sure that she's probably gotten some sun, including burns and tans given her age and the fact that the importance of sunscreen wasn't really stressed until the late 80s and high SPF sunscreens were difficult to find. Indeed back when I was a teenager, I remember wearing SPF 2 (which I bet that they don't even make anymore!). Anyway, whether it was related to her early sunburns or a lifetime's accumulation of incidental sun, she just had a couple of basil cell carcinomas removed.

So try to be more careful and be especially diligent if you had one or more sunburns as a child. If you haven't already, definitely start getting annual full body skin checks from a dermatologist no later than age 40 (but if you're fair and living in NZ I'd start now to be safe). And it should go without saying but definitely have any new spots or moles checked even if they don't meet the criteria for melanoma. It could still be basil cell carcinoma.
posted by kaybdc at 8:45 AM on December 19, 2010

As I understand it, cancer occurs when the DNA of a cell gets mutated, in a particular way. If the DNA is damaged too much, the cell dies. If it isn't damaged all that badly, it can still replicate and be skin. If it mutates in just the wrong way, it turns into cancer.

Further, the more times a cell needs to replicate itself, the more mutation that creeps in.

So, if you have had a number of bad sunburns as a child, many of your skin cells already have a lot of mutations going on. This means that there is less "reserve" for mutations to happen without effect. So even if they never get any more damage from external forces, just the process of regular cell division and the occasional mutations that happen with that lead to higher rates of cancer. Add in more external damage and the rates go up even more.

So it is still based on chance, but more burns means more chances.

There is also something to do with the different layers of skin. The layer with the melanin is meant to be able to absorb the UV. If there isn't much melanin in there, less gets absorbed and more makes its way to the lower more sensitive layers. Sunscreen tries to stop most of the UV before it ever gets to the living skin cells.

I don't know what the current research is, but there was a theory that building up more melanin leads to reduced exposure. But I don't know if the math works out on that.

(I also think there is something to do with cleanliness. Heavily washed skin has less sebum and dead skin cells coating it, which lets more UV in. Even with no sunscreen, I've found that people get burnt more heavily in areas where they are constantly wiping sweat off.)
posted by gjc at 10:07 AM on December 19, 2010

If I was to believe my government-friendly newspapers (something most good new zealanders do), I would believe that I was doomed to spending a good part of my golden years have cancerous bits carved out of my ruined skin.

I know hardly any white people over the age of 60 who haven't had anything carved out of their ruined skin, and I live in the Northeastern US, where we hardly get enough sun to produce enough vitamin D.

The threat of skin cancer is absolutely real, not something made up by the nanny state, and there's no such thing as hereditary immunity to skin cancer, so your lack of it in your family history doesn't mean that you're not at risk.

Wear sunscreen. If you find it hard to remember to bring a tube or bottle of it, get some of the one-use wipes and stuff them in your pockets.
posted by Sidhedevil at 10:42 AM on December 19, 2010 [1 favorite]

Sunscren isn't exactly benign stuff. I work outdoors and I don't use it unless its mineral based. Long sleeves and a hat if you need protection.
posted by fshgrl at 11:28 AM on December 19, 2010

The articles mentioned by fshgrl make some interesting points, but the take home for pale-skinned folks at high risk should be "The report's researchers clearly say that an effective sunscreen prevents more damage than it causes, but it wants consumers to have accurate information on the limitations of what they buy and on the potentially harmful chemicals in some of those products." (from the first article).

I fully agree that covering up is better protection, though! Just not always possible if you like to go for a swim once in a while...
posted by treehorn+bunny at 10:49 PM on December 19, 2010

The risk is high enough that you should definitely take precautions. In Australia and New Zealand, this isn't just an over-zealous health department, it's a very real issue. Most people I know over 60 have had something removed, or have skin like an old boot.

If you're on the run a lot, I'd suggest keeping a loose, long-sleeved shirt, a hat and a tube of sunscreen in your car or a backpack. That way if you find yourself about to spend more than 15 minutes in the sun, you can chuck them over whatever you're already wearing.

Keep an eye on the prime hours for sun exposure too - it may be different in NZ, but where I live the worst hours are between 10am and 2pm. I've generally found that outside those hours it might take half an hour for me to show any reaction on my skin, but in the middle of the day it's more like 10 minutes and I'm burned.
posted by harriet vane at 4:56 AM on December 20, 2010

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