Downloadable 2010 Skin Cancer Foundation Journal

Transcription

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VOL. XXVIII, 2010
NEW STUDIES LINK MELANOMA TO TANNING
MELANOMA AND
SUNNY VACATIONS
ADDICTED TO
TANNING?
THE DECLINE
OF CELEBRITY
TANNING
BANNING THE TAN AROUND THE WORLD
MICK FANNING, WORLD CHAMPION SURFER TEAM SCF:
ATHLETES AGAINST SKIN CANCER www.SkinCancer.org
© Clinique Laboratories, LLC
© Clinique Laboratories, LLC
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12| 2009foUndATionnEWSroUndUp
15| prESidEnT’SmESSAGE
17
17| LAndmArkrESEArCHLinkS
mELAnomAToUvrAdiATion
MarkTeich
18| THErviSrEAdYToroLL:
THEroAdToHEALTHYSkinToUriSBACk
BEAUTY
23
20 | BronzErnoTrEQUirEd
BEAUTYTrEndSfromTHEExpErTS
ElizabethMichaelson
23 | mELAnomASCrEEninGSAvESLivES
Shawn Allen, MD
25| HoWTopErformASkinSELf-ExAm
RogerCeilley,MD,FAAD
28| TAnninGAddiCTion:THEnEWformofSUBSTAnCEABUSE
Robin L.Hornung,MD,MPH, andSolmazPoorsattar
30| AppEArAnCETrUmpSHEALTHASAnAnTi-TAnninGArGUmEnT
JoelHillhouse, PhD
28
32
LifESTYLE
32| TEAmSCf:ATHLETESAGAinSTSkinCAnCEr
38 | A TEnniSpLAYEr’SExpEriEnCE
WilliamStebbins,MD, and C.WilliamHanke,MD, MPH
42| fromBArdoTToBECkHAm:THEdECLinEofCELEBriTYTAnninG
NinaG.Jablonski, PhD
42
46| SUnSAfETYAT SCHooL
Janice ClarkYoung,EdD, CHES, and Brenda S.Goodwin, MS
48| UndErTHESUn,EvErYTHinGYoUWEArmATTErS
SusanY.Chon,MD,FAAD
46
38
51
63
58
56
HEALTH
71
inTErnATionALAdviSorYCoUnCiL
51
|
63 | BAnninGTHETAnAroUndTHE
WorLd:nATionSmoBiLizE
CraigSinclair
LipCAnCEr:noTUnCommon,
ofTEnovErLookEd
WilliamStebbins,MDand
C.WilliamHanke,MD,MPH
66 | CLArE’SLEGACY
56 | THEriGHTWAYToTrEAT
SEASonALdEprESSion
MichaelTerman,PhD
58| proTECTYoUrEYES:EvErYdAYSTEpSToSUnSAfETY
ReneS.Rodriguez-Sains,MD
60| BrEASTCAnCErAndmELAnomA:
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SuLuoandHensinTsao,MD,PhD
8
68|
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PhilippeAutier,MD,MPH
71|
mELAnomAAndSUnnYvACATionS
ProfessorJuliaNewtonBishop,MD
ProfessorTimBishop,PhD
PaulAffleck,MA
SK I N C A NCER FOU N DAT ION JOU R NA L
sun
safety
your destination for
Sephora is honored to partner with The Skin Cancer Foundation for the fourth
consecutive year in creating the Sephora Sun Safety Kit. Our award-winning
set includes advanced protective products, all with SPF 15 or higher, housed in
a beach-friendly clutch. With 100% of the net profits benefiting the Foundation,
Sephora is committed to the education of sun safety to our clients and beyond.
We are proud to work with the leaders in the fight against skin cancer.
Pledge to uncover your most beautiful skin yet, and we
will help you start—and stick to—a daily routine that lets
you put your best face forward in four simple steps:
CLEANSE, TREAT, MOISTURIZE, PROTECT.
Plus, earn a FREE reward when you complete the challenge.
Visit sephora.com/go/skincarechallenge for more information.
SPF 60
SPF 55
SCF Journal Ad 2010.indd 1
3/8/10 11:54 AM
ABOUT THE FOUNDATION
75 | INTERNATIONAL ADVISORY COUNCIL
76 | LEADER IN THE FIgHT
AgAINST SkIN CANCER
78 | SCF OFFICERS & STAFF
80 | RESEARCH gRANTS AwARDED IN 2010
81
| pROFESSIONAL MEMBERS
88
| AMONETTE CIRCLE
90
| 2009 DONORS
92
| CORpORATE LEADERSHIp COUNCIL
93
| U.S. CORpORATE COUNCIL
94
| INTERNATIONAL CORpORATE COUNCIL
94
| SEAL OF RECOMMENDATION
95
| HIgHLIgHTS FROM SCF 2009 EVENTS
96
| REFERENCES
98
| SCF CATALOg
100 | ADVERTISERS’ INDEx
95
2010 Jo u r n a l st a f f
Ad v ERTISINg
Medical Editor
Pearon G. Lang, Jr., MD
Director of Corporate
Partnerships
Dan Latore
Publishers
Perry Robins, MD
Mary Stine
Managing Editor &
Director of New Media
Paul Melia
Executive Editor
Mark Teich
Manager, Corporate
Partnerships
Pamela McLaughlin
Assistant Manager,
Corporate Administration
Veronica Barlow
Associate Editor
Elizabeth Michaelson
Individual copies of The Skin Cancer Foundation Journal
are available for $5 (includes shipping & handling). Call (212)
725-5176 or visit www.SkinCancer.org for volume pricing
and shipping.
Journal d esign: Martin Fitzpatrick, FITZcreative.com
Miss io n st a t e Me n t o f t h e sk in Ca n Ce r f o u n da t io n
The first organization in the US committed to educating
the public and medical professionals about sun safety, The
Skin Cancer Foundation is still the only global organization
solely devoted to the prevention, detection and treatment
of skin cancer. The mission of the Foundation is to decrease
the incidence of skin cancer through public and professional education and research. For more information, visit
www.SkinCancer.org.
The opinions expressed in the Journal are those of the
authors and do not necessarily reflect the views of The Skin
Cancer Foundation.
The Skin Cancer Foundation Journal
is published by
The Skin Cancer Foundation
149 Madison Avenue, Suite 901
New York, NY 10016
Phone: 212-725-5176
Fax: 212-725-5751
E-mail: [email protected]
Website: www.SkinCancer.org
© 2010 The Skin Cancer Foundation
All Rights Reserved
11
2009 Foundation
News Round Up
MAkingAniMpression
TheFDAConsiDersreClAssiFyingUVTAnningDeViCes
The Skin Cancer Foundation is a major skin cancer information
resource for print and electronic media. In 2009, we generated
504 million impressions in print, television and radio, and 1.7
billion impressions in electronic media. Coverage of the Foundation
and our information about skin cancer appeared on local and
national news programs such as Good Morning America and
TODAY; on websites like WebMD; in magazines such as SELF
and Good Housekeeping, and in newspapers including The New
York Times, USA Today and The Wall Street Journal.
The Skin Cancer Foundation is often contacted by staff at
these and other magazines, newspapers, and television stations
when they are looking for
an expert in the field of skin
cancer. Physician members
of the Foundation serve as
spokespeople, informing the
media about the prevention,
early detection, and treatment of skin cancer.
Forty two members
participated in interviews
for television, radio, print,
and web in 2009.
In November, the US Food and Drug Administration (FDA) announced that on March 25, 2010, members of a Medical Devices
Advisory Committee Panel would meet to discuss the possible
reclassification of UV-emitting tanning beds and lamps. As of early
March 2010, tanning machines are Class I medical devices, in the
same category as elastic bandages and tongue depressors. But
according to the US Department of Health and Human Services, UV
radiation from either the sun or tanning machines is a proven human carcinogen (cancer-causing agent), and considerable research
shows it is the chief cause of skin cancer. Reclassification to Class
II or III would permit stricter regulations and more oversight.
has launched a campaign in
support of reclassification. By
the time you read this, the FDA
may have made a decision.
CAllingAllsoCiAlneTworkers
We hope you’ll join us online by becoming a fan of The Skin Cancer
Foundation on Facebook (www.Facebook.com/skincancerfoundation). Our expanded profile features regular updates on programs
like the Road to Healthy Skin Tour, Team SCF, and our Go With
Your Own GlowTM campaign. You can also view videos and photos,
download skin cancer information, and help raise awareness of
the cause.
We’re also on Twitter — follow
us at www.twitter.com/SkinCancer.
org, and check in regularly for news,
advice from the experts, and more.
12
WE’RE VERY HONORED
THE GLOW CAMPAIGN KEEPS GOING (AND GLOWING)
In 2009, The Skin Cancer Foundation was honored — again — for
its efforts to educate the public about skin cancer. In fact, the
American Academy of Dermatology (AAD) presented us with f ve
Gold Triangle Awards, setting a record for the number of wins
at one time in the Health Community Organization category. Our
honorees include the quarterly consumer newsletter Sun & Skin
News; the PSA print ad campaign Go With Your Own GlowTM;
our children’s educational program, The Sunsational Guide to
Smart Sun Safety: Fun in the Sun 101; the Road to Healthy Skin Tour, presented by Aveeno® and Rite Aid, and our brochures
Skin Cancer: If You Spot it, You Can Stop it and Understanding
UVA and UVB. This brings
our total number of Gold
Triangles to 14.
Since 2008, our Go With Your Own GlowTM ad campaign, created
for us by Laughlin Constable, has received more than $3.7 million
in ad space and has been featured in more than a dozen magazines,
including TIME, PEOPLE, and Marie Claire. Our message — that
tanning is no longer in fashion — has reached almost 300 million
readers. Look for Go With Your Own GlowTM in your favorite
magazines, and see where we’ve been featured here: www.
SkinCancer.org/go-with-your-own-glow-in-magazines.html.
raisin is a grape that didn’t have the sense to get out of the sun. And think about
it, if the giant orb in the sky can do that to a little piece of fruit, imagine
what it’s doing to your precious skin. Layers one to seven do not like being basted,
toasted, roasted, fried, and all other manner of scorched. And how does your skin
show it? Hello wrinkles. Hello crow’s feet. Hello blotches and
burns and who-knows-what-all-else. Not to be prejudiced, but
on the pecking order of brains, we humbly submit that human
beings should have more sense than dumb grapes.
T
anning’s fifteen minutes are over.
Let your inner health, beauty, and
vitality shine through.
Don’t you agree? Nothing looks better on you
than the healthy, glowing, radiant shine
ou know that indescribable something
that radiates from deep inside? Some call
it the glow. Some call it the inner shine. Some call it the
eternal beacon of your all-that-is-good (but they are rather
you were born with. Because
long-winded types.) The bottom line, however, is the same.
today, being healthy –
truly healthy – is
Nothing attracts like the fresh, natural, healthy glow of your
what’s sexy.
own skin. You’ve seen it yourself. After exercising. On
pregnant women. It’s what you’re made of, and the fact
of the matter is, nothing is as sexy as healthy. So, ask
yourself this: why burn it, scorch it, fry it, sizzle it, dull it?
Don’t have an answer? Neither do we.
Go with your own glow
www.skincancer.org
© 2008 The Skin Cancer Foundation Campaign created by partners + jeary, www.partnersandjeary.com
© 2010 The Skin Cancer Foundation Campaign created by Laughlin Constable, www.laughlin.com
Rex Amonette, MD, Senior Vice President of The Skin Cancer Foundation,
accepts a record-breaking f ve Gold Triangle Awards from American Academy
of Dermatology President David Pariser, MD
TEAM SCF IS HERE
We’re thrilled to introduce Team SCF. Featuring a partnership
with World Professional Surfers, including Mick Fanning and
Damien Hobgood; US Women’s National Team soccer stars Christie
Rampone and Lindsay Tarpley; snowboarder Shayne Pospisil;
golfer Brian Davis; angler Preston Clark and others, Team SCF
consists of elite sports professionals dedicated to sun safety.
To learn more about how these athletes protect their skin
despite rigorous schedules that require them to be outdoors (and
usually in the sun) on a daily basis, please see “Team SCF: Athletes
Against Skin Cancer” on page 32.
BACK TO SCHOOL WITH THE SKIN CANCER FOUNDATION
The Sunsational Guide to
Smart Sun Safety: Fun in the
Sun 101, has been garnering
accolades. Not only did our
program for middle and
junior high school students
win a Gold Triangle Award
from the American Academy
of Dermatology (AAD), The
Washington Post called it “fun”
and “kid-friendly.” Best of all,
95 percent of the teachers surveyed said they would use the
program annually. The program consists of an interactive website
(www.SkinCancer.org/school) and free downloadable materials.
Last year, we distributed 15,000 kits — including 455,000 student
journals — to teachers all over the US. Visit us online for new
features and updates.
13
The Sun Knows No Season
Five jane iredale products awarded the SCF Seal
of Recommendation as effective UV sunscreens.
Even in winter, the sun also rises. Luckily, jane iredale makes it easy to stay pretty, and
protected, with five products awarded The Skin Cancer Foundation Seal of Recommendation
as effective UV sunscreens:
• Amazing Base ® SPF 20
• Dream Tint ® SPF 15
• PurePressed ® Base SPF 20
• LipDrink ™ SPF 15
• Powder-Me SPF ® SPF 30
When used regularly in the prescribed manner, these products may help reduce the potential
risk of skin cancer due to overexposure to sunlight, and serve as an effective aid in the
prevention of sun‑induced damage to the skin, including sunburn and possibly premature aging.
jane iredale – THE SKIN CARE MAKEUP ® — supporting you in the fight against skin cancer.
The #1 choice of skin care professionals
At skin care specialists & beauty apothecaries in over 40 countries
The prettiest protection is at janeiredale.com
President’s Message
During the past year, we’ve seen important developments in skin
cancer awareness and anti-tanning efforts around the world,
as new studies have strengthened the link between ultraviolet
(UV) tanning and increased risk of melanoma. One key report
for the first time declared UV radiation from tanning devices
carcinogenic (cancer-causing) to humans; in another, genetic
researchers revealed that most of the mutations found in a
melanoma were caused by damage from UV radiation. These
events prompted The Skin Cancer Foundation to campaign for
stricter regulations and more oversight of tanning devices. We
During the past year, we’ve seen
important developments in skin cancer
awareness and anti-tanning efforts
around the world, as new studies
have strengthened the link between
ultraviolet (UV) tanning and increased
risk of melanoma.
commissioned a white paper summarizing the research on the
dangers of UV tanning. This led members of Congress to petition
the US Food and Drug Administration (FDA) to reclassify tanning
machines to better reflect the serious dangers they pose. Thanks
to our efforts, along with those of the National Council on Skin
Cancer Prevention, the FDA met on March 25 to hear testimony
on the reclassification of tanning beds and lamps. Reclassification to Class II or III would permit stricter regulations and
more oversight.
In July 2009, the International Agency for Research on
Cancer (IARC), affiliated with the World Health Organization
(WHO), added UV-emitting tanning devices to its list of the most
dangerous forms of cancer-causing radiation. In this landmark
report, UV radiation from tanning beds and lamps was included
in the small group of radiation sources known to cause cancer in
humans — a group including plutonium and solar UV radiation.
We contacted Dr. Philippe Autier, former head of the IARC’s
Prevention Group, which authored the report, and he agreed to
share the story of how the group reached its momentous decision
to list tanning beds among the world’s most virulent carcinogens.
In his article (page 68), Dr. Autier traces the history of the research
linking UVR from tanning devices with skin and eye cancers.
In December 2009, the Wellcome Trust Sanger Institute in
Hinxton, UK, achieved another milestone, revealing that its
scientists had decoded the entire genetic makeup (genome) of a
melanoma. The researchers found that the vast majority of the
mutations found in the melanoma were caused by damage to the
skin cells’ DNA by the sun’s UV radiation. This groundbreaking
research is covered on page 17.
These studies are of international importance, and to help
spread our sun safety message to a global audience, we have
taken steps to expand our International Advisory Council. Our
68 members, including new members from Jordan, Kuwait, and
Thailand, represent 26 countries. They are invaluable to our
international outreach and educational efforts.
One of the centerpieces of our international outreach is the
World Congress on Cancers of the Skin. This year, the 13th
Congress was held from April 7-10 in Madrid, bringing together
doctors from all over the world, including more than 120 speakers.
The World Congress allows physicians a unique opportunity to
interact with distinguished international faculty and to learn
about breakthrough discoveries in the prevention, diagnosis,
and treatment of all types of skin cancer.
The coming year promises many more vital and exciting
developments in the prevention, detection, and treatment of
skin cancer. We urge you to visit and explore our wide-ranging
website, www.SkinCancer.org, and to join our fight against the
world’s most common cancer.
President
15
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Landmark Research Links
Melanoma to UV Radiation
MArkTeiCh,eXeCUTiVeeDiTor
In December 2009, a remarkable new study made perhaps the convincing proof of UVR’s involvement. But this new cataloging
strongest case ever that some melanomas are caused by exposure of mutations, the results of which were published in Nature, all
but confirms UV radiation as a cause of melanoma.
to ultraviolet (UV) radiation.
The link between melanoma and UV radiation is further
Scientists at The Wellcome Trust Sanger Institute, in Hinxton,
UK, mapped the complete genetic material (the genome) that com- reinforced by information gleaned from a companion study of a
posed a melanoma taken from a patient with the disease. Using patient’s lung cancer genome, also recently mapped by scientists
new molecular technology, the researchers identified thousands of at the Wellcome Trust Sanger Institute. The pattern of mutations
mutations, the vast majority of which were caused by UV radiation. in both cancer genomes is extremely similar; just as the vast
Many mutations, changes or errors that occur in genes due to majority of mutations in the melanoma genome were caused by
radiation, viruses, and other causes, can ultimately lead to cancer. UV damage, a significant majority of the mutations in the lung
Over the years, evidence has added up that most skin cancers cancer genome were caused by cigarette smoking. “The profile
are caused by damage to the skin cells’ DNA by the sun’s UV of mutations we observed [in the lung cancer genome] is exactly
radiation, but this was the first time UV damage could be seen all that expected from tobacco, suggesting that the majority of the
through a melanoma’s genetic material. According to the Sanger 23,000 we found were caused by the cocktail of chemicals found
Institute, “The melanoma genome contains more than 33,000 muta- in cigarettes,” according to Dr. Peter Campbell, senior author of
tions, many of which bear the
imprint of the most common
cause of melanoma — exposure
to ultraviolet light.”
“The melanoma
In the study, the genomes
genome contains
of both normal and melanoma
more
than 33,000
tissue were decoded. When
mutations,
many
the tissues were compared,
scientists were able to pinof which bear the
point precisely where in the imprint of the most
melanoma genome mutations
common cause
occurred.
of
melanoma —
“With this genome sequence,
exposure to
we have been able to explore
ultraviolet light.”
deep in the past of each tumor,
uncovering with remarkable
clarity the imprint of these
environmental
mutagens
[causes of the mutations] on DNA, which occurred years before the lung cancer study. Most lung cancer deaths are known to be
the tumor became apparent,” the study’s coauthor, Professor caused by smoking, and it could well be that most melanoma
Mike Stratton, MD, PhD, explained. “We can see the desperate deaths are caused by UV.
“These are the two main cancers in the developed world for
attempts of our genome to defend itself against the damage from
ultraviolet radiation. Our cells fight back furiously to repair the which we know the primary exposure,” Dr. Stratton said. “For
lung cancer, it is cigarette smoke and for malignant melanoma
damage, but frequently lose that fight.”
It’s not clear to just what extent UV radiation influences the it is exposure to sunlight.”
Not all mutations cause cancer, so the scientists will next try
development of melanoma, but this research strengthens the link
between them. While 90 percent of all basal and squamous cell to determine exactly which mutations contribute to melanoma
carcinomas (the two most common skin cancers) are known to be development. “The knowledge we extract over the next few years
associated with exposure to UV radiation (UVR), some investigators will have major implications for treatment,” said Dr. Campbell.
have disagreed about the role of UVR in melanoma development. “By identifying all the cancer genes, we will be able to develop
Research has established that genetics are an important component new drugs that target specific mutated genes, and work out which
in melanoma (a family history of the disease increases one’s risk of patients will benefit from these novel treatments.”
developing it), and some scientists have maintained there was no
17
The RV is Ready to Roll:
The Road to Healthy Skin
Tour is Back
By the time you read this, The Skin Cancer Foundation’s Road to
Healthy Skin Tour, presented by AVEENO® and Rite Aid, will be
back on the road. The Tour, now in its third year, provides free,
full-body skin exams by local dermatologists.
