Skin Cancer and a Heartbroken Mom Warning Others After 18-Year-Old Daughter Dies of Melanoma

13516582_918730708256589_6636184452057655497_nAs the hottest, most intense months of summer approach I thought that I would mention my concern with skin cancer, especially in our youth. Jenna Birch wrote that although the American Cancer Society warns that melanoma is one of the most common cancers in young adults, we are still surprised to hear of cases affecting those under the age of 30. As a treating physician who cares for many melanoma patients, young patients always trouble me and our office has treated a number of teens and early twenty-year-old patients. But Jennifer Nicholson from Leeds in the U.K. wants people to know that it can happen to you. Her daughter, Freja, passed away from skin cancer last November at the age of 18.

She says fair-skinned Freja frequently spent hot British summers outside. “There isn’t a day that goes by when I don’t wish I could go back and just take five minutes to put sun cream on her delicate young skin when I mistakenly thought there was no danger,” Jennifer told the Mirror.

Nicholson spotted a mole on her daughter’s back four years before she died, and it grew from small and brown to lumpy and black. Doctors cut out the mole and did a biopsy on it, but the mole tested negative for cancer. A couple of years later, when Freja was getting pounding headaches, doctors discovered a new lump on her arm. It measured five centimeters, extending under the skin. It was melanoma.

The cancer spread to Freja’s brain, as a scan revealed a stage 3 tumor and a poor prognosis. Doctors removed the tumor, but the cancer returned in the brain, breast, arm, and lung. Even while Freja was ill, her mother recalled that she was in good spirits. She helped raise more than $10,000 for the Teenage Cancer Trust before passing away in late 2015.

“It was only then I remembered that mole on her back,” Nicholson said. “I asked if they were related and doctors gently told me I should in no way have let our guard down. …  If I’d known, I would have had her covered from head to toe — even in the U.K. sun — but I never dreamt it could lead to cancer.”

Nicholson remembers being extra cautious when her daughters were on vacation, making sure they wore sunscreen with ample SPF. However, at home in England, she mistakenly believed the sun was not “fierce enough to kill.” She told the Mirror that she still suffers from guilt, wishing she could have helped prevent Freja’s death — and she is urging other parents to help guard their kids from the harsh effects of UV radiation. “Don’t make the same mistake, because you will never ever forgive yourself,” she said.

Like most cancers, skin cancer risk increases with age, according to J. Matthew Knight, MD, section chief of dermatology at Orlando Health. “Pediatric melanoma does happen, though, and it is devastating,” he tells Yahoo Beauty. “I tell people that skin cancer acts kind of like lung cancer does with smoking. You don’t get it right away. All the sun damage that we accumulate in our youth ‘hides’ in our DNA for an average of 25 to 30 years until the skin cancer forms.” Sometimes, that timeline speeds up and results in terrible consequences.

It’s incredibly important to protect adolescents from the sun, says Knight. “Once the damage occurs, there’s nothing that can be done to reverse it,” he says. “You just have to follow up carefully with your dermatologist and hope to catch something as early as possible.”

One in five Americans will be diagnosed with skin cancer, and Knight says 90 percent of those cancers are directly attributable to UV exposure. “On average, a person’s risk for melanoma [like Freja had], one of the most serious skin cancers that can be fatal, doubles if they’ve had more than five sunburns,” he says. Tanning beds should also be avoided completely, especially by teens. Using one before age 35 increases your risk of melanoma by 75 percent.

Knight says daily application of sunscreen with SPF 15 or higher is one essential tool for preventing cancer — but not the only tool. “You have to make use of cover-ups, protective hats and shirts, umbrellas, and seek shade during the sun’s peak hours or 10 a.m. to 4 p.m.,” he says. Actually the recommendation is repeated use of sunblock every 2 hours for adequate protection.

According to the CDC, only 13 percent of teen girls and seven percent of teen boys report applying SPF 15 sunblock when they’re outside on a sunny day. Over the past year, one third of teens between the ages of 14 and 17 have ended up with sunburn, a major risk factor for skin cancer.

