Something New Under the Sun

Close up detail of the bare skin on a man back with scattered moles and freckles.

Our region may not be known for sunny weather, but that doesn’t mean we should discount the threat of skin cancer. In fact, the prevalence of skin cancer in Vermont and Northern New York is actually among the country’s highest. “Living here clearly does not give you a free pass,” says Melanie R. Bui, MD, a dermatologist at The University of Vermont Medical Center and UVM Cancer Center.

This is because exposure to ultraviolet (UV) radiation from the sun, the main cause of skin cancer, is cumulative. And sunshine doesn’t just come from above, it can be reflected from our waterways or snow. Even if you’re not frequently burned to a noticeable degree, your skin is always absorbing UV rays whenever it’s exposed and unprotected, regardless of the meteorological conditions.

“It’s obvious you need to wear sunscreen and take other precautions if you live near the equator where you burn more quickly and easily, but up here people can more easily forget,” says Marissa Matarrese, MD, a plastic surgeon at UVM Health Network - Champlain Valley Physicians Hospital. Over time, that forgetfulness can have serious consequences. “We need to get in the habit of using sunscreen whether it’s sunny or cloudy, hot or cold – UV is always coming through,” she adds.

While summer activities are an obvious opportunity for UV exposure, Dr. Matarrese reminds us of some less-obvious sources:

  • Winter sports (skiing, snowboarding, skating, snowshoeing)
  • Window light (e.g. your workspace is next to a window or you spend time driving in a vehicle)

While skin health should be a year-round concern, May is Skin Cancer Awareness Month because in the Northern Hemisphere it’s during this time of year that we tilt toward the sun. We asked experts from the UVM Health Network for practical advice on how we can best protect ourselves as the rain and cold give way to sunshine and warmth. They agree that the best way to avoid skin cancer is by limiting your sun exposure. Do the following:

  • Cover up. Wear wide-brimmed hats, sun-protective clothing and sunglasses
  • Stay indoors between 10 a.m. and 2 p.m.
  • Wear sunscreen, SPF 30 or higher. The higher, the better.

Dr. Bui also advises paying particularly close attention to areas of the body where the skin is more sensitive, like the ears and scalp. It’s important, too, to use at least a bit more sunscreen than you might think. “You usually need to apply a pretty thick layer every two hours if you're out in the sun,” she explains.

As for tanning beds, they should be avoided at all costs. “They’re incredibly dangerous and even going a couple of times significantly increases your risk of getting skin cancer,” Dr. Matarrese says.

Of course, escaping UV radiation entirely is impossible. That’s why keeping an eye on your skin, in addition to protecting it, is essential. Our experts advise using the “ABCDE” rule to determine whether making a special trip to the doctor, on top of having regular screenings, is a good idea. Look for spots that exhibit Asymmetry, Border irregularity, Color variations Diameter expansion and Evolution or changes in shape, size or color.

Infographic titled "Signs of Melanoma", with the ABCDE guide to identifying whether moles and or sun spots are benign or cancerous.

It’s not just melanoma, which typically show up in the form of moles and freckles, that you have to watch out for, Dr. Matarrese emphasizes. There are also squamous cell and basal cell cancers. These usually resemble scabbed bumps or scratches more than irregular pigmented spots. In cases like this, it’s important to note bumps or scratches that don’t heal quickly and easily, which can indicate they’re cancerous.

All these characteristics boil down to what Dr. Bui calls the “ugly duckling” sign. “That's when you have a spot that just doesn't match the other things you grow,” she says. “It sticks out, it draws the eye.” Also, ask for help checking your body.. Some patches of skin are hard to see without another set of eyes, and studies have shown that people who have someone else assisting them in monitoring their skin tend to live longer.

According to Dr. Bui, relying on cell phone apps for determining what merits medical attention isn’t a good idea – not yet anyway. “I have not come across one that is accurate enough,” she says. “It's an admirable goal, but they're not quite ready for primetime.”

In some sense, we’re always playing catch up when it comes to skin health. By the time we start paying attention to it consciously as adults, we’ve already experienced decades of UV exposure. “It starts from when you're a baby and then just continues throughout your life,” Dr. Matarrese says. “That’s the reason being proactive and vigilant is so important.”

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