In 2010, the Tour bus (a 38-foot customized RV with two exam
rooms) will make an estimated 80 stops in 24 states. Be sure to
check www.SkinCancer.org/Tour regularly for exclusive highlights
from the road, including schedule updates, photos of our volunteer
dermatologists, tour statistics, and more.
In the Tour’s first two years, 224 dermatologists donated their
time and expertise to provide free full-body skin screenings to
over 6,500 people and discovered 116 suspected melanomas.
Since melanoma is the deadliest form of skin cancer, the tour has
already potentially saved over 100 lives. Between 2008 and 2009,
dermatologists also found 1,198 suspected actinic keratoses (the
most common precancers); 574 suspected basal cell carcinomas, and
189 suspected squamous cell carcinomas. The American Academy
of Dermatology recognized the Road to Healthy Skin Tour’s
efforts by awarding The Skin Cancer Foundation a Gold Triangle
in 2009. The Tour has also been featured on both Good Morning
America and TODAY.
Additional support for the Tour is provided by Columbia
Sportswear, DUSA Pharmaceuticals, Inc.®, Solar Gard® Window
Film, and Fitness magazine.
If you won’t be able to attend the Tour, you should visit a
dermatologist once a year for a full-body skin examination. Learn
how to perform a skin self-examination on page 25.
18
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new
beAUTy
bronzernoTreQUireD:beAUTy
TrenDsFroMTheeXperTs/20
MelAnoMAsCreening
sAVesliVes/23
howToperForMAskin
selF-eXAM/25
TAnningADDiCTion:Thenew
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AppeArAnCeTrUMpsheAlThAs
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preventinganaddictionisfarbetterthantryingtotreatone.
—TAnning ADDiCTion: The new ForM oFsUbsTAnCe AbUse (p.28)
Bronzer Not Required
Beauty Trends from the Experts
elizAbeThMiChAelson,AssoCiATeeDiTor
Getting ready for the warm weather? at the Marc Jacobs show, makeup artist
According to fashion and beauty experts, François Nars actually used a ton of loose
there’s never been a better time to flaunt powder to lighten the skin tone — the
your (properly sun-protected) untanned, complete opposite of a tanned look.”
The waning of the deep, dark, dangerous
natural beauty. “We love the pale look — the
luminous, glowing skin that reflects your tan is apparent in magazines, too, Chao said.
natural skin tone,” said Eleanor Langston, “For fashion shoots, you never want a model
Beauty Director at Fitness. Her colleagues to be very tan. It’s not high fashion.” The
at Marie Claire, Cosmopolitan, and model’s real skin color — be it ivory, tawny,
Allure agree. They discussed this welcome olive, or deep brown — is the right shade.
“I think the mindset has shifted in the
trend — and how to wear it — with The
past couple of years,” Langston observed.
Skin Cancer Foundation.
“Today, the trend is towards embracing your
natural skin tone. It just looks fresher, and
onsTAge,AnDonThepAge
Fashion runways and magazines are the so much more sophisticated.” She thinks
twin bellwethers of beauty trends — if a the current popularity of untanned skin
look is in, you’ll find it there. “At the recent is “a natural progression, the result of
shows, many designers showed models who all the news about skin cancer from The
weren’t totally tanned,” said Ning Chao, Skin Cancer Foundation and dermatoloMarie Claire’s senior beauty editor. “Even gists.” Tanning is often associated with an
Dolce & Gabbana!” (The iconic Italian brand “overdone, fake look.” But at Fitness, she said,
often features bronzed models). “Designer “We want to promote a look that’s realistic,
Michael Kors is known for a sun-kissed healthy, and natural, and the models we
look. But Dick Page, the makeup artist at look for have those qualities.”
The tan-free aesthetic is visible in the
his show, said he didn’t want the superbronzed look. He used bronzer for contour editorial pages as well as the fashion pages.
rather than for all-over darkening. And For instance, Fitness no longer advises
20
Clockwise from top left:
Ning Chao, Senior Beauty Editor, Marie Claire
Victoria Kirby, Beauty Editor, Allure
Eleanor Langston, Beauty Director, Fitness
Leah Wyar, Beauty Director, Cosmopolitan
readers to wear darker makeup in the
summer; this was standard when everyone
was assumed to tan in the warmer months.
“You shouldn’t have to switch foundation
shades in the summer. We hope people’s
skin tones remain the same year round,”
Langston said. At Marie Claire, “in our June
issue, we’re running an article on how to
get bronzer-free perfect legs,” Chao said.
If you’re worried that vibrant shades
may make you look clownish, Kirby reassured us that while “bright makeup colors
can look tacky on bronzed skin, a vivid
cherry lip gloss or coral blush against a
milky complexion is beautiful.”
Celebswholook
gorgeoUs,noTTAn
A tan used to be the default look for many
stars, but that’s changed in the past few
years. “I really noticed it at the Oscars last
year,” said Chao. “You had Anne Hathaway,
Amy Adams, Nicole Kidman, Meryl Streep,
all untanned and beautiful.”
The oft-mentioned Kidman and Adams
(both natural redheads with very fair skin)
are noted for their beautiful, sophisticated,
and always tan-free looks. But you don’t
need to be alabaster-pale to make an
impact. Many stars, not all of them
so dramatically pale, have luminous,
untanned skin. The editors love the
bronze-free looks of Drew Barrymore,
Kate Beckinsale, Kristen Bell, Halle Berry,
Jessica Biel, Cate Blanchett, Emily Blunt,
Mariah Carey, Kirsten Dunst, Isla Fisher,
Jennifer Garner, Selena Gomez, Scarlett
Johansson, Eva Mendes, Kristen Stewart,
and Michelle Trachtenberg.
springAnDsUMMer2010:
iT’sAllAboUTColor
But tan-free doesn’t mean monochrome:
“There’s so much color right now,” explained
Leah Wyar, Cosmopolitan’s Beauty Director.
“That’s after years and years of the ‘natural’
face — just mascara and a glossy lip.” Ironically, with the ‘natural’ look, “people did
tend to pile on the bronzer, because that
let you wear less makeup everywhere else,”
Wyar added. But now “color is coming back:
hot pink lipstick, teal eyeliner and blue
shadow… You don’t need to wear bronzer
with these looks; the color supports itself.”
Bronzer isn’t necessary, Langston
agreed. “If you’re fair, a little color and
contrast will keep you from looking sallow.
Some luminosity will enhance your skin
tone — I like a little champagne- or pearltoned highlighter on the tops of cheeks, and
cream blushes, since powders often cake
FroMbronzeTobeAUTiFUl
in the heat.”
The
editors also noted that some celebs
Victoria Kirby, Allure’s Beauty Editor,
appear to have toned down their tans, a
is also a blush fan. “It’s very important if
move they applaud. “Many celebrities,
you’re fair-skinned and you’re not wearing
such as Christina Aguilera, used to wear
bronzer. Skip it only if you’re wearing a
tons of bronzer,” Wyar pointed out. “She
bright lip color.” She favors shades of poppy
doesn’t seem to be doing that anymore.”
coral and hot pink this season.
Langston has observed the same change in
Like Langston, Chao is seeing a lot of
Jessica Alba, noting, “Now she embraces
products with a bit of luster. “Another
her olive skin tone.”
big trend is a skin brightener in a pearly
Kirby cited Nicole Richie, recalling,
pink color rather than an orange-y bronze.
“When The Simple Life first came out,
Brighteners shouldn’t have a distinctive
she was very bronzed. She had that
shimmer, but they should give the skin a
celebutante look — streaky blond hair and
dewy sheen.”
bronzer. But now it looks like she’s letting
herself be naturally beautiful, rather than
conforming to a certain idea.”
TheglowoFheAlTh
Whether you play up your natural skin
tone with bright colors, or apply a hint of
self-tanner or bronzer, your glow will be
healthy only when you avoid UV tanning.
Today, beauty experts understand that
there’s nothing healthy about damaging
your skin. “Tanning is not aspirational!”
Langston declared. “Everyone’s gotten
the memo about how the dark tan look is
out, and not flattering. It looks healthier
to embrace and enhance your natural skin
tone… It shows you’re taking care of your
skin, and that you think avoiding sun damage is important. That’s a look we like!”
howToweArbolDColors
Wyar, Kirby, and Chao all mentioned teal,
predicting we’ll see it and other equally vibrant shades in eyeliners and eye shadows.
But if your idea of a bright hue is taupe, take
heart: It’s not hard to “find your comfort
level with color,” according to Wyar. “For a
lot of people, lip color is the easiest way to
experiment. For instance, if you want a pop
of color, use a gloss.” When she hears the
siren call of fuchsia lipstick, Wyar applies
the bright color before anything else. “You
get a sense of how much color is on your
face, and you can adjust the rest of your
makeup accordingly.”
Rich pigments lend themselves to a
light touch. “You can build color by layering.
If you’re pale, you might want just a wash
of bright color. If you’re darker, look for
a creamy formulation that goes on more
boldly,” Wyar advised.
Besides, many bright hues are surprisingly easy to wear: “Teal blue on the eyes
works with any complexion,” Chao promised. “As long as you don’t go overboard!”
21
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Melanoma
Screening
Saves Lives
The Benefits of Total-Body
Skin Examination
and Skin Self-Exams
Shawn Allen, MD
M
elanoma is by far the deadliest form of skin cancer and
a major public health concern. The American Cancer
Society estimated that about 68,720 new melanomas
were diagnosed in the US during 2009, resulting in
about 8,650 deaths.1
As with many cancers, the sooner melanoma is detected, the
better the prognosis. The risk of dying from the disease, in fact,
is directly related to the depth (thickness) of the cancer, which
is related to the amount of time it has been growing unnoticed.
Fortunately, skin cancers are usually readily visible. Patient skin
self-examination, physician-directed total-body skin exams, and
patient education are the keys to early detection.
Taking issue with this, in February 2009 the United States
Preventative Services Task Force (USPSTF) stated that “current
evidence is insufficient to assess the balance of benefits and
harms of using a whole-body skin examination by a primary care
clinician or patient skin self-examination for the early detection
of cutaneous [skin] melanoma, basal cell cancer, or squamous
cell skin cancer in the adult general population.”2 However, the
USPSTF position is based solely on a review of studies from 1999 to
2005, and omits more recent research clearly showing the benefits
of skin self-exams and total-body skin exams.2 Importantly, it
did not look at the value of skin cancer screenings performed
by board-certified dermatologists as opposed to a primary care
physician. Currently, there is compelling evidence that both skin
self-exams and total-body skin exams can play major roles in
detecting potentially deadly melanomas and other skin cancers.
Skin Self-Examinations
With skin self-exams, it is possible for patients to detect their
own melanomas. Brady, et al found that up to 57 percent of newly
diagnosed melanoma patients first spotted their own melanomas
by skin self-exams.3 We see similar findings in our clinics, as many
melanoma and other skin cancer patients come to us complaining
of a new or changing mole. For this reason, educating patients
and the public about skin self-exams is critical. [See “How to
Perform a Skin Self-Exam” on page 25.]
Studies have also shown that people who perform skin
23
BEAUTY
self-exams have thinner (and therefore less advanced) melanomas;4,5 self-exams and the corresponding earlier detection of
melanomas may reduce mortality by as much as 63 percent.6
Professional Total-Body Skin Exams
Physicians’ total-body skin examinations are also of great importance, especially since only about one third of individuals at risk for
melanoma actually perform skin self-exams.7,8 Additionally, many
patients are unaware of melanomas on their skin: A recent study
showed that most melanomas detected in a general dermatology
practice setting were found as a result of dermatologist-initiated
total-body skin exams. Overall, 56.3 percent of melanomas were
found by the dermatologist and were not mentioned by the patient
as a reason for the visit.9
Multiple studies indicate that physicians are also more likely
to detect melanomas at a thinner (earlier) stage than non-physicians7,10,11 (See Table 1). Kantor and Kantor found that detection
initiated by a dermatologist was significantly associated with
melanomas under 1.0mm, the definition of a thin melanoma,9 and
Aitken, et al found that whole-body clinical skin examination in the
three years before diagnosis was associated with a 14 percent lower
risk of being diagnosed with a melanoma thicker than .75mm. This
is perhaps the strongest evidence to date that whole-body clinical
skin examination reduces the incidence of thick melanomas, and
suggests that total-body skin exams would significantly reduce
melanoma mortality.12 (For more information on melanoma
thickness and its relationship to prognosis and staging, visit
www.skincancer.org/melanoma/stages-of-melanoma.html.)
Although the USPSTF currently maintains there is not
enough evidence to support total-body skin exams by primary
care physicians, the fact that they did not consider screenings
by dermatologists (who are intensively trained in skin cancer
recognition) in their analysis is significant. Nonetheless, a welltrained primary care physician can be extremely helpful in cases
where a concerned patient requests a total-body skin exam. When
the patient asks about a specific lesion, if there is any suspicion
that it may be a cancer, he or she can be referred to a highly
trained dermatologist.
Despite the recent USPSTF position statement, it is clear from
both clinical studies and common sense that total-body skin
exams and skin self-exams play a critical role in early detection
of melanoma, a potentially deadly skin cancer when discovered
at later stages.
References available on p.96.
DR. ALLEN is Director and Founder of Dermatology Specialists of Boulder,
PC, and Assistant Clinical Professor in the Department of Dermatology
at the University of Colorado School of Medicine.
Table 1: Differences in the Mean Thickness of Melanomas
Detected By Physicians vs. Non-Physicians
STUDY
MEAN THICKNESS (mm)
Physician
Non-Physician
Carli, et al7
.68mm
.90mm
Epstein, et al10
.23mm
.90mm
Swetter, et al11
.60mm
.98mm*; 1.43mm**
*Spouse/partner **Patient
24
How to Perform
a Skin Self-Exam
6
roger CeilleY, mD, faaD
Skin self-exams should be performed once
a month, in addition to an annual full-body
skin exam by your physician. A skin selfexam involves systematically examining
your entire body for skin changes that could
be warning signs of the most common
skin cancers (basal and squamous cell
carcinomas and melanoma).
Basal cell carcinoma is rarely fatal, but
like squamous cell carcinoma (SCC), can
be disfiguring if not treated in a timely
fashion. SCC also causes about 2,500 deaths
per year in the US. Warning signs for these
skin cancers include:
• A spot, sore, shiny bump or nodule,
scaly lesion, or wart-like growth that
continues to itch, hurt, crust, scab,
erode, ooze, or bleed
• An open sore or wound that does not
heal within 2-3 weeks
• A white, yellow, or waxy
scar-like area, or a reddish patch
or irritated area.
Melanoma is the deadliest form of skin
cancer, killing an estimated 8,650 people
in the US this past year alone. Melanomas
are often mistaken for moles. However,
moles and melanomas differ in significant
ways. The ABCDEs, below, describe the
characteristics that can help you identify
potential melanomas.
the aBCDeS of melanomaS
A The mole is asymmetrical; the two
sides do not match
B The mole is irregular in outline or
border
C The mole changes color or appears
pearly, translucent, tan, brown, black,
or multicolored
D The mole is bigger than 6mm
in diameter, or the size of a
pencil eraser
E The mole evolves or changes in
any way
Also be on the lookout for moles that
appear after age 21. Any new skin growth,
beauty mark, mole, brown spot, wound,
or sore that doesn’t heal can be cause for
concern; consult your physician if you
have questions.
To perform a self-exam, you’ll need a
bright light, full-length mirror, hand mirror,
two chairs or stools, and a blow dryer.
1
In front of a full-length
mirror, study your
face, especially the nose,
lips, mouth and ears —
front and back.
2
Examine the palms, hands,
fingers, fingernails, and
fronts and backs of the forearms.
Look at the neck, chest and
torso; women should check
underneath the breasts.
Use both mirrors to view
the lower back, buttocks,
and backs of the legs.
Sit down, and prop your
foot on another chair or
stool. Using the hand mirror,
examine your genitals. Look at
the legs, especially
ankles, tops and
undersides of feet, and
between the toes.
On your next self-exam, note any
changes in your skin, such as increases
in size, differences in shape, and the appearance of any new growths. If your skin
shows any warning signs of skin cancer,
consult your physician.
3
5
7
8
Use a blow dryer to
check your scalp,
exposing each section to view.
Check the upper arms,
including underside and
underarms.
Next, turn your back
to the full-length
mirror and use the hand
mirror to examine the
reflection of the back of
your neck, shoulders, and
upper back.
4
DR. CEILLEY is Clinical Professor, Department
of Dermatology, University of Iowa, Iowa City,
and is in private practice in West Des Moines,
IA. He is Past President of both the American
Academy of Dermatology and the American
Society for Dermatologic Surgery. He has
authored or coauthored over 100 scientific
publications, books, and chapters. The American
Society for Dermatologic Surgery awarded Dr.
Ceilley the 2003 Samuel J. Stegman Award for
distinguished service.
25
thiS Skin CanCer foUnDation PUBliC SerViCe aDVertiSement iS aVailaBle for meDia USage.
for more information, PleaSe ContaCt: Jamie SYlVeS, (212) 725-5176 ext. 120 [email protected]
T
anning’s fifteen minutes are over.
Let your inner health, beauty, and
vitality shine through.
618124D1_1_GC-journal:CLAR100078_ANNUAL_JOURNAL
2/19/10
11:48 PM
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NEW
BEAUTY
TANNING ADDICTION
The New Form of Substance Abuse
Robin L. Hornung, MD, MPH,
and Solmaz Poorsattar
UVR and Skin Cancer
Skin cancer is the most common form of
cancer in the United States, and one of the
most preventable. Exposure to ultraviolet
radiation (UVR) from the sun or from indoor
tanning machines has been identified as
the principal avoidable risk factor for
the development of both melanoma and
nonmelanoma skin cancers (NMSC).1
Despite overwhelming evidence linking
UVR to skin cancer, exposure to the sun
and indoor tanning machines continues
to increase.2,3 Multiple studies show that
despite repeated health warnings and
increased knowledge about the dangers of
excessive UVR exposure, many individuals,
particularly adolescents and young adults,
still use little or no skin protection outdoors
and when visiting tanning salons.4
This continued, purposeful exposure to
a known cancer-causing agent suggests
28
Many frequent tanners
report relaxation and
mood-enhancing effects as
their motivation for tanning,
suggesting psychological
dependence.
that factors besides lack of knowledge
are driving individuals to tan. While
many report that the desire for a tanned
appearance is the strongest motivation for
sunbathing and tanning bed use,4 tanners
also report mood enhancement, relaxation,
and socialization.5 It has been suggested
by the popular media and suspected by
dermatologists for years that one reason
tanning is so popular is that UV light
is addictive.
It’s easy to see why tanning would be
compared to other substance dependencies. Common behaviors involved in abuse
and addiction, like cigarette smoking and
heavy drinking, are prevalent among adolescents and young adults. They are often
initially perceived as image-enhancing,
and practiced despite knowledge of their
dangers. Some of the reported benefits of
frequent tanning — mood enhancement
and relaxation — are also consistent with
addiction. Furthermore, many frequent
tanners report difficulty quitting.
What We Know About
Tanning Addiction
Frequent tanners exhibit signs of both
physical and psychological dependence.
When a substance causes physical dependency, repeated use of that substance
causes symptoms of increased tolerance,
craving, and withdrawal.6 UV light has
been shown to increase release of opioidlike endorphins, feel-good chemicals that
relieve pain and generate feelings of wellbeing, potentially leading to dependency.
A 2006 study used naltrexone, a drug
that blocks the endorphins produced in the
skin while tanning, to induce symptoms
of withdrawal in frequent tanners. In this
study, 50 percent of frequent tanners given
naltrexone before UVR exposure exhibited
withdrawal symptoms, including nausea
and jitteriness. These symptoms were not
observed in any of the infrequent tanners
given naltrexone in the study.7
Diagnostic and Statistical Manual of
Mental Disorders, Fourth Edition (a.k.a.
the DSM-IV) defines substance dependency
as having three or more of the following
use-related symptoms over a 12-month
period: tolerance, withdrawal, difficulty
controlling use, negative consequences,
significant time or emotional energy spent,
putting off or neglecting other activities,
and desire to cut down.11
The CAGE questionnaire is a clinical
tool used to diagnose substance-related
disorders. A version of it modified to
measure tanning addiction includes four
questions: Have you ever felt you needed
to Cut down on your tanning? Have people
Annoyed you by criticizing your tanning?