Nicholson does not want any other young people to suffer her daughter’s fate. She is determined to create a legacy for Freja and raise awareness about the risks of sun exposure. “I tell any parent to keep an eye on any moles on their children,” she told the Mirror, and “to do everything they can to protect the whole family from the sun, wherever you are.”

It’s not a complete shocker to hear about people partaking in behaviors that they know are unhealthy. (Fried food, caffeine, or beer bongs, anyone?) Still, the idea of tanning — actively lying out in the sun — seems a particularly retro and risky choice in 2016, since melanoma is such a deadly form of cancer. But according to a new American Academy of Dermatology survey, people are still going after that “healthy glow,” even though they know there’s no such thing.

Whether you’re lying in the sun or in an indoor tanning bed, tanning is dangerous. And while it seems most young women understand that danger, many of them are still tanning and putting themselves at risk for skin cancer. According to a new American Academy of Dermatology survey, 71 percent of 18- to 34-year-old women know that there is no such thing as a healthy tan, and 66 percent know that getting a base tan is not a healthy way to protect themselves from the sun’s harmful ultraviolet rays. The survey also indicates that these women understand what’s at risk when they tan, as 98 percent know that skin cancer can be deadly.

“Melanoma, the deadliest form of skin cancer, is the second most common cancer in young women, and we believe this may be due in part to their tanning habits. It is alarming that young women are continuing to tan even though they’re aware of the danger,” says board-certified dermatologist Elizabeth S. Martin, MD, FAAD, chair of the AAD Council on Communications. “Exposure to UV radiation, whether it’s from the sun or an indoor tanning device, is the most preventable risk factor for skin cancer. Women need to take their knowledge and turn it into action by protecting themselves from the sun and staying out of tanning beds.”

In an effort to communicate this message, the AAD has released a new skin cancer public service advertisement/PSA called “Arms,” which features two young women comparing their tans at various stages in their lives. The emotional ad concludes with the two friends clasping hands in the hospital as one of them reveals she has advanced stage melanoma.

“We hope this PSA inspires young women to give up dangerous tanning practices and protect their skin by seeking shade, wearing protective clothing, and using a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher,” Dr. Martin says. “A tan is not worth your life.”

Over the course of the PSA, the friend who develops melanoma is shown to have a mole that gets larger and darker with the passage of time, which demonstrates the importance of monitoring your skin for suspicious spots. Skin cancer, including melanoma, is highly treatable when detected early.

“Early detection is vital in the fight against skin cancer, so everyone should regularly perform skin self-exams,” Dr. Martin says. “If you notice any irregular spots on your skin, or anything changing, itching or bleeding, see a board-certified dermatologist.”

The AAD highlights the importance of early detection in another skin cancer PSA released last month, entitled “Looking Good.” The humorous ad features a man posing in the bathroom mirror until his wife catches him from the doorway. A female voiceover encourages men to regularly examine their skin and find a partner to help.

A whopping 98 percent of women between the ages of 18 and 34 who tan understand that skin cancer can be deadly, the survey found — and 71 percent of the women know that the idea of a “healthy tan” is a fallacy. Further, 66 percent of women surveyed know that getting a base tan is not an effective way to protect themselves from the sun’s harmful ultraviolet rays.

As Kasey Lynn Morris, a Ph.D. in social psychology about to start her post as a researcher with the National Cancer Institute, tells Yahoo Beauty, “Identity and self-esteem concerns are a very important motivation in health behaviors” — even more important than health itself. In other words: Being healthy is one thing, but if looking tan (or, more positively, eating healthily or exercising) makes you feel better about yourself, then it will likely win out.

The sunscreen market has become undeniably complex over the last few decades, with a seemingly endless supply of creams, sprays, and lotions vying for a spot on your skin — and a veritable alphabet of active ingredients, from avobenzone to zinc, claiming to do the best job of blocking out cancer-causing rays. Luckily, the Environmental Working Group has released its 10th annual Guide to Sunscreens, rating hundreds of the market’s options for safety and efficacy — and BS factor — just in time for the unofficial start of summer.