Have you ever felt Guilty about tanning?
Have you ever felt you needed to tan first
thing in the morning (Eye-opener)?
Many recent studies show that a number
of frequent tanners score positive on the
Some of the reported benefits of frequent
tanning — mood enhancement and relaxation —
are also consistent with addiction.
Another study found that frequent
tanners were able to distinguish between
otherwise identical UV and non-UV lightemitting tanning beds.8 Tanners in this
study showed an overwhelming preference
(95 percent) to tan in the UV light-emitting
bed. Participants suggested that UV
tanning created a more relaxed mood
and even relieved pain, possibly due to
endorphin release.9
Psychological dependence refers to the
effect of a substance on the brain’s reward
system and its memory of rewards. The
production of sensations of pleasure or
well-being encourages repeated use.6 Many
frequent tanners report relaxation and
mood-enhancing effects as their motivation for tanning, suggesting psychological
dependence.
Also supporting this idea of psychological dependence is a recent study in which
21 percent of 14–17-year-old indoor tanners
reported difficulty quitting. Quitting was
most difficult for those who started tanning at age 13 or younger,10 and those who
tanned more frequently.
The CAGE Questionnaire
The American Psychiatric Association’s
CAGE, meeting criteria for a UV light
substance-related disorder.12 In one survey,
18 percent of undergraduate students in
Washington State who acknowledged
purposely tanning their skin scored
positive on the CAGE.5 These students
also demonstrated difficulty in controlling
use — they admitted continuing high-risk
tanning behavior despite adverse personal
experiences, such as blistering sunburns
or a family history of skin cancer.
A survey of beachgoers in Texas
found that 26 percent of sunbathers met
tanning-modified CAGE criteria and 53
percent met a tanning-modified DSM-IVTR (Text Revision) diagnosis for a UV light
tanning dependency.13
What We Can Do
Indoor tanning is also associated with
other behavioral health risk factors, such
as smoking, alcohol, recreational drug use,
and eating disorders.14 All these findings
warn us that frequent tanning can lead
to unhealthy dependence or addiction in
some individuals.
Preventing an addiction is far better
than trying to treat one. Early primary
prevention should include public education
targeting young children, adolescents, their
parents and caregivers. Preventive behaviors learned early in life will more typically
be practiced later in adulthood.15 Seatbelt
use in automobiles is a good example of this.
Since tanning in childhood and adolescence is linked to more difficulty in quitting,
banning indoor tanning in children may
help prevent the habit from developing.
Thirty-one states currently have some
form of legislation in place.16
We can also learn from those who have
studied addictive behaviors and their treatment. Human behaviorists have developed
the Stages of Change model, where the stage
of addiction is first identified in order to
find an intervention that will be most effective.17 As patients are then treated for their
addiction, they go through different stages
of change, from Precontemplation (not yet
acknowledging their behavior problem)
to Maintenance (maintaining positive
behavioral changes). Future research on
behavior change models will help us better
target optimal interventions.
In the meantime, simple measures
can be effective. For those who seek the
golden look, self-tanning creams and
sprays, which use non-UV chemicals to
tint the skin, have never been associated
with increased skin cancer risk. For an
endorphin boost (which self-tanners do not
supply), exercise could be a competing —
and healthy — coping response. Finally,
tanners should avoid high-risk relapse situations, such as tanning environments and
associating with other tanners. Of course, it
always helps to solicit support from family
and friends.
DR. HORNUNG works as a pediatric dermatologist at The Everett Clinic, a large, nationally
recognized multispecialty clinic in Washington. Previously, she spent nine years as Chief
of Pediatric Dermatology at Seattle Children’s
Hospital and the University of Washington,
where she conducted much of her research in
skin cancer prevention and indoor tanning
issues. She is Board-certified in Dermatology,
Pediatric Dermatology, and General Preventive
Medicine and Public Health.
Solmaz Poorsat t ar is a medical researcher
with a special interest in the primary prevention
of skin cancer and high-risk tanning behavior,
and a doctoral candidate at the University of
California - San Francisco School of Medicine.
29
BEAUTY
Appearance Trumps Health
As an Anti-Tanning Argument
Joel Hillhouse, PhD
30
to improve their appearance, then credible
information on how tanning harms the
appearance should dissuade many from
the habit. So our workbooks also draw
attention to tanning’s unattractive effects
on the skin (fine lines, wrinkles, sagging,
and brown spots, for instance), with
images of people with weathered faces.
Additionally, the workbook contains
several humorous images to aid memory
retention, including close-ups of tortoise
skin, a baby’s bottom, and a burned chicken.
However, our research shows that focusing
on the benefits of avoiding UV tanning is
more effective than heavy reliance on
scare tactics.
Of course, young people still want to
look good. If they feel they do not have
better options, many will convince themselves, or be convinced by the tanning
industry, to return to UV tanning. For
this reason, our approach also teaches
young people about alternative means to
look good, such as exercise; healthy weight
control; wearing stylish clothes that don’t
require a tan (such as long-sleeved shirts
and long pants); and, for those who still
desire the tanned look, sunless tanning.
This approach has proven consistently
effective in several studies, reducing tanning behaviors and intentions by 33-50
percent in college-aged female indoor
tanners.1,2 [See Figure 1.] This corresponds
with a growing body of research on the
effectiveness of appearance-based tanning
interventions.3-6
After 15 years of research, we’ve found
an approach that seems highly effective
for young tanners. In the future, we hope
to discover whether these methods can be
widely disseminated through communication channels popular with youth, such as
the internet, cell phones, and texting.
Mean Number of Visits to
Indoor Tanning Salons over
a Three-Month Period
“I know I’ll probably get skin cancer from
tanning, but that will be when I’m old, like
in my forties.”
Those words, from a student of mine,
changed how I looked at skin cancer prevention in young people. Both my personal
focus and professional training had always
emphasized the value and importance of
health. If you know something is unnecessarily harming your health, and you know
ways to prevent it, you’d change what you
were doing, right? That student taught me
that not everyone values health the same
way I do. She also gave me insight into
why traditional educational efforts, with
their focus on long-term health issues, were
having little impact on young people’s risky
sun habits and tanning behavior, especially
indoor UVR (ultraviolet radiation) tanning.
Since that day more than 10 years ago,
my colleagues and I have pursued a skin
cancer prevention strategy focusing on
appearance, which our empirical research
demonstrates is a key factor in young
people’s decision to tan indoors.
In our tanning interventions, we provide
college-aged, female UVR tanners (71 percent of tanning salon patrons are girls and
women aged 16-29) with a workbook that
resembles a women’s fashion magazine. It
depicts attractive, untanned models, as well
as images of bronzed television stars who
have publicly stated that they use non-UVR
tanning products (“sunless tanning”) and
wear sunscreens with an SPF of 30+. We
theorized that if young people tan primarily
Our experience persuading young
people to reduce and even quit tanning has
taught us a number of important lessons:
• Know your audience. What do
they value and what is important in
their daily lives?
• Respect your audience. If they
don’t value health in the same
way you do, they aren’t necessarily
unintelligent or uneducated. You
cannot reach an audience you talk
down to.
• Persuade your audience.
Provide credible information on the
short-term, appearance-damaging
effects of exposure, and discuss
healthy, non-tanning alternatives to
improve appearance. This may help
young people rethink their tanning
decisions.
Pre
Post
10
8
6
4
2
0
Treatment Group Control Group
Figure 1. Indoor tanning visits before and after
(“pre” and “post”) appearance-focused intervention
DR. HILLHOUSE is Professor of Public Health,
East Tennessee State University, Johnson City
References available on p.96..
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lifeStYle
team SCf: athleteS
againSt Skin CanCer / 32
a tenniS PlaYer’S exPerienCe / 38
from BarDot to BeCkham: the
DeCline of CeleBritY tanning / 42
SUn SafetY at SChool / 46
UnDer the SUn, eVerYthing
YoU wear matterS / 48
as long as implicit messages about sun protection run counter to medical
facts and public health messages, we will be fighting an uphill battle
against skin cancer. – from BarDot to BeCkham: the DeCline of CeleBritY tanning (p. 44)
TEAM
SCF
Athletes Against Skin Cancer
What do World Professional Surfers including Mick Fanning and Damien Hobgood,
soccer superstars Christie Rampone and
Lindsay Tarpley, snowboarder Shayne
Pospisil, record-setting angler Preston Clark,
and PGA Tour golfer Brian Davis have
in common? They’re not just renowned
athletes, but people committed to protecting
themselves from skin cancer, the world’s
most common cancer. And they’ve joined
Team SCF, a group of dedicated sports
professionals, to talk about their sun
protection habits.
Playing the sport you love in the fresh
air, for up to twelve hours a day, seven
days a week — what’s not to love? While
these athletes are devoted to their work,
they often face one very unappealing job
hazard: the high risk of skin cancer.
32
People who spend a lot of time outdoors are particularly vulnerable to the
cumulative damage caused by the sun’s
harmful ultraviolet (UV) radiation. Almost
90 percent of nonmelanoma skin cancers
(NMSC) like basal and squamous cell
carcinoma, the two most common skin
cancers, are associated with exposure to
UV radiation. Recent research also shows
that the vast majority of mutations (gene
changes or errors due to radiation, viruses,
and other causes) found in melanoma, the
deadliest form of skin cancer, are caused
by UV radiation.
BeComing ProS at SUn SafetY
The world’s #1 surfer, Mick Fanning,
grew up with good sun protection habits.
Today the two-time and current Association of Surfing Professionals (ASP) World
Champion still wears a high-SPF sunscreen
and a shirt or long-sleeved rash guard
(an athletic shirt made of material such
as spandex or nylon) when surfing. And
while he’s chasing waves seven days a week,
the Australian is careful. “I avoid surfing
in the middle of the day, when the sun is
most intense, and every time I get out of
the water, I reapply sunscreen.”
While Australians tend to be welleducated about sun protection (Australia
has the highest melanoma rates in the
world, and most citizens are familiar
with one or more skin cancer awareness
campaigns), many Europeans are not so
lucky. UK native Brian Davis has already
been treated for two basal cell carcinomas
(BCC) and a squamous cell carcinoma
(SCC), even though he’s only in his thirties.
The first European to win the PGA Tour
From left: Preston
Clark, Christie Rampone,
Brian Davis, Shayne
Pospisil, Lindsay Tarpley,
Mick Fanning, Damien
Hobgood
Qualifying Tournament, in 2004, the golfer
“never heard anything about skin cancer in
the UK. We just didn’t wear sun protection.”
But when Davis and his family settled in
Florida five years ago, they began hearing a
lot more about the damage the sun can do.
So when his wife noticed a discolored spot
six months, or sooner if he notices changes
to an existing spot.
New Jersey resident and two-time
Olympic Gold medalist in soccer Christie
Rampone has also discovered that you
don’t need to live in a sunny climate to
sustain sunburn and sun damage. “The
While these athletes are devoted to their
work, they often face one very unappealing job
hazard: the high risk of skin cancer.
on his neck, Davis went to a dermatologist,
who confirmed that the spot was a basal
cell carcinoma. He’s since been treated for
another BCC and an SCC on his nose. Today,
Davis is a pro at skin self-exams as well as
golf, and he sees his dermatologist every
worst days aren’t the ones that are that
hot and sunny. It’s the overcast days [up
to 80 percent of the sun’s UV radiation can
penetrate clouds] when you’re not thinking
about the sun — then you really get burned.”
The soccer wonder woman (captain of
the US Women’s National Team and the
2009 Women’s Professional Soccer’s Hint
Water Sportswoman of the Year, among
other titles) is especially careful, since both
her mother and grandfather have been
treated for skin cancer. “I apply sunscreen
about an hour before practice, and I get
one with as high an SPF as I can find — at
least a 35, usually a 50.” She also applies
an eye cream with SPF around her eyes;
she’s found that this skin is often neglected.
Rampone’s US Women’s National teammate and fellow Olympic gold medalist
Lindsay Tarpley makes sun protection
as easy as she can for herself. When the
St. Louis Athletica forward isn’t on the
field, “I try to stay out of the sun!” But
Tarpley, dubbed girls’ soccer ESPN RISE
high school player of the decade in 2009,
spends a lot of time outdoors training and
33
LIFESTYLE
playing, and consequently has developed a
comprehensive protection routine: “Every
time I shower or wash my face, I apply a
moisturizer with an SPF (usually a 30+).
Then, about half an hour before I get on the
field, I apply sunscreen.” Tarpley prefers a
spray sunscreen for the face, which she puts
on her hands and then applies. “I spray a lot
on my hands,” she explained. For the body,
she uses a lotion-based sunscreen. (The Skin
Cancer Foundation recommends using one
ounce, or two tablespoons, of sunscreen for
skin cancer. “Two close family members
[including Tarpley’s mother, who has had
basal cell carcinoma] have been treated
for skin cancer in the past few years,” she
explained. “This really made it hit home
for me. I’m pretty passionate.”
Winter Weather Advisory:
Protect Your Skin
Most of the athletes we spoke to compete in
hot weather, but sun protection is equally
important in the winter. Snowboarder
Sunscreen is a part of my equipment, my routine,
and who I am and what I do. If it allows me to play
golf, it’s good. — Brian Davis
the entire body, including a nickel-sized
dollop on the face, and reapplying every
two hours, or immediately after swimming
or sweating heavily.)
Recently, Tarpley’s started wearing
hats in addition to the sunglasses she slips
on “pretty much every time I go out.” She
also regularly performs skin self-exams
and sees a dermatologist for an annual
full-body skin exam. Her dedication stems,
in part, from personal experience with
34
Shayne Pospisil, whose recent wins include
the 2009 Oakley Arctic Challenge and Red
Bull Snowscrapers, is well aware of the
risks the snow poses. “The sun’s reflection off the snow increases exposure,” he
pointed out. Thanks to the glare, up to
80 percent of UV rays hit the skin twice.
And for every 1,000 feet of elevation, UV
exposure increases 8-10 percent. “I’m up
on Mount Hood in Oregon a lot,” Pospisil
said. “That’s over eleven thousand feet
above sea level.”
In addition to the cold- and wet-weather
gear that covers his torso and limbs, “I
wear a mask that protects my whole face,”
Pospisil explained. He’s rarely without a
cap that covers his scalp and ears, and
wears sunscreen on all exposed areas. He’s
particularly careful to apply a white zinc
oxide product to the lips. When the face
mask is not in use, Pospisil wears oversized
snow goggles or sunglasses.
The Accessory Advantage
Bass fishing may sound like a recipe for
relaxation, but it’s a demanding sport. “You
spend ten to twelve hours a day standing up,
with no ‘time outs’ for weather,” explained
angler Preston Clark, best known for his
record-breaking 11 pound, 10 ounce catch
in the 2006 Bassmaster Classic. “It takes a
toll on your body.”
The Florida-based Clark knows what
he’s talking about. When he was in his
mid-thirties, Clark’s long-unprotected skin
began showing signs of sun damage. “My
ears were always peeling, bleeding, and
cracking,” he said. “They’d never heal. My
nose and lips were in bad shape, too.” But
since impulse-buying a French foreign legion hat (a visored hat with flaps that cover
the ears and neck) a few years ago, Clark’s
never looked back. “Not only do I wear a
sunscreen with an SPF of 50 every time I go
out, I also wear UV-blocking sunglasses and
shirts, usually long-sleeved, with a high
UPF.” (UPF, or Ultraviolet Protection Factor,
measures clothing’s ability to screen out
UV light; a shirt with a UPF of 30 would
let just 1/30th of the sun’s UV radiation
penetrate the fabric. The Skin Cancer
Foundation recommends clothing with a
UPF of 30+.) It’s working, and Clark’s ears
have healed, too.
The importance of sun-protective
clothing and accessories can’t be overemphasized. Damien Hobgood has picked up
surfing trophies all over the world, winning
WORLD PROFESSIONAL SURFERS
Members of Team SCF
Michel Bourez
Taj Burrow
Ben Dunn
Bede Durbridge
Mick Fanning
CJ Hobgood
Damien Hobgood
Phil MacDonald
Jake Pato
Tiago Pires (above)
Luke Stedman
David Weare
Gony Zubizarreta
tournaments from Brazil to Fiji. He has
already had several suspicious lesions
removed from his face and back, despite
of the fact that he’s always been careful
about applying sunscreen. Hobgood usually
wears a rash guard, or, in colder waters,
a wetsuit (a long-sleeved synthetic rubber
suit that provides UV protection from the
shoulders and trunk on down). Hobgood’s
even donned a hooded wetsuit with a bill,
like a baseball cap. This not only protects
the vulnerable scalp, but offers a bit of
shade to the upper face.
No Excuses
Some athletes, professional and amateur
alike, have expressed concern that sunscreens, hats, sunglasses, and protective
clothing might not feel comfortable and end
up impeding their game. Davis admitted
he originally had doubts: “The first time I
wore [UV-blocking] sunglasses, I thought, ‘I
can’t play with these on!’ But I got used to it
— now I compete with them on.” Sunscreen
on his hands doesn’t interfere with his grip,
either. “I wipe my hands down before every
shot, anyway,” he said.
Sunscreen running into the eyes is a
perennial concern (and an occasional excuse for not wearing any), but the pros have
ways of dealing with this: Fanning and
Tarpley are careful to allow enough time for
the sunscreen to be absorbed into the skin
(at least 30 minutes) before practice, while
Tiago Pires, Portugal’s first ASP World Tour
surfer, uses a non-greasy, water-resistant
stick sunscreen in the eye area. Clark likes
sunscreens with a zinc oxide base, which he
finds tend not to run, and Rampone applies
Vaseline to her eyebrows, since she’s found
that it keeps the sunscreen on her forehead
from migrating into her eyes.
Davis said, “Sunscreen is a part of my
equipment, my routine, and who I am and
what I do. If it allows me to play golf, it’s
good.” Fanning summed it up: “There’s
always a way to protect yourself. You’ve
got to take those extra couple of minutes
to get ready.”
The Next Generation
Although kids are notorious for not wanting
to wear sunscreen or protective clothing,
the professionals are up to the challenge.
Christie Rampone’s young daughter “is
always in hats. She likes stick sunscreen,
since she can put it on herself. Then I get
any spots she’s missed, and apply a spray.”
But Davis may have found the most
effective method to keep his two boys
sun-safe. “They cannot go outside if they’re
not wearing sunscreen, so we don’t have
a problem getting it on them!”
35
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The World Professional Surfers is proud to
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LIFESTYLE
A Tennis Player’s Experience
WILLIAM STEBBINS, MD, AND C. WILLIAM HANKE, MD, MPH
William Stebbins, MD, and C. William Hanke, MD, MPH, spoke
to Jennifer Reinbold, a former pro tennis player who coaches in
Indianapolis. Jennifer competed in nine grand slam tournaments,
reaching the Wimbledon quarterfinals in 1983 before losing to the
eventual winner, Martina Navratilova. After years of sun exposure,
and some experience with skin cancer, Jennifer practices what
she preaches: Respect the sun!
Q: What was your experience with sun exposure as a young
tennis player?
A: I grew up in South Africa, two hours north of Johannesburg. I
started tennis at eight, to spend more time with my older brother
and his friends. We played outdoors year-round — there were no
indoor facilities then. I had very light skin, so I was susceptible
to sun damage. But little information was available about the
long-term dangers of sun exposure.
When I was a young child, my mother was vigilant about my
sun exposure because she didn’t want me to get wrinkles. She
38
was a pretty advanced thinker! She always had me wear a hat
and sunscreen, which really stung when it got in my eyes. But
I remember several blistering sunburns during summer beach
vacations. While competing, I wore sunscreen on my face, but
not always on my body — I was concerned that sunblock might
trickle onto my hands, interfering with my grip. And in higher
competition, I often skipped wearing a hat because I thought it
might be a distraction.
Q: When did you start becoming aware of the harmful
effects of the sun?
A:When I was a teenager on tour in England, my father had a
melanoma, the most dangerous skin cancer, removed from his
forearm. My parents didn’t like to give me bad news when I was
away, so they told me about it only after the fact. Fortunately,
the surgery was successful.
Q: How have you altered your sun protection behavior?
A:After retiring from the tour, I married and began teaching
tennis in the Indianapolis area. In summers, I was often on
courts eight hours straight. By then, I usually wore long-sleeved
shirts; a bandana around my neck; and a wide-brimmed hat,
along with sunscreen. But the effects of sun damage I sustained
over the years started to appear. I’ve had several skin precancers
removed at every visit to the dermatologist, which is at least
twice a year. I had a basal cell carcinoma, the most common skin
cancer, removed from my neck, and a squamous cell carcinoma,
another common skin cancer, removed from my forearm. Once
a person gets one skin cancer, they face about a 50 percent risk
of developing another within five years.
Q: How do you reduce your risk of getting further cancers?
A:First, I do a careful head-to-toe skin check once a month. If
I notice anything abnormal, I see my dermatologist. (This is in
addition to my regular twice-yearly appointments). Also, I always
use protective clothing and sunscreen, and avoid playing and
teaching outdoors in the middle of the day, when UV exposure
is most intense.
Q: Do you think the message about sun protection is getting
through?
A:There is more sun awareness today. Most players I teach or
play with wear sunscreen and have a hat in their tennis bags.
However, they don’t usually reapply sunscreen when playing
for extended periods. Also, just because they have a hat or visor
doesn’t mean they use it! Many players don’t realize their scalps
are as vulnerable as the rest of their bodies.
Q: What information have you passed along to your children?
A:When my sons Derek and Graham were babies, I bought special
UV-protective clothing for them to use at the beach. Now, one son
carefully protects himself, wearing a hat and sunscreen when
playing tennis outdoors, and a long-sleeved SPF 50 swimshirt
when he swims. My other son is more resistant, and likes to
tan. I have tried to educate him, providing sunscreen, hats, and
protective clothing; the rest will be up to him! I know other
teenage tennis players with his attitude — they know the dangers
of sun exposure, but still like the look of a tan, and like most
teenagers, believe they are invincible.
Q: Any last words of advice for tennis players?
A:Don’t forget to protect yourself. And keep your eye on the ball!
DR. STEBBINS is currently a Mohs micrographic surgery and procedural dermatology fellow under the direction of Dr. C. William Hanke
at the Laser & Skin Surgery Center of Indiana and St. Vincent Hospital,
Indianapolis, Indiana.
DR. HANKE is the Director of the Laser & Skin Surgery Center of Indiana
in Carmel, IN, and Senior Vice President of The Skin Cancer Foundation. He was the first physician in the United States to earn triple full
professorships in Dermatology, Otolaryngology Head and Neck Surgery,
and Pathology and Laboratory Medicine. He is past President of the
American Academy of Dermatology, and has served as President of
five surgical specialty societies: the American Society for Dermatologic
Surgery, American College of Mohs Micrographic Surgery and Cutaneous Oncology, the International Society of Cosmetic Laser Surgeons,
International Society for Dermatologic Surgery, and the Association
of Academic Dermatologic Surgeons. He has written more than 350
publications including 91 book chapters and 20 books.
Figure 1: Jennifer (age 3) at a beach in South Africa with her older brother,
Trevor Mundel, now Global Head of Research and Development at Novartis
Pharmaceuticals.
Figure 2: Jennifer (seen at age 22) played on the women’s professional tennis
tour for eight years.
Figure 3: (L to R) Jennifer with PA Nilhagen, renowned coach and Director of
Tennis at 5 Seasons Sports Club in Indianapolis, along with her son Derek, 17,
a member of the 2009 Indiana State High School Championship Tennis Team.
39
sun protection – a way of living™
SkinCancer.org
LIFESTYLE
From
BARDOT to
BECKHAM
The Decline of
Celebrity Tanning
1960
1970
nIna g. JaBLonSkI, Phd
T
he 1960s gave us many things — like The Beatles, birth control pills,
and photos of Brigitte Bardot on the beach. The iconic French film star
epitomized the freedom of the era by flouting traditions of modesty and
sun avoidance. Photos of Bardot circulated widely, and “le topless” became an
institution on French beaches. Her suntan itself became a statement. It was
the seamless tan of a woman of leisure, and it announced that she controlled
her own body, and wasn’t confined by the social norms of past eras. At the
time, people who protested were not considered prudent, just prudes, and in
the 1960s that was as good as being dead.
42
1980
1990
2000
2010
1) Brigitte Bardot 2) George Hamilton 3) The popularity of Sid the Seagull, the icon
of the original “Slip! Slop! Slap!” campaign in Australia, led to the rapid adoption
of sun protection and sun avoidance behaviors in Australia during the 1980s and
1990s. The campaign name was officially changed to “SunSmart” in 1988, and
the slogan has been extended to “Slip! Slop! Slap! Seek! Slide! Protect yourself
in five ways from skin cancer.” Illustration: Pauls Sloss; based on character by
Alex Stitt. Provided courtesy of The Cancer Council of Victoria. 4) Nicole Kidman
5) Victoria Beckham
Bardot’s look was youthful and sexy, and inspired thousands
to follow her example. Before long, magazines and movies were
filled with tanned celebrities of both sexes, including men like
George Hamilton, whose year-round tan became synonymous
with a life of leisure and privilege, along with sex appeal. Through
the 1980s, tanning was de rigueur, and the tanned look came to
denote both the good life and good health. Pallor was for corpses.
The sun-tanning phenomenon of the mid-20th century, and the
many kinds of tanning available today, are not anomalous fads.
They were instigated and are maintained by celebrities, whose
images are widely propagated by the media. Celebrities command
our attention and induce imitation. After all, we as a species are
highly imitative: As infants we observe and imitate our mothers,
and we imitate others throughout childhood. Imitation teaches us
to survive; it also helps insure that positive behaviors are directed
toward us. As teenagers, we increasingly imitate people outside
of our families, creating and cementing connections within peer
groups. As teenagers and adults, we imitate to gain and maintain
higher social status, an effect that is more pronounced in women
than in men.1
The celebrity-inspired rise of sun-tanning behaviors from
the 1960s through 1980s had two major consequences. The first
and most important was the increased incidence of melanoma
and nonmelanoma skin cancers.2-4 This trend became a matter
of public concern first in Australia, which has the highest skin
cancer incidence and mortality rates in the world.5 The prevalence
and high costs of skin cancer in Australia spawned the first
widespread public health campaigns — including the current
“SunSmart” program — aimed at promoting sun protection and
sun avoidance.6 This campaign notably didn’t invoke celebrity
43
LIFESTYLE
promotion, but was propelled by the memorable cartoon f gure
of “Sid the Seagull,” whose actions were widely imitated, even if
his appearance was not (Figure 3).
The second consequence of the post-60s tanning craze was
the rise of technologies for customized, on-demand tanning. This
began with development and widespread marketing of ultraviolet (UV) radiation-emitting tanning lamps, beds, booths, and
facilities — often glamorized by the name “salons” — where
Whether from booth, bottle,
or spray, on-demand tanning
established and maintained
popularity thanks to
celebrity adoption and highly
effective marketing.
these devices could be used. Then followed the development of
non-UV artif cial tanning agents (“self-tanners”), which could
simulate the tanned look for people who were unable to tan
or who for the sake of safety or convenience, preferred to tan
without exposure to UVR. Whether from booth, bottle, or spray,
on-demand tanning established and maintained popularity thanks
to celebrity adoption and highly effective marketing. The so-called
“healthy glow” — achieved by UV exposure, spray-on tanning, or
cosmetics — became and still is big business.
The appeal of the tanned look comes not only from its association with glamour and sex appeal, but from the physiological
reinforcement of UV-based tanning behavior.7 Researchers have
found that UVR exposure releases mood-lifting hormones called
endorphins that can literally create a dependency known as
“tanning addiction,” stimulating tanners to seek more UVR
exposure. [For more on tanning’s addictive qualities, see p.28.]
This dangerous combination of addiction and so-called glamour
means that many people at greatest risk of skin cancer remain
highly motivated to tan,8 even when they know the dangers.
Today, highly imitated female celebrities such as Britney Spears
and Paris Hilton famously mix and match real and fake tanning,
giving much impetus to booth-and-bottle, look-good-feel-good
promotions at tanning establishments.
THE BRONZE AGE EBBS
However, more female celebrities today are proudly pale, including
some — like Victoria Beckham and Nicole Kidman — who have
explicitly abandoned the bronzed look in favor of their natural
color. Their renunciation of even the spray-on fake tan, as they opt
instead to “go with their own glow,” is signif cant because they are
taking the glamour and prestige out of the tanned look. Female
celebrities increasingly appear to realize that their looks and
behavior have immediate ramif cations on hundreds of thousands
of young women. More celebrities need to understand that their
every word and action can inf uence the behavior of devoted
followers, many of whom are slavishly imitative young women
whose skin is highly vulnerable to potentially carcinogenic sun
exposure. Australian model Elle Macpherson’s recent declaration,
“I tan safely,” was strongly criticized by dermatologists,9 but was
taken as encouragement by many people seeking reinforcement for
their unsafe, outdated approach to sun exposure. When a behavior
is as popular and consistently reinforced as tanning, celebrities
don’t have to engage in egregiously “SunStupid” behaviors to negate
hard-won gains in sun safety.
We have not yet reached the “End of the Bronze Age.”10 Although
models and celebrities with susceptible, pale-skinned and lighteyed phenotypes are less likely to be portrayed with dark tans
today than they were two or three decades ago,11 continuing
promotion of the tanned look is worrisome and dangerous. As
long as implicit messages about sun protection run counter to
medical facts and public health messages, we will be f ghting an
uphill battle against skin cancer.
DR. JABLONSKI is a biological anthropologist who conducts studies
on the evolution of humans and their primate relatives using fossil and
other evidence. Her greatest interest is in reconstructing parts of human
evolution that don’t have a fossil record, like skin. She is the author of
Skin: A Natural History (University of California Press, 2006), and is
Professor and Head of the Department of Anthropology at Penn State,
University Park.
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imag
GO WITH YOUR OWN GLOWTM
I n 2 0 0 8, The S k i n C a nc e r Foundation launched its Go With
Your Own GlowTM campaign to inform the public — including the
more than 30 million Americans who use tanning salons every
year — that tanning is no longer in fashion: Loving your own
natural shade is what’s in. Thanks to the $3.7 million in ad
space donated by magazines including TIME, PEOPLE, O: The
Oprah Magazine, SHAPE, and Food & Wine, our public service
announcements have reached more than 280 million readers
to date.
The print campaign, created pro bono by advertising agency
Laughlin Constable, originally featured three full-color PSA ads;
we now have seven. The ads address the reader directly, with
44
a chatty exhortation to Go With Your
Own GlowTM — that is, to cultivate
your skin’s natural beauty and, most
importantly, avoid tanning. You
can see all the places where Go
With Your Own GlowTM has been
featured at www.skincancer.
org/go-with-your-own-glow-inmagazines.html.
© 201
0 The
Skin
Cancer
Founda
tion
Campaig
n crea
ted by
Laughli
n Con
stable,
ww
ine w
w.laugh
lin.com
ThIS SkIn cancEr FoundaTIon PuBLIc SErvIcE advErTISEMEnT IS avaILaBLE For MEdIa uSagE.
For MorE InForMaTIon, PLEaSE conTacT: JaMIE SYLvES, (212) 725-5176 ExT. 120 [email protected]
raisin is a grape that didn’t have the sense to get out of the sun. And think
about it, if the giant orb in the sky can do that to a little piece of fruit,
imagine what it’s doing to your precious skin. Layers one to seven do not like being
basted, toasted, roasted, fried, and all other manner of scorched. And how does your
skin show it? Hello wrinkles. Hello crow’s feet. Hello blotches and
burns and who-knows-what-all-else. Not to be prejudiced, but
on the pecking order of brains, we humbly submit that human
beings should have more sense than dumb grapes.
Don’t you agree? Nothing looks better on you
than the healthy, glowing, radiant shine
you were born with. Because
today, being healthy –
truly healthy – is
what’s sexy.
LIFESTYLE
Sun Safety
at School
Janice Clark Young, EdD, CHES, and Brenda S. Goodwin, MS
T
he risk of skin cancer begins with
a child’s first exposure to sunlight.
The sun’s ultraviolet (UV) radiation damages the skin, eyes, and
immune system,1 and the effects
are cumulative. Although light-skinned
people are the most susceptible to skin
cancer, everyone is vulnerable and should
be vigilant about sun safety.
Sun protection should begin at birth,
since establishing healthy routines in
childhood can foster positive lifelong
preventive habits.2 Sun safety is especially
important for young people because multiple sunburns (in fact, just one blistering
sunburn) during childhood and adolescence
more than double the risk of melanoma in
the future.3
For Students
The World Health Organization (WHO)
notes, “UV radiation exposure during the
school years contributes significantly to
total lifetime sun exposure.”1 During a
child’s typical weekday, six to nine hours
are spent at school. Sunlight is most intense
between 10 AM and 4 PM, when students
are often outdoors for recess and other
46
school or after-school activities. Many
school grounds lack the adequately shaded
areas needed to limit UV exposure.
Shade can be provided by solid roof
structures, gazebos, awnings, shade
cloth, and natural shade, such as thickly
leaved trees.4 However, these partial shade
of priority),” an article in Health Education
Research advises.5 Teachers, coaches, and
staff should model sun protection behaviors
during outdoor activities. Rescheduling
these activities to avoid midday exposure
is also especially important, since some
schools prohibit wearing caps, hats, and
Sun safety is especially important for
young people because multiple sunburns
(in fact, just one blistering sunburn) during
childhood and adolescence more than
double the risk of melanoma in the future.
methods still allow some UV exposure
(even on gray days, since UV rays pass
through clouds, rain, and fog), so more
sun protection strategies are needed.
Children must be instructed to “protect
themselves when outdoors by using shade,
clothing, hats and sunscreen (in that order
sunglasses on school property due to the
association with gang activities and/or
drug use.6
For Schools
Professional development for school
staff should address sun safety policies,
PROMOTING SUN SAFETY AT SCHOOL8
Parents
• Apply sunscreen to children’s exposed skin before school, and
provide sunscreen for reapplication later in the day.
• Provide sunscreen for outdoor school field trips.
• Remind children to be sun-safe when outdoors.
• Work with the principals, teachers, PTA, and school board to
support district-wide sun protection policies.
Teachers and School Personnel
•
•
•
•
Integrate sun safety lessons into appropriate academic areas.
Be a “sun-safe” role model for students.
Remind students to practice sun protection behaviors.
Educate parents and community members about sun protection behaviors.
Principals
• Promote sun safety to students, school personnel, and community members.
• Work with parents and community members to develop a sun
safety policy and curricula for students and staff.
School Superintendents and Board Members
• Approve sun safety in-service training for teachers and staff, and
classroom sun safety education for students.
• Implement a district-wide sun safety policy.
• Provide outdoor shade for playgrounds and athletic areas.
Community Health Care Providers
• Regularly discuss sun safety with young patients and parents.
• Begin sun safety education at birth before mother and baby leave
the hospital. (Infants should not be exposed to the sun in their
first six months.)
• Educate teachers, staff, administrators, and school board
members about sun safety.
• Help develop sun safety policies in school districts.
practices, and teaching strategies.1 Teachers can take advantage
of the many free, age-appropriate sun protection curricula or
lessons. K-8 classroom materials are available through the SunWise
School Program (www.epa.gov/sunwise), as are lessons from the
Sun Safety Activity Guide (www.nsc.org). For grades K-12, the
Melanoma Foundation (www.melanomafoundation.com) offers
SunSmart America, and the Shade Foundation (www.shadefoundation.org) provides the Sun Safe School Guide. The Skin Cancer
Foundation also has free materials for teachers and students in
grades 5-8 at www.SkinCancer.org/school.
Many US school districts lack written sun safety policies. This
plus misunderstanding and lack of knowledge of UV radiation risks
contributes to children’s poor sun protection practices.7 Certain
existing policies define sunscreen as “medicine,” require parental/
medical permission for its application, or prohibit teachers/aides
from applying it to children.6 A revised sun protection policy
might recommend that parents 1) include sunscreen in students’
supply kits; and 2) sign permission slips allowing their children
to apply sunscreen before going outside. Permission slips would
be kept in the students’ permanent school health records.6
Suggestions for creating a policy, as well as a sample policy,
are available at www.sunsafetyforkids.org/schoolpolicy/.
From top: Shade structures covering
playground equipment; shade trees
at school.
For Communities
Community members, businesses, and organizations can assist
in sun protection efforts by 1) serving on school sun safety
committees; 2) donating money to buy trees/shrubs and shade
structures; 3) planting trees or installing shade structures on
school grounds; and 4) making sunscreen available for school/
recreation use. Additionally, in some states, grassroots advocacy
is needed to pass laws allowing the legal distribution of sunscreen
and the use of hats in schools and community recreation programs.
It behooves all adults to become positive role models who
practice and promote sun protection behaviors.2 School personnel
and parents can be instrumental in establishing these lifelong
healthy behaviors.
For more information, go to www.cdc.gov/cancer/skin/pdf/
sunsafety_v0908.pdf
Dr . Yo u n g is an Associate Professor in the Department of Health and
Exercise Sciences at Truman State University, Kirksville, MO.
Br e n da G o o dw in is an Instructor in the Department of Health, Physical Education and Recreation at Missouri State University, Springfield, MO.
47
LIFESTYLE
Under the Sun, Everything
You Wear Matters
SUSAN Y. CHON, MD, FAAD
W
hat’s the best way to protect your skin from sun
damage? Dermatologists tell patients to avoid the sun
or seek the shade during the most intense part of the
day (between 10 AM and 4 PM), and to consistently
apply broad spectrum sunscreens with an SPF of 15
or higher. “Broad-spectrum” means that the sunscreen provides
some protection against both UVA and UVB rays, while SPFs refer
specifically to UVB protection. SPF 15 sunscreens filter out 93
percent of the sun’s UVB radiation; SPF 30s filter out 97 percent.
Both shade-seeking and sunscreen should be key elements in
anyone’s sun safety program. However, studies have shown that
clothing is the single most important factor in daily sun protection.
Unfortunately, not all clothing is created equal. Have you talked
with your dermatologist about what to wear? What’s the best
way to dress to protect your skin from sun damage?
Our clothing choices have a huge impact on our cumulative
sun exposure. Basal and squamous cell carcinoma, the two most
common types of skin cancers, account for more than one million
cases a year in the US alone and up to 96 percent of all skin
cancers.1 The primary cause of these two skin cancers is UV
radiation from the sun.2 So what we wear each day really counts.
Sun-Safe Women’s Wear
You may already own some clothing that provides betterthan-average sun protection. In general, tightly knit, dark- or
bright-colored clothes block more UV radiation, as opposed to
whites and pale pastels. For women, some current fashion trends
feature “drapey” looks that offer more coverage. For instance,
long shirts or blouses, also known as tunics, have been in vogue
for several years. Tunics, typically with long, loose sleeves and
hems that can reach the knees, cover more of the torso than the
usual shirt and are often paired with jeans or leggings. Jeans
are perennially stylish, and also offer terrific sun protection:
Dark blue denim is estimated to let just 1/1700th of the sun’s UV
radiation reach the skin. Like jeans, leggings are often dark-colored,
and they tend to be made of thick, tightly woven fabrics that let
little light through. For a more elegant and modest feminine look,
long or “maxi” dresses, which usually reach the ankles, are quite
popular. They expose a lot less leg than their shorter counterparts.
Lightweight scarves can now be seen throughout the year and
provide both color and sun protection to the often-exposed neck
48
and upper chest. Scarves are also great for layering, another
current fashion trend.
Manly Coverings
We’re seeing more coverage in men’s clothing as well. Men’s shirts
and shorts have increased in sleeve and leg length, shielding
more of the arms, legs, and torso than in years past. For a change
from shorts, three quarter-length pants (a.k.a. clam diggers)
provide more leg coverage but are still casual and comfortable.
Headwear is also seeing a renaissance, with retro men’s styles
like the fedora and the newsboy surging back into popularity.
While not as wide-brimmed or protective as a floppy beach hat,
they are a big improvement over men’s most common hat style,
baseball caps, which have no brims in back or on the sides. Fedoras
Clothing is the single most important
factor in daily sun protection. Unfortunately,
not all clothing is created equal…
sport brims from 1” to 4” all around, and newsboys have broader
crowns than caps as well as more substantial, often visor-like,
front brims. The fedora and newsboy provide critical continuous
protection for the often exposed scalp and upper face, and a fedora
or Stetson provides extra protection for the ears and neck, which
receive virtually no coverage from baseball caps.