First, the good news: EWG has deemed a whopping 203 beach and sport sunscreens as best on the market, plus 22 stellar options in the “for kids” category. They range from high-priced mineral-based creams — Badger, Blue Lizard, Beautycounter — to more affordable (and findable) drugstore brands, such as Aveeno and Yes to Cucumbers. (The worst picks for kids, meanwhile, come from brands such as Banana Boat, Coppertone, CVS, and Neutrogena. See the full “worst” list here.)

Also good: EWG declares sunscreen regulations are moving in the right direction. Since 2011, labels must now include warnings about skin cancer and aging, and cannot make misleading claims such as “waterproof” or “sunblock” (as opposed to “sunscreen”). A couple of years ago, Pres. Obama signed the 2014 Sunscreen Innovation Act, which created a better FDA process for reviewing and approving new ingredients. And since 2007, EWG has found a dramatic increase in the availability of mineral-only sunscreens, doubling from 17 percent of products to 34 percent in 2016.

But the bad news also abounds. Sonya Lunder, EWG senior analyst, tells Yahoo Beauty that many of this year’s findings were worrisome. “The bottom line message is that the FDA sets weak rules for skin protection from sunscreen, and as a result,” she says, “we see worrying marketing trends and products that are overpromising.”

The biggest problems, according to EWG’s 2016 report, which analyzed more than 750 beach and sport sunscreens, are that nearly three quarters of the products provide inferior sun protection or contain potentially dangerous active ingredients — such as worst-offenders oxybenzone, a known hormone disruptor, or retinyl palminate, a form of vitamin A that’s potentially harmful to skin.

“Those chemicals are the two we are most consistently concerned with,” Lunder notes. “They go right alongside our concerns about high SPFs — which are used incorrectly — and sprays.”

The problem with high SPFs, she explains, is how misleading those numbers can be: High-SPF products tempt people to apply too little sunscreen and stay in the sun for too long. And while the FDA has proposed prohibiting the sale of sunscreens with SPF values greater than 50, it has not issued a regulation. Meanwhile, the number of products touting an SPF of 70 or higher has skyrocketed in the past few years.

Sunscreen sprays, too, are increasingly popular. In 2007, less than 20 percent of the sunscreens EWG reviewed were sprays; this year, nearly 30 percent were. But EWG worries that these products pose an inhalation risk and may not provide an even enough coating on skin — and in 2011, the FDA raised similar concerns, threatening to ban sprays until manufacturers could provide data about their safety and worth.

Consumers should also choose wisely when it comes to moisturizers that contain SPF protection, Lunder urges. “They tend to break down and are not as strong [as regular sunscreens] to begin with, so applying them once a day is not enough unless you’re working inside,” she says. “Otherwise they only last about two hours. So this idea of ‘daily-wear’ sunscreen” can be questionable.

And then there are the chemicals. Oxybenzone and retinyl palminate may be the most worrisome, but they’re not the only problems: Octinoxate and homosalate are linked to hormone disruption, while octisalate and avobenzone have links to skin allergies. Even the health impacts of mineral-based products, which contain nanoparticles of zinc oxide and titanium dioxide, are not fully known. Still, EWG considers them to be the best options out there today because they do not penetrate the skin.

Finally, EWG’s report found that many products inaccurately claim to prevent skin cancer, despite the fact that most scientist and health agencies, including the FDA, have not conclusively found that sunscreen can prevent most types of skin cancer.

Still, the consensus among researchers is that the most important step people can take to reduce their risk of melanoma — a deadly type of skin cancer that’s on the rise — is to avoid sunburn. And to not rely on sunscreens alone, but to bring hats, clothing and other forms of shade into the mix.