The Joys of Unisex
The Skin Cancer Foundation recommends wide-brimmed (3” or
greater) hats for both men and women, and many chic styles can
be found today for both sexes. Bucket and outback hats for women
can be every bit as stylish as fedoras and Stetsons can be for men.
And whatever your gender, if you wear an oversized straw hat,
the weave should be tight, so that little or no light gets through.
When purchasing sunglasses, the important thing for sun safety
isn’t style or price, but UVA-UVB protection; look above all for a
label stating that the pair blocks 99-100 percent of UVA and UVB
rays. Wraparound styles with side shields and extra large frames
are fashionable, and provide excellent sun protection. Finally, in
the past few years, the hooded sweatshirt, or hoodie, has become
ubiquitous for both sexes. Unlike other sweatshirts, casually
stylish hoodies can help protect the scalp and back of your neck.
Wash and Wear: Laundry Additives and UPF Labels
Several clothing lines today make special sun-protective attire with
a high UPF (ultraviolet protection factor). A UPF label indicates
that the clothing item absorbs a certain percentage of UV rays.
For instance, a shirt with a UPF of 30 allows just 1/30th of the
sun’s UV light to penetrate the fabric. [The Skin Cancer Foundation
recommends clothes with a UPF of 30 or higher; for information on clothes with our Seal of Recommendation, please see
www.SkinCancer.org/seal]. Companies such as Coolibar and
Columbia Sportswear make clothes ranging from swimwear to
golf shirts to light jackets that block up to 95 percent of the sun’s
UV rays. Many sun-protective clothing lines can be found in large
retailers such as Target, Academy, and REI.
To boost the protection provided by your everyday clothing,
you can mix an additive (like Sunguard™, by Rit®) into your next
load of laundry. When it is washed into your clothes, the product’s
active ingredient absorbs up to 96 percent of UV rays and can
last up to 20 washings. A white cotton t-shirt typically has a UPF
of about 5, but when washed with a UV absorber, can provide
a UPF of about 30.
Dress Smart
So what should you wear to your next barbeque? Tank top and
shorts? You might be better off with a tunic and leggings or
a long-sleeved shirt and three quarter-length pants washed in
Sunguard™. The tunic top would add much-needed protection
to the vulnerable shoulders and upper chest, and the leggings or
long shorts would provide greater coverage of the lower thighs
and even the lower legs. You could also add a high-UPF light
jacket. Since the material is so light and breathable, you could
wear your original outfit and not worry about sweating off your
sun protection.
Is wearing the right clothing enough? Well, it’s a great start.
But remember, for ideal sun protection, implement all the methods
we’ve discussed: Avoid the midday sun, seek shade, apply a broad
spectrum sunscreen with an SPF 15+ daily, and wear broadbrimmed hats, UV-blocking sunglasses, and clothing that can
offer solid sun protection. When you get out of bed in the morning,
think twice: The clothes you choose each day help determine not
just how others see you, but how well you protect yourself from
lifelong sun damage.
DR. CHON is an Assistant Professor in the Department of Dermatology
at the University of Texas MD Anderson Cancer Center, Houston. She
screens and treats patients for skin cancers and melanoma.
Internet Sites for Sun-Protective Clothing
www.sunprecautions.com (Solumbra)
www.coolibar.com
www.athleta.com
www.exofficio.com
Information about Sunguard™ by Rit®: www.sunguardsunprotection.com
49
hEaLTh
LIP cancEr: noT uncoMMon,
oFTEn ovErLookEd / 51
ThE rIghT waY To TrEaT
SEaSonaL dEPrESSIon / 56
ProTEcT Your EYES:
EvErYdaY STEPS To Sun SaFETY / 58
BrEaST cancEr and MELanoMa:
how ThEY arE LInkEd / 60
Since good mood, sunlight, and spring and summer tend to go together, many once believed that sprawling
in the sun or a tanning bed was the answer to Sad — that the ultraviolet (uv) light they give off was a virtually
magical cure. – ThE rIghT waY To TrEaT SEaSonaL dEPrESSIon (p.56)
LIP CANCER:
Not Uncommon, Often Overlooked
wILLIaM STEBBInS, Md, and c. wILLIaM hankE, Md, MPh
S
kin cancer is the most common type of cancer
the two most common skin cancers, basal and squa-
in the US. Despite increased awareness that
mous cell carcinoma (BCC and SCC). Most frequently
it is usually caused by the harmful effects of
occurring in fair-skinned males over the age of 50,
ultraviolet (UV) light, one in five Americans will develop
cancer of the lip comprises approximately 0.6 percent of
skin cancer in their lifetime.2
all cancers in the US.3 Studies have shown that males
1
The lips are a not uncommon, but often overlooked
are 3-13 times more likely to develop lip cancers, likely
site for nonmelanoma skin cancers (NMSC), including
due to occupation-related sun exposure combined with
HEALTH
greater tobacco and alcohol use.4,5
The lower lip is approximately 12 times more likely to be
affected, owing to its greater exposure to sunlight. A recent 25-year
retrospective study of 2,152 patients with lip cancer revealed that
81 percent occurred on the lower lip,4 with males predominating
by 3 to 1. Large epidemiological studies have shown that up to
95 percent of NMSCs on the lower lip are SCCs.6
Given their highly visible location, the majority of lip cancers
are easily detectable and treatable at an early stage. The most
commonly employed treatments include surgery, radiation, and
cryotherapy (freezing with liquid nitrogen), with cure rates for
early lesions nearing 100 percent.7 Although cancers of the lip
have relatively low rates of spread to nearby lymph nodes and
papillomavirus (HPV) in certain oral cancers, but it has not to
date been found to be a major cause of lip cancers. The most
important risk factor by far is cumulative UV exposure, which
is associated with up to 90 percent of all NMSCs.9 A study of
Canadian farmers showed they had a threefold increased risk
of lip cancer compared to people with indoor occupations, even
after accounting for a history of smoking.10
Immunosuppressed populations in particular must remain
extremely vigilant about lip cancer. Kidney transplant patients
have a 30-fold increased risk due to use of immunosuppressive
anti-rejection drugs.11 People receiving higher doses of immunosuppressants tend to develop more NMSCs than those on lower doses,12
and patients with HIV also demonstrate higher skin cancer risk.13
Studies have shown that males are 3-13 times
more likely to develop lip cancers, likely due to
occupation-related sun exposure combined with
greater tobacco and alcohol use.
distant sites, the relapse rate after treatment can range from 5-35
percent, and the mortality associated with large or recurrent SCC
of the lip is as high as 15 percent in some studies.6 Once these
cancers spread to local lymph nodes, five-year survival rates
decrease to approximately 50 percent.8
Distribution of Lip Cancers
To assess incidence and gender associations for lip cancers, we
prospectively evaluated 100 consecutive patients visiting our
practice. The type of skin cancer, specific location on the lips, and
gender of the patient were included in the evaluation.
Our study population consisted of 51 males and 49 females with
a total of 68 SCCs and 32 BCCs. Figure 1 [page 54] demonstrates
the normal anatomy of the lip, while Figure 2 [page 54] shows the
distribution and type of skin cancers among the patients. As in
numerous prior studies, the most common location was the lower
lip. Also consistent with earlier studies was an overwhelming
predominance of SCCs compared to BCCs on the lower lip (50
vs. 5), and a higher proportion of upper lip cancer in females
compared to males; 60 percent of upper lip cancers occurred
in females vs. 40 percent in males. About 70 percent of these
upper lip cancers in women were BCCs. Across both sexes, BCCs
accounted for 60 percent of upper lip cancers, compared to only
nine percent of lower lip cancers. Finally, while most studies cite
a significantly higher ratio of men with lip cancers compared to
women, in our study, incidence was virtually 1:1. This is likely due
to smaller study numbers and the predominance of patients from
the same geographic area, which may not be representative of the
general population.
Risk Factors
Lip cancer has been associated with smoking, alcohol consumption, and immunosuppression. Emerging data implicate human
52
Immunocompromised patients, especially those with chronic sun
exposure (which further suppresses the immune system), must
be monitored closely.
Treatment of Lip CancerS
When detected and treated early, lip cancer is almost always
curable. However, large or recurrent cancers (possibly resulting
from insufficient initial treatment) elevate the risk for local and
distant spread.
For several reasons, including greater conservation of healthy
tissue and an extremely high cure rate, Mohs micrographic surgery
is commonly used to treat lip tumors. Mohs surgery involves
removing thin layers of skin tissue, which are then color-coded,
mapped, and microscopically examined. If malignant cells are
detected, more tissue from the affected area is removed. This
process is repeated until no more cancer can be found.
Mohs surgery offers the highest cure rate of any treatment
modalities for primary or recurrent lip tumors,14 with cure rates
of 90-100 percent. In one study of 49 patients with SCC of the lip,
the five-year cure rate was 92 percent, compared to 80 percent
for (non-Mohs) surgical excision and radiation therapy.14
Tumors often extend beyond what the naked eye can detect,
but Mohs surgery, with its use of microscopic examination, allows targeted removal of malignant cells while sparing normal
skin. This permits optimum functional and cosmetic results. [See
Figure 3.]
Prevention of Lip Cancers
Regular use of photoprotective lip blocks (lip products that contain
sunscreen) reduce the risk of lip cancer.15 However, many people
remain unaware how important consistent lip protection is. In a
study of 299 beachgoers, 94 percent demonstrated a high awareness of the risks of UV damage to the skin in general, but only
Current Science with a
Global Perspective.
The Archives of Dermatology publishes relevant research and studies from around the world to enhance
the understanding and pathophysiology of cutaneous disease. Quality papers deliver information to
physicians for optimal patient care.
For subscription and publication details visit
archdermatol.com
HEALTH
69 percent demonstrated a high awareness
of risk factors specifically for lip cancer.16
Seventy percent of beachgoers used no lip
protection whatsoever, and even among
those who otherwise properly applied
sunscreen, only 37 percent used any lip
protection.
Furthermore, while photoprotective
lip blocks can be effective in reducing UV
exposure, most people do not apply them
properly. From a practical standpoint, the
actual Sun Protection Factors (SPFs, which
measure protection against the sun’s UVB
rays) provided by lip blocks are almost always lower than the number on the package
because the blocks are not applied thickly
or frequently enough.17 Additionally, many
commercially available photoprotective lip
blocks may be poorly absorbed and can be
broken down quickly by UV light, losing
their effectiveness — two compelling
reasons for frequent reapplication.18
CONCLUSION
Despite being exposed to large amounts
of UV light, the lips are often overlooked
as a potential site for skin cancers. It is
critical to exercise careful sun protection
through a combination of sun avoidance
and shade-seeking; frequent application of
a high-SPF lip block; and careful monitoring of skin changes. Any changes to the lip
that concern you should be brought to the
attention of your physician immediately.
DR. STEBBINS is currently a Mohs micrographic surgery and procedural dermatology
fellow under the direction of Dr. C. William
Hanke at the Laser & Skin Surgery Center of
Indiana and St. Vincent Hospital, Indianapolis,
Indiana.
DR. HANKE is the Director of the Laser &
Skin Surgery Center of Indiana in Carmel, IN,
and Senior Vice President of The Skin Cancer
Foundation. He was the f rst physician in the
United States to earn triple full professorships
in Dermatology, Otolaryngology Head and
Neck Surgery, and Pathology and Laboratory
Medicine. He is past President of the American
Academy of Dermatology, and has served as
President of f ve surgical specialty societies:
the American Society for Dermatologic Surgery,
American College of Mohs Micrographic Surgery
and Cutaneous Oncology, the International Society of Cosmetic Laser Surgeons, International
Society for Dermatologic Surgery, and the Association of Academic Dermatologic Surgeons.
He has written more than 350 publications
including 91 book chapters and 20 books.
Figure 1: Normal anatomy of the lips
PHILTRUM
VERMILION BORDER
ORAL COMMISSURE
VERMILION
(Red Portion of Lip)
Figure 2: Distribution of BCCs and SCCs
Vermilion Border (upper)
BCC: 6 SCC: 6
Vermilion (upper)
BCC: 11 SCC: 4
Oral Commissure (upper)
BCC: 10 SCC: 8
Oral Commissure (lower)
BCC: 2 SCC: 18
Vermilion (lower)
BCC: 1 SCC: 17
Vermilion Border (lower)
BCC: 2 SCC: 15
Figure 3
A
B
This patient presented with a 1x1 cm SCC of the lower vermilion lip.
A) Appearance of lower lip after removal of tumor using Mohs micrographic surgery.
B) Natural healing of lower lip 4 weeks after procedure.
54
HEALTH
The Right Way to Treat
Seasonal Depression
Michael Terman, PhD
Is the cold, dark winter making you SAD? If you sit at a light box — usually for 30
Seasonal affective disorder (SAD) is a minutes after rising — even your most
condition that can bring on a full-blown disruptive clinical symptoms can clear
depression that reappears yearly, usually in up quite quickly, sometimes within days.
So, if you see a salon advertising UV
winter, with major relief in the late spring
and summer. It can destroy your ability to tanning as a cure for SAD, don’t believe
work, meet family obligations, and engage it. Early morning sunlight, which light
socially (or sexually). Feelings of anxiety therapy approximates, provides the lowest
amount of UV radiation of the day, and
and despair are also common.
SAD-related depression is usually the UVR therapy hypothesis was disproved
accompanied by physical symptoms: dif- when investigators found no reduction
ficulty waking up, sleeping longer hours,
craving carbohydrate-rich foods, and
gaining weight that is easily lost in late
spring. Nearly 10 million people in the US
have SAD, and three times as many have
“winter doldrums,” with similar, though
UV radiation is not the
not clinically severe, symptoms.
Since good mood, sunlight, and spring solution: bona fide light
and summer tend to go together, many once therapy works through the
believed that sprawling in the sun or a eyes, not the skin.
tanning bed was the answer to SAD — that
the ultraviolet (UV) light they give off was
a virtually magical cure. And, as it turns
out, light does play a role in the treatment
of SAD. But it’s visible light, not UV, that
accounts for light’s antidepressant effect. of antidepressant effect when UVR was
What’s the right way to treat SAD and eliminated from light boxes.1 However, in
the winter doldrums? Visible light therapy, a recent study, college women who showed
which is generally provided by a light box. either mild or severe symptoms of SAD
This light provides a spring-like sunrise were far more likely to abuse indoor tansignal that travels from the retina in the ning (having 40 sessions or more per year).2
eye to the biological clock in the base of Since UVR stimulates the body to produce
the brain, so that the internal clock and endorphins, chemicals that produce feelthe clock on the wall stay coordinated. ings of calm and well-being, this temporary
Ordinary indoor lighting is about 50-300 “high” may influence tanning’s popularity
lux (the equivalent of twilight), while a among women with SAD. However, it is not
light box with 10,000 lux of illumination the solution; bona fide light therapy works
provides a true, early, outdoor daylight level. through the eyes, not through the skin.
56
HOW SAD MAKES US SAD
SAD is linked to melatonin, a sleeprelated hormone. Generally, melatonin
levels in the body are higher at night
and lower in the morning. For people
with SAD, however, the cycle is often
delayed, and melatonin levels remain
elevated into the morning, causing
them to oversleep or leaving them
fatigued. Meanwhile, the brain’s
internal clock relies on early morning
light to keep our circadian rhythms
in sync with local time, but the late
sunrises of winter deny our bodies
that essential signal. Depression can
result when we have to keep waking
up while it’s still dark. SAD is more
frequent in the northern half of the US,
where winter sunrise is significantly
later than in the south. It is also more
common toward the western edge of
time zones – sunrise is about an hour
earlier on the eastern edges.
Photo © Center for Environmental Therapeutics.
with a dermatologist before starting bright
light therapy.
Additionally, people with conditions
including age-related macular degeneration, lupus erythematosus, chronic actinic
dermatitis, and solar urticaria may react
poorly (photosensitively) to the blue light
produced by light boxes. For these SAD
patients, a milder form of light therapy,
dawn simulation, has seen initial clinical
success.6 In dawn simulation, timed lights
are activated automatically to gradually
replicate a low-level springtime sunrise
while you’re still in bed.
It can be difficult to tell whether your
winter slump is clinically significant.
You can get anonymous, confidential
feedback online using the Personal
Inventory for Depression and SAD
in the Self-Assessment section at the
nonprofit Center for Environmental
Therapeutics (www.cet.org). If your
depression is severe, consult a mental
health specialist. Print out the report,
and discuss it with your doctor
if indicated.
Light Box Essentials
Many light therapy products are commercially available. However, few have been
clinically tested, and some may pose risks
to the skin or eyes. Here are some guidelines, based on the recommendations of the
Center for Environmental Therapeutics:
• The light box should have been
tested successfully in peer-reviewed,
placebo-controlled clinical trials.
• The box should be able to provide
10,000 lux illumination.
• The box should have a smooth
diffusing screen that filters out the
small amount of UVR emitted by
the fluorescent bulbs in most light
boxes. The safest light boxes use a
polycarbonate diffuser.
• The light should project downward
toward the eyes to minimize glare.
• Smaller is not better. Miniature
devices cause glare, and even small
head movements will take your
eyes out of the therapeutic range. In
general, light boxes should be no
smaller than 15” wide and 12” high
(180 sq. in.).
Finally, the lamp should give off white,
not colored, light. Soft white light is highly
recommended. Full spectrum and blue (or
bluish) light provide no known therapeutic
advantage — blue light causes glare, and
over the long term may harm the retina.3
Boxes that give off inadequately filtered
UV are particularly hazardous to the skin
and eyes4 of people taking photosensitizing
drugs (medications that sensitize the skin to
the sun). Photosensitive people may develop
rashes, itchiness, bumps, or lesions on the
skin as a result of exposure to UV light
and have a higher risk of developing skin
cancer. Typical UV photosensitizers include
antibiotics and NSAIDs (non-steroidal antiinflammatories, like ibuprofen). Everyone
who uses a light box should make sure it
has a polycarbonate diffuser to screen out
UV light adequately, but for people taking
photosensitizing drugs, a filter is especially
important.
Other drugs can photosensitize people
to visible blue light, which exists in varying degrees as a component of white light.
Anyone using tricyclics or neuroleptics5
(common psychiatric drugs), antiarrhythmics, or antimalarial drugs should check
Conclusion
Light therapy for SAD can be a boon for
quality of life for half the year. But users
must keep an eye out for safety and efficacy: much commercial apparatus has
received inadequate testing, or none at
all. Many doctors are still unacquainted
with this powerful non-drug technique. To
learn more about light therapy, the newly
published Chronotherapeutics for Affective
Disorders7 is a comprehensive guide. And
remember: Visible light, not harmful UV
radiation, is the key to relieving symptoms
of SAD. A light box, not a tanning machine,
can help improve your mood and sleep
without risking your health.
DR. TERMAN directs the Center for Light
Treatment and Biological Rhythms at Columbia
University Medical Center (www.columbia-chronotherapy.org). He is President of the nonprofit
Center for Environmental Therapeutics (www.
cet.org), a consortium of doctors and researchers
dedicated to developing and disseminating nondrug interventions for mood and sleep disorders.
57
HEALTH
PROTECT
Your Eyes
Everyday Steps to Sun Safety
RENE S. RODRIGUEZ-SAINS, MD
For most of us, the eyes are the most
cherished of our senses. Yet we potentially
expose them to danger simply by going
outside. Over time, the sun’s rays can
seriously damage the eyes and surrounding skin, sometimes leading to vision loss
and conditions from cataracts and macular
degeneration to eye and eyelid cancers.
However, simple daily protective strategies
will help keep our eyes and the sensitive
skin around them healthy.
Don’t Take the Sun Lightly
Certain types of light from the sun can
wreak havoc:
Ultraviolet A and Ultraviolet B light:
Ultraviolet A (UVA) and ultraviolet B (UVB),
powerful, invisible rays with wavelengths
shorter than visible light, are the most
dangerous parts of sunlight. They can
cause cataracts, eyelid cancers and other
skin cancers,1,2 and are believed to play a
part in macular degeneration, a major cause
of vision loss for people over age 60.3 In
addition, UV rays can prematurely wrinkle
and age the skin around the eyes.
High-Energy Visible Light (HEV
light)/Blue Light: HEV light – high-energy
visible light in the violet/blue spectrum – is
a potential contributor to cataracts and
other serious eye maladies.1,2 Blue light can
damage the retina over time, leading to
macular degeneration. The retina is the
membrane where images are formed and
transmitted to the brain. The macula, the
region of sharpest vision located near the
center of the retina, is the most likely area
to be damaged.
58
Are You at Risk?
The fairer your skin, the greater your age,
and the lighter your eyes, the higher your
long-term risk, especially if your work or
recreation involves prolonged sunlight
exposure. Light eyes are at increased risk
for skin cancer and certain eye diseases
because they contain less of the protective
pigment melanin.
But all of us are susceptible to these
cancers or other conditions caused by the
sun. We need to protect ourselves daily,
because the damage keeps adding up.
How Sunlight Damages the Eyes
Although designed to protect the eye, the
eyelid’s skin is thin and contains many
fragile tissues vulnerable to UV light.
Inside the eye, the lens and cornea, both
transparent, filter UV rays, but years of
UV absorption can damage them. The lens,
the eye’s focusing mechanism, can turn
yellowish and cataractous. The cornea, the
area in front at the outer layer of the eye,
admits light and images to the retina. UV
damage can cause:
Eyelid cancers: Eyelid skin cancers,
including basal cell carcinoma (BCC),
squamous cell carcinoma (SCC), and
melanoma, account for 5 to 10 percent of
all skin cancers.4,5 Most occur on the lower
lid, which receives the most sun exposure.
BCCs make up about 90 percent and SCCs 5
percent or more of all eyelid cancers, while
melanomas account for 1-2 percent.4-6
While BCCs elsewhere on the body
rarely spread, eyelid BCCs potentially can
spread to the eye itself and surrounding
areas. SCCs grow faster and have greater
potential to spread.
Both SCC and BCC are found mainly
in patients with a long history of sun
exposure,7 while melanomas are especially
associated with intense, intermittent sun
exposure and sunburns.
When diagnosed and treated early, eyelid cancers usually respond well to surgery
and follow-up care, with the eye and eyelid
largely retaining normal function. But left
untreated, they can be dangerous. Watch
for these early warning signs:
• a lump or bump that bleeds or
does not disappear
• persistent red eye or eyelid
inflammation that does not respond
to medication
• new flat or elevated pigmented
lesions with irregular borders
and growth
• unexplained loss of eyelashes
If you have any of these signals, consult a
skin cancer specialist or ophthalmologist,
even if you feel no discomfort.
Intraocular melanoma: Although
rare, it is the most common eye cancer
in adults.8 It starts in the uveal tract, the
middle layer of the eye containing the iris
(the colored part of the eye) and choroid
(the layer under the retina). Symptoms may
include blurred vision and a change in the
shape of the pupil (the dark area in the
center of the iris).
Conjunctival cancers: Once rare,
these have been rising rapidly in incidence,
especially among older people. Incidence
among white men increased 295 percent
over a 27-year period.9-11 Melanomas of
the conjunctiva, the protective membrane
covering the outside of the eye and the
inside of the eyelids, may be more common
in patients with atypical mole syndrome;12
these patients sometimes have 100 or
more moles, as well as one or more moles
8 mm (1/3 inch) or larger in diameter, and
one or more moles that are atypical. All
patients with cutaneous (skin) melanomas
and/or atypical moles should have yearly
ophthalmologic evaluations.
Cataracts: The most common cause
of treatable blindness,13 cataracts are a
progressive clouding and yellowing of the
crystalline lens, the eye’s focusing mechanism. At least 10 percent of cataract cases
are directly attributable to UV exposure,4
especially UVB. In the US alone, more than
one million operations to remove cataracts
are performed every year.4,14,15
Macular degeneration: Often referred
to as age-related, or senile, macular
degeneration, it is now believed to be
caused by cumulative UV damage to the
retina. The macula, the region of sharpest
vision near the center of the retina, is the
most likely area to be damaged. Macular
degeneration is one of the major causes of
vision loss in the US for people over age
60.3 Some studies point to UVA and HEV
light as potential causes.1,2,16
Keratitis, or corneal sunburn:
Excessive UV exposure from the sun or
tanning machines can burn the cornea,
the clear refracting surface that admits
light and images to the retina. Protective
lenses are always advisable when you are
exposed to UV. They are a must for skiers
or snowboarders, since UV is more intense
at high altitudes, and since snow reflects
back about 80 percent of the sun’s rays,
so that they hit your eyes a second time.
Water and sand also reflect UV rays.17,18
Virtually all these conditions can be
found during a routine ophthalmologist’s
exam. Ideally, have a complete yearly exam,
including dilated funduscopy.
Best Defense
Lenses that absorb/block UV offer strong
defense against eye and eyelid damage. It’s
best to wear sunglasses year-round in the
sun.13 UVA light can damage the eyes and
the skin around them throughout the year.
Even on overcast days, UV can penetrate
through clouds and haze.
Check if the glasses meet ANSI and/or
ISO standards for traffic signal recognition,
meaning they permit good color recognition.
Sunglass lenses come in many shades,
with neutral gray, green, or brown usually
For proper protection,
sunglasses should offer
the following:
• The ability to absorb and block 99
to 100 percent of UVA and UVB
light. Ideally, they should also
guard against HEV light.
• Sufficient size to shield the eyes,
eyelids, and surrounding areas.
The more skin covered, the better.
Wraparound styles with a comfortable, close fit and UV-protective
side shields are ideal.
• Durability and impact resistance.
• Polarized lenses to eliminate glare,
especially when driving, but also
out in the snow or on the water,
where reflection greatly magnifies
glare. Continuing glare can
cause fatigue, headaches, and
even migraines.
offering the most comfortable vision.
Choose the color that works best for you.
Before purchasing sunglasses, check
tags, labels, or packaging to make sure the
lenses provide proper UV protection. For
extra assurance, look for The Skin Cancer
Foundation’s Seal of Recommendation.
Other Defenses
Other safety measures are also important.
Wearing a hat with at least a 3”
brim all around can block up to
half of all UVB rays from your
eyes and eyelids.13 Hats or tinted
visors also help block UV from entering
your eyes from above.
Since sunglasses and hats
cannot cover your entire face,
sunscreen is also important.
Finally, whenever outside,
seek shade, especially between
10 AM and 4 PM.
Remember, practice all these strategies
year-round — including when you’re on
vacation, spring, summer, winter and fall.
References available on p. 97.
DR. RODRIGUEZ-SAINS is an ophthalmic
plastic and reconstructive surgeon, ophthalmic
oncologist, and ophthalmologist. He is a Clinical
Assistant Professor at NYU-Langone Medical
Center and a professional member of The Skin
Cancer Foundation.
59
HEALTH
Breast Cancer and Melanoma:
How They Are Linked
SU LUO AND HENSIN TSAO, MD, PHD
Since breast cancer is the most frequently
diagnosed noncutaneous (non-skin) cancer
among women in the United States,1 it is
not surprising that many individuals with
breast cancer will develop melanoma (the
deadliest form of skin cancer) and vice
versa. However, recent studies exploring
how often individual patients develop
both cancers suggest that it has to do
with more than just coincidence: A recent
study by Murphy, et al, for example, found
that patients with either breast cancer or
melanoma were almost four times more
likely to develop the other malignancy
than probability would lead researchers to
expect.2 Specific causes linking the diseases
may be in play, and genetic or environmental factors may also contribute. On the
other hand, the association may at least
partly result from more rigorous detection – in other words, a detection bias. This
occurs when health care providers who
carefully monitor cancer patients detect a
second cancer that might otherwise have
been missed.
Whatever clues we can gather about
an association between breast cancer
and melanoma may help lead to patient
interventions that could reduce the risk
of a second cancer. Just what do we know
so far about the links between these
two cancers?
Population-Based Studies
Population-based data provide the most
statistically significant estimates of cancer
incidence.3 When exploring the frequency
of two primary cancers occurring together,
epidemiologic studies often focus on a
population-based registry of one cancer,
then evaluate data for the development of
the second. The findings are presented as a
standardized incidence ratio (SIR), a ratio
of observed to expected number of cases.
60
Melanoma After Breast Cancer
Recent registry-based studies offer SIRs
ranging from 1.16 to 2.74 for melanoma
development after breast cancer, meaning that 1.16 to 2.74 times the number of
expected melanoma cases occurred after a
breast cancer occurred.4-6 (The range may
reflect differences in methodology or variations in the composition of the examined
population.) An accurate estimate may
A recent study found that
patients with either breast
cancer or melanoma were
almost four times more
likely to develop the other
malignancy than probability
would lead researchers
to expect.
be a 29 percent excess risk for melanoma
in breast cancer patients, as found in the
largest group study of over 500,000 breast
cancer patients.7 Higher-risk still were
breast cancer patients age 50 or younger,
who in a study by Goggins, et al, had a
46 percent higher risk of melanoma after
breast cancer.4
Breast cancer patients who receive
external radiation therapy (XRT) also
have an especially heightened melanoma
risk4,6 — Goggins, et al found a 42 percent
higher risk of melanoma4 — even at nonirradiated sites.8
However, patients who undergo XRT
for breast cancer may be examined more
frequently, reflecting a detection bias that
could lead to more melanomas being found.
Breast Cancer After Melanoma
Studies of melanoma patients have not
generally shown statistically significant
higher risks of a subsequent breast cancer.9,10 However, using the National Cancer
Institute’s Surveillance, Epidemiology and
End Results (SEER) data from 1973-1999,
Goggins, et al did detect modest but significant increases in breast cancer risk after
melanoma and vice versa.4 The risks of
breast cancer among female melanoma
survivors and melanoma among breast
cancer survivors were elevated by 11
percent and 16 percent, respectively. This
mutual association, especially among
breast cancer patients age 50 or younger,
suggests genetics may play a role.4
Genetic Associations
Investigators looking for a possible genetic
link have zoomed in on several genes that
are known risk factors for either melanoma
(such as the CDKN2A gene) or breast cancer
(such as the BRCA2 gene). A small number of
melanoma cases are familial (occurring in
people who have one or more close relatives
with melanoma). Of these, about 20-40
percent have mutations in the CDKN2A
gene. A study of familial melanoma cases
with CDKN2A mutations showed these
families not only had multiple cases of
melanoma, but also an increased risk of
breast cancer.11 However, the association
between the two cancers was still quite
weak. To date, genetic testing for mutations
in high-risk genes for melanoma such as
CDKN2A among breast cancer patients is
not warranted.12
However, people who have high-risk
genes for breast cancer may be predisposed
to melanoma. The Breast Cancer Linkage
Consortium found that BRCA2 mutation
carriers have 2.58 times greater risk than
non-carriers of developing melanoma.13,14
The Xeroderma Pigmentosum group D
gene (XPD) has also been recently implicated in both melanoma and breast cancer.
This gene is associated with xeroderma
pigmentosum, an inherited skin condition
in which sufferers are dangerously vulnerable to ultraviolet light (UV) exposure, and
often suffer multiple skin cancers, including melanoma. Certain variations in the
XPD gene are modestly associated with
heightened breast cancer risk, while others
are modestly associated with melanoma in
patients over age 50.15
Detection Bias
Detection bias can increase the apparent
risk of a second malignancy. The SEER
analysis found a higher than expected number of localized (but not thicker, later-stage)
breast cancers diagnosed after melanoma,
suggesting some role for detection bias;
increased scrutiny may have led to earlier
detection of the breast cancers.4 Indeed,
patients as well as their physicians may be
more vigilant with their skin examinations.
However, this possible detection bias has
not shown up with melanomas discovered
after breast cancers; studies have demonstrated that the increased melanoma risk
among breast cancer patients has fluctuated
very little over time. A detection bias would
have shown a gradual decline in risk, as
intense scrutiny eased.7
Environmental and
Hormonal Influences
Socioeconomic factors could also contribute
to the association of breast cancer with
melanoma.3 For instance, behaviors such as
tobacco, alcohol and sunscreen use or lack
thereof could all be related behaviors in
certain economic strata. The role of female
hormones (such as estrogen receptors3), already known to play a role in breast cancer,
have also been a concern with regard to
stimulating melanoma growth, especially
in light of associations between melanoma
and pregnancy.16 (While pregnancy does not
increase the risk of melanoma, melanomas
diagnosed during pregnancy tend to be
thicker, and more dangerous, than those
in non-pregnant patients.)
Conclusions
While epidemiologic studies have long
noted an association between breast cancer
and melanoma, the exact nature of this
relationship is far from understood. It could
be that DNA damage and genetic changes
hindering DNA repair may affect the risk
of many different types of cancers.
For patients who have had breast cancer, an annual total-body skin check by a
trained professional makes sense, and more
frequent exams may be needed for those
who have gone through radiation therapy.
Likewise, post-melanoma surveillance
typically should involve evaluation of the
lymph nodes near the breast. Teaching
patients to examine this area routinely
could lead to earlier detection of breast
cancer metastases.
SU LUO is a medical student at the University
of Miami Miller School of Medicine. She is
conducting research in mutation analysis of
pigmented lesions at the Wellman Center for
Photomedicine, Massachusetts General Hospital.
She will receive her MD in 2011.
DR. TSAO is the Director of the Melanoma and
Pigmented Lesion Center and the Melanoma
Genetics Program at Massachusetts General
Hospital, and Associate Professor of Dermatology
at Harvard Medical School. He leads a cancer
genetics laboratory at the Wellman Center for
Photomedicine at MGH. Dr. Tsao is widely published and has lectured internationally about
melanoma, genetics, and skin disease.
61
ADVERTISEMENT
IDENTICAL TWINS (NO SURGERY)
☎
Darrick E. Antell, MD, FACS
212-988-4040
web: www.antell-md.com
e-mail: [email protected]
Diplomate, American Board of Plastic Surgery
850 Park Avenue, New York, NY 10075
Please cut out for educational purposes
What could more purely demonstrate
the effects of photodamage than a
study of identical twins?
Please feel free to cut these photos out, and show them to help educate your patients.
Darrick E. Antell, MD, a New York City plastic surgeon has performed multiple
studies of aging in identical twins and the photos above demonstrate the effects of
sun damage firsthand. At the time of these photos, both twins were 59 years old.
However, the twin on the left had a long history of sun exposure, and had been a
practicing nudist.
As they are genetically alike, any variation in the damage to their skin was clearly due
to environmental factors, in this case ultraviolet (UV) exposure. The more sun-damaged
twin has deeper wrinkles and sagging skin, when compared to her twin sister.
Visit Dr. Antell’s website for more information, or see interviews on this topic with
the twins on YouTube, search under Dr. Antell identical twins.
Darrick E. Antell, MD, FACS
Diplomate, American Board of Plastic Surgery
850 Park Avenue, New York, NY 10075
☎ 212-988-4040
web: www.antell-md.com e-mail: offi [email protected]
ADVERTISEMENT
A PUBLICATION OF THE SKIN CANCER FOUNDATION • VOL. 11, 2010
nEWS frOM THE
inTErnATiOnAL
ADviSOry cOUnciL
The iArc’s damning report on tanning was a kind of final straw, and on november 9, 2009, the
Brazilian national Health Surveillance Agency (AnviSA) banned Uv cosmetic tanning altogether
throughout the country. — Banning The Tan Around The World (p.65)
BANNING THE TAN
AROuND THE WORLD
Nations Mobilize
crAig SincLAir
In the 2008 issue of this Journal, I described the case of Clare Oliver, a young journalist
who died from melanoma, the deadliest skin cancer, a few years after using tanning
beds. In her last days, Clare gave broadcasts from her hospital bed, urging fellow
Australians to refrain from tanning. In the year after her death, her cautionary tale and
warnings were continually cited by journalists, health groups, and politicians calling
for legislation to control the indoor tanning industry in Australia.
Two years later, I can report that Clare’s impact, bolstered by convincing new
international research on tanning’s harmful effects, has been monumental, not just in
Australia but around the world. The evidence is so strong now against indoor tanning
that many nations have been roused to action, lobbying and legislating against the
dangers posed to their young people and other citizens by tanning devices.
THE TAnning PAnDEMic
In the past three decades, since being introduced to America by Friedrich Wolff in
1978,1 tanning salons have been a notable growth industry. Indoor tanning is now
widely practiced in most developed countries with sizable light-skinned populations,
particularly Northern Europe, New Zealand, the US, and Australia.
63
INTERNATIONAL
In the US, nearly 30 million people tan indoors yearly,2 the Cancer (IARC), affiliated with WHO, published a report adding
tanning industry raking in about $5 billion.3 About 10 percent UV radiation (UVR) from tanning beds to its group of the most
of Northern Europeans use sunbeds on a regular basis,4 with as dangerous forms of cancer-causing radiation for humans, alongside
elements such as radon and plutonium as well as solar UVR.14
many as one in three women reporting sunbed use in the UK.5
This tanning explosion has particularly been embraced by
Then, researchers at the Wellcome Trust Sanger Institute
(and marketed to) young people, who are especially vulnerable to in Hinxton, England, mapped the genetic material that made
long-term damage from tanning lamps’ ultraviolet (UV) radiation; up a patient’s melanoma, discovering that the vast majority of
it can age their skin prematurely and leave them at significantly mutations found in the melanoma were caused by UVR. Many
higher lifetime risk of skin cancer.
mutations — changes or errors occurring in genes due to radiation,
Despite the scope of the problem, restrictions on youthful tan- viruses, and other causes — can lead to cancer.15
ning (and tanning in general) in most countries have been minimal.
Convincing evidence now links skin cancer to frequent use
For example, the US Food and Drug Administration (FDA) ranks of tanning beds and tanning bed use among young people. One
tanning machines as a Class I medical device, about as dangerous study found that people who use tanning beds are 2.5 times more
as elastic bandages, and its limited federal regulations reflect this.6,7 likely to develop squamous cell carcinoma (SCC), the second most
Until the past few years in Europe, the only countries to limit the common skin cancer, and 1.5 times more likely to develop basal
amount of ultraviolet B (UVB) radiation coming from sunbeds were cell carcinoma, the most common cancer.16 Other research shows
Belgium, France, and Sweden.8
(Typically, UVA made up about
95 percent and UVB five percent
of tanning bed radiation.) In the
UK, there is no effective control
of the suppliers or operators of
sunbeds; the industry is almost
With the weight of evidence
entirely unregulated. Children
mounting, many countries
at virtually any age can walk
have awakened to the dangers
into a tanning automat alone,
and with no one in attendance
of tanning beds, launching
for screening or oversight, can
legislation to regulate and
drop in some coins and have the
reduce their use, especially
tanning session of their choosamong young people.
ing. The media have reported the
devastating first degree burns
some children sustained; one girl
burned 70 percent of her body in
16 minutes.9
Even supervised salons come
up lacking. In a study of 332 tanning salons in Northern Ireland,
for example, a high number were found to have shockingly poor that the overall risk of melanoma for all tanning bed users is
17
standards. In one fifth of the salons, skin type was not even increased by 15 percent, and that first exposure to tanning beds
18
discussed with customers, and only 44 percent of customers in youth increases melanoma risk by 75 percent.
In general, the highest skin cancer rates are found in nations
with skin type I (people with the lightest skin type, who can
burn badly but cannot tan) were advised not to tan. In a quarter where people are fairest-skinned and where the tanning culture is
strongest: Australia, New Zealand, North America, and Northern
of the salons, the staff itself was not trained about UV risks.10
Europe.19 Skin cancers have surged in all these places, and indoor
tanning must be playing a part.
Aftermath: a Surge in Skin Cancers
Indoor tanning in Australia, for example, has been associated
What has been the effect of this skyrocketing sunbed use? Research
with
a 22 percent increased melanoma risk among all solarium
suggests a significant increase in skin cancers. The World Health
Organization (WHO) reports that 132,000 cases of melanoma and users, and up to 98 percent increased risk for those who became
20
over two million cases of other skin cancers occur worldwide each users when younger than 35. According to the Queensland
11
Institute
of
Medical
Research,
tanning beds cause 281 cases of
year, with estimates as high as 66,000 melanoma-related deaths
8
melanoma
a
year
in
Australia,
killing
43, and are responsible for
a year. Frequent tanners using new high-pressure sunlamps
17
may receive as much as 12 times the annual UVA dose compared 2,572 squamous cell carcinomas.
In the UK, where skin cancer incidence has quadrupled since the
to the dose they receive from sun exposure,12 and WHO reports
5
that 10 minutes in a sunbed matches the cancer-causing effects 1970s, rising faster than any other cancer, it is widely believed that
13
this
meteoric
rise
significantly
involves
increased
use of artificial
of 10 minutes in the Mediterranean summer sun.