Morris, who spent time researching sun tanning in the face of skin-cancer threats while she was a student at the University of South Florida, explains that tanning, in particular, may be an even harder nut to crack than, say, smoking. “Smoking has become something where people say, ‘Eww, smoking is gross,’ and so you don’t want to be the type of person who smokes,” she explains. “But for women especially, appearance is a prime source of self-esteem, so there’s that competing motivation of being healthy but also having that ‘healthy glow.’”

For perpetuating the myth that a tan is healthy, we can thank, for starters, Coco Chanel, who apparently turned the pre-Industrial Revolution idea of a leisure-class pallor on its head in the 1920s by accidentally getting too much sun on a Mediterranean cruise. Photographs of her made the sun-kissed look chic, and tanning became aspirational, a symbol of wealth and leisure. Even though that idea has been ever-so-slowly tamped down since the 1980s, when sunscreens with higher SPFs were introduced, it’s been a tough one to fight.

A quick and unscientific Facebook poll for this article, asking those who like to get tan why they do it when they know it’s unsafe, brought in the following responses: “It’s another addiction that’s hard to break,” “Makes me feel better to be nice and tan — and makes my teeth look whiter,” and “I just think I look healthier.”

Barbara Greenberg, a Connecticut-based psychologist, tells Yahoo Beauty, “My sense is that people feel like it’s a very quick way to look refreshed and like they’ve just been on vacation. Like Botox and other quick fixes,” she says, “it certainly takes on an addictive quality. Men and women seem to become equally addicted. They also feel like it makes them look younger, and associate tans with youth.”

The youth factor is a big influence, Martin tells Yahoo Beauty. “Unfortunately, I think some women (and men) continue to tan because they see the immediate results of the tan but do not consciously recognize the risk of skin cancer they will face in the future. Young people often see skin cancer as a disease of older people,” she says, whereas melanoma is the second most common cancer in women ages 15 to 29. “Many young women still use indoor tanning beds, unfortunately, and using indoor tanning devices before age 35 can increase your risk of melanoma by 59 percent, with the risk increasing with each use.”

Martin says she often hears patients say they only tan for special occasions, or before a vacation, but she aims to warn them all the same. “I remind them that tanning in any way is damaging the DNA in their cells,” she says. “I quote the statistics. I tell them about one of my first patients who had an invasive melanoma at age 19 and how frightening that was for that patient and that family. … I often also tell them that while they may feel like this tan makes them look great for this prom, or this vacation, if they choose not to tan and choose to protect their skin, they will look better than everyone else at their class reunions! Many times each day, I say, ‘You will thank me when you are 40. I promise.’”

Next are the common mistakes regarding the application of sunblock:

1. You’re not wearing a sunscreen every day.It’s the incidental sun exposure during our lifetime (5 minutes here and 5 minutes there) that can contribute to an increased risk of skin cancer—as well as to increased wrinkles and premature skin aging. Most people don’t think they need sunscreen if they’re just outside for 5 minutes or on cloudy days (80 percent of the sun’s rays penetrate through clouds—even in winter). The sun’s ultraviolet (UV) rays can even penetrate through windows—in the office, home, and car—so you may be getting exposed even if you’re not outdoors. What’s more: sand, concrete, and water (as well as ice and snow in winter) can reflect up to 85 percent of UV rays—meaning even if you’re wearing a hat or are sitting under an umbrella, you’re still exposed.

That’s why you should be applying SPF—be it in your moisturizer or as a separate sunscreen— first thing in the morning so you start off with protection. (Check out our favorites in Best Sunscreens For Every Need.) Also, keep in mind that your lips and hands need protection, too: look for balms/creams with an SPF 15 or higher.

Regular sunscreen use does make a difference: a study in the Annals of Internal Medicine found that people who use sunscreen daily have “noticeably more resilient and smoother skin” than those who don’t.

2. You’re not applying sunscreen soon enough. If you’re wearing a chemical sunscreen (anything with sun-protective chemicals like oxybenzone, octisalate, or avobenzone), you need to apply it at least 30 minutes before going in the sun. “This gives the sunscreen time to get into the skin and render the protection necessary,” explains dermatologist Jerry D. Brewer, M.D., a skin cancer specialist at the Mayo Clinic, in Rochester, MN.