Two important international reports in the past year strongly tanning devices. At least 100 of the 1,800 annual melanoma-related
21
reinforced the association between tanning, melanoma, and other deaths are attributed to artificial UV radiation.
Similarly,
in
Norway
and
Sweden,
the
annual
incidence rate
skin cancers. First, the International Agency for Research on
for melanoma has more than tripled in the past 45 years,19 with
64
N ews from the I nternational A D V I S O R Y C O U N C I L
the desire to have a tan and the accompanying growth in sunbed
use considered prime causes. One study showed a significant
increase in melanoma risk for Norwegian and Swedish women
who regularly used sunbeds.19
An International Wake-up Call
With the evidence mounting, many countries have launched
legislation to regulate sunbed use, especially among young people.
• In the US, California, Texas, and at least 29 other states
have passed their own legislation governing the use of tanning facilities by minors.22 California led the way in 2004,
banning sunbed use for teens under age 14,23 and Texas
recently passed the most restrictive law in the country,
prohibiting use for all children and adolescents under
age 16.5.24,25
• In 2007, the European Commission of Health and Consumer
•
•
•
•
Services ruled that all new tanning machines brought into
the European Union must reduce UVB to 1.5 percent of
their UV emissions, not exceeding an “erythemal-weighted
irradiance” of 0.3 W/m2, about 12 on the ultraviolet index
scale. This lower UVB intensity should reduce the risk
of sunburn, allowing slightly greater margin for error in
determining exposure times.
In Europe, France, Belgium, Germany, Scotland, Spain, and
Portugal all now restrict sunbed use for persons under age
18. In France, the regulations also require all UV radiationemitting appliances to be declared to the health authority.
Trained personnel must supervise all commercial establishments, and any claim that they provide health benefits is
forbidden.19,26
In addition to its recently passed legislation banning
under-18s from using sunbeds, Scotland has mandated that
all sunbed salons be supervised, with proper information
provided to customers.26
The province of New Brunswick in Canada also now bans
under-18s from using sunbeds.26,31,32
As so often in the field of UV protection, Australia has taken
a leadership role. All five states in Australia have banned
sunbed use for teens.27-9 [For more on Australia’s antitanning efforts in the past two years, see “Clare’s Legacy”
on page 66.]
Finally, Brazil recently one-upped all other nations. With their
long tradition of outdoor tanning, Brazilians had increasingly
embraced indoor tanning as well in recent years (especially in the
south), even as melanoma rates were climbing. Some legislative
controls were in place regulating operation of sunbeds, in an
attempt to reduce their impact on health, but inspections showed
these regulations were not being followed. A government working
group was established to review existing legislation, and after
extensive discussions with health authorities and the sunbed
industry, it was determined that the health benefits of sunbed
tanning were little or none, certainly not enough to outweigh
their dangers. The IARC’s damning report on tanning was a kind
of final straw, and on November 9, 2009, the Brazilian National
Health Surveillance Agency (ANVISA) banned UV cosmetic tanning
altogether throughout the country.30
Gathering Steam
Following the lead of these nations, and swayed by the
mounting research, other countries are now jumping on the
anti-tanning express.
• In the US, though the FDA has not yet strengthened its
tanning bed regulations, it recently held a public meeting
to consider raising sunbeds from a Class I medical device to
Class II or III, thereby allowing the FDA to increase safety
regulations and oversight.31,6
• The Canadian Dermatology Association (CDA) has launched
a campaign called “Indoor Tanning Is Out” to educate
Canadians about the dangers of tanning beds, gathering
support to convince Parliament to ban indoor tanning
for people under age 18.5. As part of the campaign, young
tanners who are now battling skin cancers have publicly
presented their personal stories.31,32
• Lawmakers in the UK, urged by the British Association of
Dermatologists, have also initiated efforts to ban teenagers
from using tanning beds, and to eliminate the dangerous
coin-operated unmanned booths.33 Nearly 90 percent of the
population surveyed backs these proposals, and legislation
is likely forthcoming to ban young people under age 18.34
Wales is very close to final approval of such legislation.
Odds are, this momentum will only keep building as more and
more research comes to light. Given the mounting evidence about
the risks of tanning beds and the number of countries introducing
legislation to control these risks, I expect that one day public use
of these dangerous devices will be a thing of the past, reserved
for medical use in doctors’ offices, where they rightfully belong.
CRAIG SINCLAIR is Director of the Cancer Prevention Centre, Cancer
Council Victoria, Australia. He is also Head of the World Health Organization’s Collaborative Center for UV Radiation, and Chairman of both the
Cancer Council Australia’s National Skin Cancer Committee and the
Standards Australia Committee on Artificial Tanning.
65
inTErnATiOnAL
Clare’s Legacy
Clare Oliver, a budding 26-year-old Australian journalist,
died from melanoma on September 13, 2007. At age 19, she
had made several visits to a tanning parlor, sustaining
skin damage, and in the days before her death, she wrote a
newspaper story and gave broadcasts from her hospice bed
calling for a ban on tanning beds.1
Her words did not fall on deaf ears. Driven by the public
outcry and media firestorm her case stirred up, legislators
have passed laws across Australia significantly regulating
the tanning industry.
All five major states in Australia — New South
Wales, Victoria, South Australia, Western Australia, and
Queensland — have banned access to tanning beds for
everyone under age 18.2,3 Most states also ban access to
fair-skinned people (skin type I),2,3 and operators must
display health warnings or risk up to million-dollar fines.4
This flurry of legislation has driven countless tanning parlors
out of business, leaving the industry in peril.4
From 1996 to 2006, The Australian Yellow Pages® showed
more than a 300 percent increase in tanning salons.5 In the
most recent Yellow Pages® for each capital city, the number
66
had dropped by 32 percent in the past three years. Most
striking was the change in Melbourne, with a 51 percent
decrease in solarium businesses.5,6 Similarly, by late 2009, only
half of the 150 businesses using sunbeds in South Australia
were still operating, and some of those had stopped offering
tanning beds as well.7,8
Victoria’s solarium industry was on the brink of collapse,
with a 45 percent drop in tanning salons since the State
Government regulations were introduced.4 It had gotten so
bad for the tanning industry that its peak body, the Australian
Tanning Association, had to disband after being legally
challenged by government regulators for its actions.4
Researchers reported in a 2009 Australian and New
Zealand Journal of Public Health that the number of
tanning salons nationally had dropped from 406 to 278.5,6
And sometime this year, the number is expected to have
dropped by up to 60 percent4 — not all the way there yet,
but Clare would undoubtedly be proud of the progress that
has been made.
N EWS F ROM T H E I N T ER NAT IONA L A DV ISORY COU NCI L
31st Annual Meeting of the International Society for Dermatologic Surgery
ANNOUNCEMENT
in cooperation with:
The Romanian Society for
Aesthetic Medicine and Dermatologic Surgery
Mark your Calendar
Bucharest/Romania
September 23-26, 2010
Get detailed information at: info @ isdsworld.com // www.isdsworld.com
ISDS Headquarters Office // Seeheimer Straße 3 // D-64297 Darmstadt/Germany
Phone: +49 (0) 6151 9518 89 2 // Fax: +49 (0) 6151 9518 89 3
INTERNATIONAL
The Road to Group I
How the International Agency for Research on
Cancer Came to Classify Indoor Ultraviolet (UV)
Tanning as Carcinogenic to Humans
Philippe Autier, MD, MPH
I
n 2009, a working group of the International Agency for Research on
Cancer (IARC), affiliated with the World Health Organization (WHO),
added ultraviolet radiation (UVR) from tanning machines to its Group I
list of the most carcinogenic (cancer-causing) forms of radiation. Citing
evidence from years of international research on the relationship between
indoor tanning and skin cancer, the IARC placed this type of UVR in
a danger category alongside offenders such as radon, plutonium, and
solar UVR.
UVB and Skin Cancer
An estimated 90 percent of all skin cancers
are associated with exposure to UV radiation, mainly from the sun. UV reaches the
earth in the form of shortwave, ultraviolet
B (UVB) and long-wave, ultraviolet A (UVA)
rays. Scientists have been studying UVR
for decades, and by the end of the 1980s
had well documented the carcinogenic
properties of UVB. They knew that in
the lab, it caused DNA mutations in skin
cells that led to the development of cancer;
triggered the growth of what resembled
human squamous cell carcinoma (the
second most common human skin cancer)
in rodents; and was more responsible than
68
UVA for inducing sunburn. At the same
time, studies provided increasing evidence
that sunlight was the main environmental
cause of skin cancer, the risk of which was
then strongly associated with a history of
sunburn. Thus, UVB was believed to be the
Visible Light
Ultraviolet Light
UVA
700–400 nm
400–320 nm
(nm = nanometer or
billionths of a meter)
increasing wavelength
UVB
320–290 nm
major cause of skin cancer. Much less data
was available on the role of UVA in skin
cancer. However, scientists considered it
of the utmost importance to learn more,
believing that research could prompt
innovations in sun protection, such as
improved, broader spectrum sunscreen
formulations.
After a thorough review of all available data from laboratory, animal, and
human studies, in 1992 a Working Group
convened by the IARC first placed solar
radiation, and more specifically the sun’s
UV radiation, in the IARC Group I of the
most dangerous carcinogenic agents for
humans.1 (For details on the criteria for
Group I, see www.iarc.fr — monograph
program.) However, there wasn’t yet
sufficient evidence to assign specific
wavelengths, like UVB, to Group I,
so both UVA and UVB were classified as
“probably carcinogenic to humans,” placing
them in the IARC’s Group IIa. Evidence
suggested but was not yet conclusive that
UVB was a human carcinogen, and UVA
was suspected to be a carcinogen.
Uncertainties primarily resulted from
the many unanswered questions about the
causes of melanoma, the deadliest form of
N ews from the I nternational A D V I S O R Y C O U N C I L
Figure 1. Risk of Melanoma in People <35 Years Old at First Sunbed Use4,6
STUDIES
Swerdlow et al, 1988
Westerdahl et al, 1994
Chen et al, 1998
Walter et al, 1999
Westerdahl et al, 2000
Veierod et al, 2003
Bataille et al, 2005
Figure 1: A 2006 survey (meta-analysis) of key tanning
bed studies over the past two decades found an overall
75 percent increase in melanoma when indoor tanning
began before tanners reached age 35. [The size of the box
on each line (each line repesenting a different study) is
proportional to the number of the subjects included in
each study.] Summary relative risk indicates the total
range of relative risk, from 1.35 - 2.26.
skin cancer. In animal studies, UVB was
found to induce squamous cell carcinoma
(SCC), but had not been found to cause
tumors resembling human melanomas;
nor had DNA mutations specific to UVB
exposure been found in melanoma. Epidemiologic studies (statistical studies on
human populations that explore the links
between human health effects and specified causes) suggested that melanoma was
due to intermittent, intense sun exposure,
acquired mainly during tanning, leisure, or
sports activities. This would explain why
melanoma was frequently found on areas
normally sun-protected in everyday life,
such as the trunk and thighs. In contrast,
SCC occurred most frequently on chronically sun-exposed areas (e.g., the head and
neck) of elderly subjects, and was considered to be mainly due to cumulative sun
exposure. At that point, the involvement
of sun exposure, and of UVB in particular,
in the development of melanoma simply
did not appear as clear or important as it
was in SCC. With even less known about
UVA, it was deemed premature to make a
clear-cut distinction between UVB’s and
UVA’s roles in skin cancer.
The Role of UVA
The marketing of modern UV tanning
devices started at the end of the 1980s,
with the advent of fluorescent lamps mainly
emitting UVA rays. (Some UVB — less than
five percent of the lamps’ UV output — also
Summary relative risk
1.75 (1.35 – 2.26)
0.5
1.0
1.5
2.0
2.5 3.0
5.0
7.0
Relative Risk
was emitted, since this wavelength is better
at inducing a deep, long-lasting tan.) With
no convincing proof yet of UVA’s link to
skin cancer and only a low amount of UVB
included, tanning vendors could argue that
acquiring a tan was safe (or safer) when
obtained at a salon.
Powerful UV tanning
units may be 10 to 15
times stronger than
the midday sunlight on
the Mediterranean Sea,
subjecting indoor tanners
to UVA doses well above
those experienced during
daily life or even when
sunbathing outdoors.
During the 1990s and into the 2000s,
indoor tanning became very popular
among light-skinned populations, and is
now suspected to be one cause of the rise in
melanoma incidence. Powerful UV tanning
units may be 10 to 15 times stronger than
the midday sunlight on the Mediterranean
Sea, subjecting indoor tanners to UVA doses
well above those experienced during daily
life or even when sunbathing outdoors.
The fact is, repeated exposure to large,
concentrated amounts of UVA constitutes
a new experience for human beings.
Studies have gradually strengthened the
evidence for a causal relationship between
UVA exposure from indoor tanning and
skin cancer, especially melanomas of the
skin and eyes. These data were systematically reviewed in an IARC monograph in
June 2009, and the main results can be
summarized as follows:
1. Extensive laboratory data and animal
experiments document a role for UVA in
skin cancer development.2,3 In fact, UVA
penetrates the skin more deeply than
UVB and can cause damage to cells in the
middle layer of skin (the dermis), while
UVB does most of its damage in the top
layer (epidermis). UVB causes DNA mutations more directly, while UVA causes DNA
damage more indirectly; however, in both
cases the DNA mutations can lead to cancer.
And there is some evidence that the body’s
repair and removal of damaged DNA is
less effective when the damage is caused
by UVA.
2. Experiments in human volunteers show
that tanning lamps produce the types of
DNA damage associated with UV-induced
skin cell mutations that can lead to cancer.4
3. Experiments in human volunteers also
show that both UVA and UVB can damage
the immune system.4
69
INTERNATIONAL
4. Systematic reviews of studies show
that intermittent, intense sun exposure
is the main environmental risk factor for
melanoma5; this pattern can be simulated
by indoor UV tanning.
5. While studies have not consistently
shown that indoor UV tanning is a risk
factor for melanoma, during a 2006 IARC
review, all seven studies examined found
a significant increase in melanoma risk
(ranging from a 40 percent increase to
a 228 percent increase) when indoor UV
tanning started during adolescence or
young adulthood.4,6 The meta-analysis (an
analysis of the results of several studies)
found an overall 75 percent increase in
melanoma risk when indoor UV tanning
began before tanners reached age 35
[Figure 1]. In another meta-analysis, the
Working Group found some evidence that
UV tanning increased the risk of squamous
cell carcinoma, especially when tanning
bed use started before age 20. These
results were highly consistent with the
considerable data pointing to childhood
and adolescence as the key periods for
initiation and development of melanoma
in adulthood.7
6. Four studies have reported an increased
risk for ocular melanoma among UV tanning device users.8 Again, the risk of this
rare but dangerous cancer was greater
for subjects who started indoor tanning
before age 20.
Further review of the studies by the
IARC found no indication that the findings were due to any problems with study
design. All the research substantiated a role
for both UVA and UVB in human cancer
development. Thus, the entire UV spectrum
and UV-emitting tanning devices were
classified as carcinogenic to humans.9
UV tanning’s relationship to the rise in
melanoma incidence has been corroborated
by a number of recent epidemiological
studies. A few years ago, we predicted
that we would begin seeing an increase
in melanomas associated with tanning bed
use on the trunk, especially in women.10 In
areas where indoor UV tanning is popular,
especially among teenagers and young
adults, such as in Sweden, Iceland, and
A = Men
B = Women
12
12
10
10
8
6
4
2
8
6
4
2
0
1960
DR. AUTIER is the Research Director of the iPRI
(International Prevention Research Institute), in
Lyon, France, and the former Head of the Unit of
Prevention Evaluation and Cluster Coordinator
of the Biostatistics and Epidemiology Cluster
at the International Agency for Research on
Cancer (IARC), affiliated with the World Health
Organization (WHO).
Dr. Autier is a member of the editorial board
of Melanoma Research and the European Journal of Cancer and a member and co-chairman
of EPIMEL, the Epidemiology and Prevention
section of the EORTC Melanoma Cooperative
Group. He has published more than 140
scientific articles.
B
CASES PER 100,000
CASES PER 100,000
A 2. Melanoma in Sweden, 1960-200411
Figure
Northern Ireland, sharp increases in the
incidence of melanoma on the trunk have
indeed been described.11,12 [See Figure 2].
In view of all the amassed knowledge
on the detrimental effects of indoor UV
tanning, public health officials need to
increase control over indoor tanning, starting by preventing exposure to UV lamps
by teenagers and young adults.
0
’70
YEAR OF DIAGNOSIS
’80
’90
’00
Men, head-sites
Men, trunk
Men, upper limbs
Men, lower limbs
Men, multiple parts/unspec
’04
1960
’70
YEAR OF DIAGNOSIS
’80
’90
’00
’04
Women, head-sites
Women, trunk
Women, upper limbs
Women, lower limbs
Women, multiple parts/unspec
Figure 2. Incidence (cases/100,000, European Standard Population) of melanoma
by body site, men and women, Sweden 1960-2004. While leg melanomas have
always predominated in light-skinned women, after 1975 incidence rates for women
increased more rapidly on the trunk than on the legs, and by the end of the 1990s,
the incidence of trunk melanomas had caught up to that of leg melanomas. Experts
hypothesize that this phenomenon among women is largely due to increased
full-body exposure to tanning devices.
70
N ews fr o m t h e I nternati o na l A D V I S O R Y C O U N C I L
Melanoma
and Sunny
Vacations
PROFESSOR JULIA NEWTON BISHOP, MD
PROFESSOR TIM BISHOP, PHD
PAUL AFFLECK, MA
Melanoma, the most serious form of skin
cancer, occurs everywhere in the world.
However, it is much more frequent in
fair-skinned peoples, particularly those
living in sunny locales. The most common
type of melanoma, superficial spreading
melanoma, is seen mainly in people with
fair skin.
Over the last century, people developed
more positive attitudes towards sun exposure [see From Bardot to Beckham; Skin
Cancer Foundation Journal Vol. XXVIII,
page 42], and holidays to sunny climes
increased. People also began wearing far
less clothing outdoors at beaches and other
vacation areas. This growth in recreational
sun exposure is believed to be the reason
melanoma cases have increased so dramatically in the past 50 years.
Sun Exposure Patterns
and Melanoma Risk:
What the Data Show
Case-control studies comparing melanoma
patients (cases) with non-patients (controls)
provide strong evidence that sunburn is
an important factor in the development
of melanoma; people with the disease are
more likely to have a history of sunburns
than those without the disease. However,
the relationship between the pattern of sun
exposure and melanoma risk is complicated.
We might have expected a fairly simple
relationship, whereby increased overall
sun exposure raises the risk of melanoma.
However, the studies do not show this, and
only by pooling data from many studies
have we been able to understand why.
Dr. Sara Gandini, of the European
Institute of Oncology in Milan, did a type
of study called a meta-analysis, in which
she put together and then examined the
results of many different studies on melanoma risk factors.1 Her research showed
that intermittent, intense sun exposure
(the kind obtained on a sunny holiday)
was associated with an increased risk of
melanoma, while large amounts of regular
daily sun exposure were not.
Recently, Yu-Mei Chang of the University
of Leeds did an even more detailed study,
a pooled-analysis, combining not just the
results but the original data from various
studies.2 Dr. Chang’s study confirmed that
regardless of where people live, sunny
holidays are associated with an increased
risk of melanoma. Large amounts of sun
exposure accumulated over a long period,
71
INTERNATIONAL
DANGER: People with
red hair are at increased
risk, as are people with
freckles regardless of
hair color, and people with
blue, green, or gray eyes.
such as might result from working outside,
were shown to be associated with increased
melanoma risk only on certain body parts
(such as the limbs); furthermore, this increase was mainly limited to very sunny
countries, like Australia.
The studies suggest a key role for sunny
holidays and sunburn in melanoma development for people living in temperate zones.
However, when pale-skinned people live in
locales closer to the equator, both holiday
sun exposures and very large cumulative
sun exposures are believed to increase
their melanoma risk. Large cumulative
sun exposures are also known to increase
the risk of the nonmelanoma skin cancer
(NMSC) squamous cell carcinoma for people
living either in temperate or warmer zones.
The Role of Genetics
In all case-control studies, inherited
characteristics — such as skin type (how
easily the skin burns in the sun), hair color,
and eye color — have been shown to be
important when it comes to melanoma risk.