If you’re wearing a physical sunblock—with non-chemical ingredients like titanium dioxide or zinc oxide—you can apply it when you’re out in the sun as these offer immediate protection.

3. You’re not layering antioxidants under your sunscreen. Many sunscreens contain antioxidants, but they can quickly lose their potency. The reason: most antioxidants—like vitamins C and E, green tea, and pomegranate—aren’t stable enough to maintain their long-term benefits when mixed into a sunscreen. But antioxidants are critical because they help negate the skin-damaging and skin-aging free radicals generated by the sun’s ultraviolet light.

4. You’re not applying enough sunscreen.“The average person uses less than half the amount they should be using,” says Steven Q. Wang, M.D., director of Dermatologic Surgery and Dermatology for the Memorial Sloan Kettering Cancer Center, in Basking Ridge, New Jersey. “You need to apply a shot glass worth of sunscreen to your entire body every two hours.” So a typical 5oz bottle of sunscreen is really only 5 full-body applications. If you notice that you’re bottle of sunscreen is lasting longer than a few days when you’re on a beach vacation, you’re definitely not using enough.

5. You don’t reapply often enough. You’ve rubbed in your sunscreen in the morning, but you can’t stop there. You need to continually reapply (at least every two hours) to get effective protection. Also know that spray sunscreens don’t cover skin as effectively as a lotion, so if you use them, you need to rub them into your skin and reapply sometimes more often than every two hours. “If you’re tanning through sunscreen,” says Dr. Brewer, “then either the sunscreen is not being reapplied often enough or too little is being put on.” Also, don’t be fooled by terms like water-resistant or water-proof. This means that the sunscreen may stay on your skin when you’re swimming, but once you get out, it’ll quickly get rubbed off when you towel off to dry.

6. You use SPF 50+ to get the most effective sun protection. While SPF 50 may sound like a lot more protection than SPF 30, the higher the number doesn’t always guarantee much more protection and actually gives you a false sense of security. In fact, studies show that sunscreen with SPF 30 can block about 97% of all incoming UVB rays (note that SPF designates protection against burning UVB rays—not UVArays) while SPF 50 only blocks 98% of all incoming UVB rays. For most effective protection, you need to block against UVB and UVA rays, so look for a sunscreen that says “broad-spectrum” protection. New FDA rules state that if a product offers “broad-spectrum” protection, it must be stated on the front label.

7. You don’t avoid the sun. “Everyone is always talking about using a sunscreen or wearing sun-protective clothing,” says Dr. Wang, “but very few people talk about avoiding the sun altogether. Instead of seeking shade or staying out of the sun between its strongest hours of 10 a.m. and 4 p.m., people go out and get as much exposure as they can.” And this is the problem.

“UV radiation causes direct DNA damage to the cells,” explains Dr. Wang. “Cells do have a mechanism to repair the damage, but as we get older, our repair mechanism diminishes. If the skin cells aren’t able to be repaired, cancer can result.” UV radiation also suppresses production of a key structural protein called collagen and accelerates collagen breakdown, causing wrinkling and eventually, sagging skin. “We’re operating on younger and younger patients with skin cancer,” explains Dr. Brewer, “so it can happen to you.” Follow these rules of sun protection and chances are, it won’t.

For more information on skin cancer prevention and detection, visit SpotSkinCancer.org. There, you can also find instructions on how to perform a skin self-exam, download a body mole map for tracking changes in your skin and find free SPOTme® skin cancer screenings in your area. SPOT Skin Cancer™ is the AAD’s campaign to create a world without skin cancer through public awareness, community outreach programs and services, and advocacy that promote the prevention, detection and care of skin cancer.

So, enjoy your Independence Day and remember to make good decisions and protect yourselves from the warm, inviting, but dangerous rays of the sun.

 

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