People with red hair are at increased risk, as
are people with freckles regardless of hair
color, and people with blue, green, or gray
eyes. Our genes control these characteristics, and recent studies have highlighted
the role they play. For example, the genes
MC1R and TYR influence skin color and
how the skin reacts to sunlight.3,4
Moles (benign nevi) are also an important risk factor. Studies of twins show
that genes largely determine our number
of moles. A mole is a growth of pigmentproducing cells (melanocytes). Though
72
normal moles are individually harmless,
having a large number is a risk factor for
melanoma; having over 100 indicates a
higher melanoma risk than having red hair.
The reason for the increased risk is probably
that “mole genes” result in melanocytes
that tend to divide more, over a longer
period of one’s life, especially when the
skin is exposed to the sun. More division
This growth in
recreational sun exposure
is believed to be the reason
melanoma cases have
increased so dramatically in
the past 50 years.
of melanocytes means a greater chance
of developing mutations that can lead
to melanoma.
Conversely, the risk of melanoma
resulting from sunny holidays is lower in
people with very few moles and dark skin
that rarely or never burns. So, the number
of moles we have and our skin color are
determined at least in part by our genes
(our heredity), and certain genes increase
melanoma risk. The likelihood of developing a melanoma is then also influenced by
sun exposure. The idea that disease results
from both inherited genes and the environment is well accepted in many areas of
health. For instance, smoking causes lung
cancer, but whether a particular smoker
will develop lung cancer partly depends
on his or her genes.
What is it about sunny holidays that
appears to cause melanoma? Most people
living in Europe and North America work
inside, and many take relatively short
but very sunny holidays. Often, most of
the body is exposed to the sun on these
vacations, and the combination of fair, unacclimatized skin and sudden intense sun
exposure causes a lot of sunburn. Research
has shown that the sun’s ultraviolet radiation can damage not only the DNA in our
skin cells, but also our immune system,
reducing the body’s ability to repair the
damaged DNA. This dual challenge to
the system may play a central role in
causing melanoma.
Intermittent, Intense Sun
Exposure and Vitamin D
Some sun exposure can be beneficial to
psychological health, and since it also
brings about vitamin D synthesis, many
experts also consider it important to physical health. However, there is clear evidence
that in fair-skinned and “moley” people,
holiday sun exposure and sunburn have
been resulting in a sustained increase
in melanoma incidence. To control this
dramatic increase, it will be necessary to
moderate this type of exposure in the vulnerable. However, because of vitamin D’s
vital health benefits, such as bone-building
and disease-fighting, this should be done
without resulting in vitamin D deficiency.
What are adequate levels of vitamin D?
In cardiovascular disease studies, both low
and high levels of vitamin D were reported
as harmful.5 The effects of vitamin D on
several aspects of health are considered
most favorable at a serum level of around
70nmol/L (70 nanomoles of vitamin D
per liter of blood). This level in the blood
depends on very many things such as body
mass index, genes, etc. In the US, the Office
of Dietary Supplements has established
tolerable upper intake levels for vitamin
D at 25 mcg/1,000 International Units or
IU, for babies under one year old; and 50
mcg/2,000 IU for everyone else. While rare,
vitamin D toxicity can cause nausea, weakness, and raised blood levels of calcium,
which may lead to mental confusion and
heart rhythm problems.
Since sunburn can start after a few
minutes of unprotected sun exposure, it
is safest for fair-skinned people to gain most
of their vitamin D by eating vitamin D-rich
foods and taking vitamin D supplements in
line with recommended daily allowances.
For those whose skin almost never burns,
who are not “moley,” and who do not have
a family history of skin cancer, the message is less clear. Such people should avoid
sunburn but make sure they obtain enough
vitamin D. Darker-skinned people living in
temperate zones must be especially vigilant
about taking in enough vitamin D, because
the greater amounts of pigment (melanin) in
their skin make them less able to produce
the vitamin in response to UVB exposure.6
Conclusion
Melanoma is not the only reason to practice
sun protection, since large doses of sun
exposure spread over a long period also
accelerate skin aging and increase the risk
There is clear evidence
that in fair-skinned and
“moley” people, holiday sun
exposure and sunburn
have been resulting
in a sustained increase in
melanoma incidence.
• Avoid excessive sun exposure
and sunburn.
• Maintain adequate levels of
vitamin D without compromising
your health.
PROFESSOR NEWTON BISHOP is a consultant dermatologist at St. James’s University
Hospital in the UK city of Leeds, the head of
the melanoma research group within the section of epidemiology and biostatistics at the
University of Leeds, and the scientific coordinator of the international melanoma research
consortium GenoMEL.
PROFESSOR BISHOP is the head of the section of
epidemiology and biostatistics within the Leeds
Institute of Molecular Medicine at the University
of Leeds, UK.
PAUL AFFLECK is a project manager with the
international melanoma research consortium
GenoMEL.
of developing squamous cell carcinoma (a
common form of NMSC that kills 2,500
Americans annually). Some combination
of intermittent, intense exposure and
long-term, cumulative exposure also
plays a part in basal cell carcinoma, the
most common skin cancer. So, despite a
somewhat complicated picture, a clear
message can be given:
[Editor’s note: The Skin Cancer
Foundation advises everyone to use
sun protection outdoors and to obtain
vitamin D chiefly through food and/or
supplements. Adults who practice sun
protection or have limited sun exposure
may increase their intake of vitamin
D to 1,000 IU daily.]
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INTERNATIONAL
References
Banning the Tan Around the World (p.63)
1. The history of tanning beds, eHow, http://www.ehow.com/about_4805677_
history-tanning-beds.html
2. Kwon HT, Mayer JA, Walker KK, Yu H, Lewis EC, Belch GE. Promotion of
frequent tanning sessions by indoor tanning facilities: two studies. J Am Acad
Dermatol 2003; 46:700-5.
3. Demierre MF. Time for the national legislation of indoor tanning to protect
minors. Arch Dermatol 2006; 139:520-4.
4. Sunbeds. www.who.int. 24 Mar 2009. http://www.who.int/uv/faq/sunbeds/
en/index.html
5. http://www.procprblog.com/tanning-makes-skin-cancer-the-most-commonform-in-young-women
6. Advocacy. The Skin Cancer Foundation. http://support.skincancer.org/site/
PageServer?pagename=FDA_Dec_2009_Petition
7.Learn if a Medical Device Has Been Cleared by FDA for Marketing, http://
www.fda.gov/MedicalDevices/ResourcesforYou/Consumers/ucm142523.htm
8. Under 18s ‘shouldn’t use sunbeds’. BBC News. 17 March 2005. http://news.
bbc.co.uk/2/hi/health/4357689.stm
9.Hope J. Girl, 10, suffers burns on 70% of her body after 16 minutes in coinoperated tanning booth. Mail Online 1 May 2009. http://www.dailymail.co.uk/
health/article-1176167/Girl-10-suffers-burns-70-body-16-minutes-coin-operatedtanning-booth.html
10. Gavin A, Donnely C, Devlin A, et al. Public at risk – a survey of sunbed
parlour operating practices in Northern Ireland. British Journal of Dermatology
2010; 162:627-632. http://www.qub.ac.uk/research-centres/nicr/FileStore/PDF/
Filetoupload,184170,en.pdf
11. Sun bed consultation. Environmental Health, Environmental Health Officers’
Association, Department of Health and Children, Dublin 2. http://www.ehoa.ie./
docs/sunbeds0608.doc.
12. 11th ROC: Ultraviolet Radiation Related Exposures. 27 January 2005. U.S.
Department of Health & Human Services. 15 April 2008. http://ntp.niehs.nih.gov/
ntp/roc/eleventh/profiles/s183uvrr.pdf
13. Sunbed use as a melanoma time bomb? World Health Organization. www.
who.int 24 march 2009. http://www.who.int/uv/faq/sunbeds/en/index5.html
14. El Ghissassi F, Baan R, Straif K, et al. A review of human carcinogens — Part
D: radiation. WHO International Agency for Research on Cancer Monograph
Working Group. The Lancet Oncology 10; August 2009, Special Report: Policy.
IARC Monographs.
15. Pleasance ED, Cheetham RK, Stephens PJ, et al. A comprehensive catalogue
of somatic mutations from a human cancer genome. Nature 16 December 2009.
Advance online publication. http://www.nature.com/nature/journal/vaop/ncurrent/
full/nature08658.html.
16. Karagas MR, Stannard VA, Mott LA, et al. Use of tanning devices and risk of
basal cell and squamous cell skin cancers. J Natl Canc Inst 2002; 94:224; doi:10.1093/
jnci/94.3.224
17. Gordon LG, Hirst NG, Gies PHF, Green AC. “What impact would effective
solarium regulation have in Australia?” MJA October 2008; 189:7:6:375-8.
18. The International Agency for Research on Cancer Working Group on artificial
ultraviolet (UV) light and skin cancer. The association of use of sunbeds with
cutaneous malignant melanoma and other skin cancers: A systematic review.
International Journal of Cancer 2006; 120:1116-1122.
19. Gara R. Sunbeds Cause Skin Cancer, Warns WHO. HEALTH NEWS 17 March
2005. http://health.dailynewscentral.com/content/view/521/63.
20. Perry M. Solariums found to raise skin cancer risk in young. January 18 2008. nzherald.co.nz. www.nzherald.co.nz/lifestyle/news/article.
cfm?c_id=6&objectid=10487507
21. Diffey BL. A quantitative assessment of melanoma mortality from ultraviolet
A sunbed use in the U.K. British Journal of Dermatology 2003; 149(3).
22. Tanning restrictions for minors. A state-by-state comparison. NCSL, National
Conference of State Legislatures. Updated January 2010. http://www.ncsl.org/
IssuesResearch/Health/TanningRestrictionsforMinorsstatelawssummary.
23. California bans kids from tanning salons. Reuters Saturday September 25, 2004.
Expressindia.com. http://www.expressindia.com/news/fullstory.php?newsid=36533.
24. Dellavalle RP, Parker ER, Cersonsky N, et al. Youth Access Laws. In the dark
at the tanning parlor? Arch Dermatol 2003; 139:443-448.
25. Texas prohibits indoor tanning for minors. Articlesbase.com August 20 2009.
Shared by skininc.com. http://www.articlesbase.com/health-articles/texas-prohibitsindoor-tanning-for-minors-1145300.html.
26. http://www.opsi.gov.uk/legislation/scotland/acts2008/en/08en05-d.htm
27. Solarium ban for under-18s and fair-skinned people, New South Wales,
Australia. Medical News Today, April 11, 2008. http://www.medicalnewstoday.
com/articles/103748.php
28. Restrictions put on solarium users, from Australian Associated Press, May
11, 2009.
29. Stark J. Tanning salons are fading fast. theage.com.au THE AGE June 21 2009,
http://www.theage.com.au/national/tanning-salons-are-fading-fast-20090620-crz0.
html.
30. Cumberland S, Jurberg C. From Australia to Brazil: sun worshippers beware.
Bulletin of the World Health Organization 2009 August; 87(8):574-575. doi: 10.2471/
BLT.09.030809. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2733274
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31. Canada moves to ban indoor tanning in kids under 18. EmaxHealth. From
Canadian Dermatology Association. http://www.emaxhealth.com/1275/66/35364/
canada-moves-ban-indoor-tanning-kids-under-18.html
32. Canadian Dermatology Association homepage. http://www.dermatology.ca/
indoortanning/index.html
33. Morton E, Wighton K. Dying for a tan: Live It campaigns for clampdown after
teen sunbed ban in Wales. http://www.thesun.co.uk/sol/homepage/woman/health/
health/2662839/Dying-for-a-tan-Liv... 10/1/2009
34. Public wants ban on sunbeds for under 18s. Cancer Research UK Press Release.
Cancer Research UK Thursday 16 July. 2009.http://info.cancerresearchuk.org/news/
archive/pressrelease/2009-07-16-public-want-ban-on-sunbeds-for-under-18s.
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1.Oliver O. A tan to die for. Herald Sun August 23, 2007. http://www.news.com.
au/national/a-tan-to-die-for/story-e6frfkx0-1111114248428
2. Solarium ban for under-18s and fair-skinned people, New South Wales,
Australia. Medical News Today, April 11, 2008. http://www.medicalnewstoday.
com/articles/103748.php
3. Restrictions put on solarium users, from Australian Associated Press, May
11, 2009.
4. Stark J. Tanning salons are fading fast. theage.com.au THE AGE June 21 2009,
http://www.theage.com.au/national/tanning-salons-are-fading-fast-20090620-crz0.
html.
5. Makin JK, Dobbinson SJ. Changes in solarium numbers in Australia following
negative media and legislation. Australian and New Zealand Journal of Public
Health 2009; 33:5.
6. Shepherd T. Cancer dangers shut solariums in South Australia. From: The
Advertiser October 7, 2009. http://www.news.com.au/national/cancer-dangersshut-solariums-in-south-australia/story-e6frfkx9-1225783559095
7. Australians turn their backs on solariums, ABC News online, Wed. October
7, 2009, http://www.abc.net.au/news/stories/2009/10/07/2706889.htm
8. Shepherd T. Tough regulations for solariums come into force. The Advertiser
January 7, 2009, updated March 11, 2010. http://www.adelaidenow.com.au/news/
south-australia/tanning-salons-put-people-at-risk/story-e6frea83-1111118516119.
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2. Rünger TM, Kappes UP. Mechanisms of mutation formation with long-wave
ultraviolet light (UVA). Photodermatology, Photoimmunology & Photomedicine
2008; 24:2–10.
3. Ridley AJ, Whiteside JR, McMillan TJ, et al. Cellular and sub-cellular responses
to UVA in relation to carcinogenesis. Int J Radiat Biol 2009; 85:177-195.
4. International Agency for Research on Cancer (IARC). Exposure to artificial UV
radiation and skin cancer. IARC Working Group Reports No 1. IARC, Lyon; 2006
(freely available at www.iarc.fr).
5. Gandini S, Sera F, Cattaruzza MS, et al. Meta-analysis of risk factors for cutaneous
melanoma: II. Sun exposure. Eur J Cancer 2005; 41:45–60.
6. International Agency for Research on Cancer Working Group on artificial
ultraviolet (UV) light and skin cancer. The association of use of sunbeds with
cutaneous malignant melanoma and other skin cancers: a systematic review. Int
J Cancer 2007; 120(5):1116-1122. Erratum in: Int J Cancer 2007; 120(11):2526.
7. Autier P, Boyle P. Artificial ultraviolet sources and skin cancers: rationale for
restricting access to sunbed use before 18 years of age. Nat Clin Pract Oncol 2008;
5(4):178-179.
8. Vajdic CM, Kricker A, Giblin M, et al. Artificial ultraviolet radiation and ocular
melanoma in Australia. Int J Cancer 2004; 112:896-900. PM:15386378.
9. El Ghissassi F, Bann R, Starif K, et al. A review of human carcinogens – Part
D: radiation. Lancet Oncol 2009; 10(8):751-752.
10. Boniol M, Autier P, Doré JF. Re: A prospective study of pigmentation, sun
exposure, and risk of cutaneous malignant melanoma in women. J Natl Cancer
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11. Dal H, Boldemann C, Lindelöf B. Does relative melanoma distribution by body
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12.Héry C, Tryggvadóttir L, Sigurdsson T. A melanoma epidemic in Iceland: possible
influence of sunbed use. Am J Epidemiology (2010, in press).
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2005; 41(1):45-60.
2. Chang YM, Barrett JH, Bishop DT, Armstrong BK, Bataille V, Bergman W, et
al. Sun exposure and melanoma risk at different latitudes: a pooled analysis of
5700 cases and 7216 controls. Int J Epidemiol 2009; 38(3):814-30.
3. Gudbjartsson DF, Sulem P, Stacey SN, Goldstein AM, Rafnar T, Sigurgeirsson
B, et al. ASIP and TYR pigmentation variants associate with cutaneous melanoma
and basal cell carcinoma. Nat Genet 2008; 40(7):886-91.
4. Bishop DT, Demenais F, Iles MM, Harland M, Taylor JC, Corda E, et al. Genomewide association study identifies three loci associated with melanoma risk. Nat
Genet 2009; 41(8):920-5.
5. Wang TJ, Pencina MJ, Booth SL, Jacques PF, Ingelsson E, Lanier K, et al. Vitamin
D deficiency and risk of cardiovascular disease. Circulation 2008;117(4):503-11.
6. Clemens TL, Adams JS, Henderson SL, Holick MF. Increased skin pigment
reduces the capacity of skin to synthesise vitamin D3. Lancet 1982;1:74-6.
International Advisory Council
The International Advisory Council, representing 26 countries, supports and guides the Foundation’s mission to implement prevention
and detection programs for populations at high risk, to disseminate vital information in many languages, and to conduct and co-sponsor
national and international conferences for the medical profession and the general public on this most common cancer.
ARGENTINA
Hugo Cabrera, MD
Patricia Della Giovanna, MD
Patricia Dermer, MD
Leon Jaimovich, MD
Fernando M. Stengel, MD
AUSTRALIA
Ross Barnetson, MD
Robin Marks, MD
Wm H. McCarthy, MD, AM., M.Ed
AUSTRIA
Hubert Pehamberger, MD
Klaus Wolff, MD
BELGIUM
Diane I. Roseeuw, MD
Bertrand Richert, MD
BRAZIL
Cleire Paniago-Pereira, MD
CANADA
Jason Rivers, MD
COSTA RICA
Rodolfo Núñez, MD
ECUADOR
Reuhollah Khozein, MD
FRANCE
Robert L. Baran, MD
Jean-Pierre Cesarini, MD
Brigitte Dréno, MD
Caroline Robert, MD
Nicole Basset-Séguin, MD
GERMANY
Alina Fratila, MD
Claus Garbe, MD
Irmtraud Günther-Klamke, MD
Eckart Haneke, MD
Harald zur Hausen, MD
Gerhard Sattler, MD
Wilhelm Stolz, MD
Luitgard Wiest, MD
GREECE
Dimitra Dasiou-Plakida, MD
Panagiota Emmanouil, MD
Andreas Katsambas, MD
George N. Sgouros, MD
IRELAND
Gillian M. Murphy, MD
Brigid O’Connell, MD
ISRAEL
Joseph Alcalay, MD
Alejandro Ginzburg, MD
Isaac Zilinsky, MD
Miriam Ziv, MD
ITALY
Giorgio Landi, MD
Luigi Rusciani Scorza, MD
Antonio Tulli, MD
JORDAN
Laith Akkash, MD
SPAIN
Francisco Camacho-Martinez, MD
Alejandro Camps-Fresneda, MD
Julian S. Conejo-Mir, MD
Carlos Guillén Barona, MD
Miguel Sanchez Viera, MD
SWEDEN
Ann-Marie Wennberg, MD
SWITZERLAND
Günter Burg, MD
THAILAND
Atchima Suwanchinda, MD
UNITED KINGDOM
Irene Leigh, MD
Rona MacKie, MD
Lesley E. Rhodes, MD
John Hawk, MD
Christopher Rowland Payne, MD
KUWAIT
Sahar Ghannam, MD
MEXICO
Jorge Ocampo-Canadiani, MD
THE NETHERLANDS
Rob C. Beljaards, MD
Jan M. Werner Habets, MD
Kai Munte, MD
Hendrik A.M. Neumann, MD
Bing Thio, MD
PHILLIPINES
Sylvia S. Jacinto-Jamora, MD
PORTUGAL
António Silva Picoto, MD
Osvaldo Correia, MD
ROMANIA
Ana-Maria Forsea, MD
75
LEAdER IN
ThE FIGhT
The Foundation’s mission is to decrease the incidence of the disease by means of
public and professional education, medical training, and research.
The Skin Cancer Foundation:
Leader in the Fight Against Skin Cancer
Since its founding in 1979, The Skin Cancer Foundation has set
the standard for educating the public and the medical profession
about skin cancer, its prevention by means of sun protection, the
need for early detection, and prompt, effective treatment. It is the
only international organization devoted solely to combating the
world’s most common cancer, now occurring at epidemic levels.
Skin cancer is the most common cancer in the world, with
more than 13 million cases diagnosed annually. one of every
three cancers diagnosed is a skin cancer, and up to 65,161 people
die every year from skin cancer. The incidence of melanoma continues to rise at a rate faster than that of any of the seven most
common cancers.
Each year in the U.S. there are more new cases of skin cancer
than the combined incidence of cancers of the breast, prostate,
lung and colon. Almost 9,000 people die from melanoma in the U.S.
every year. Nonmelanoma cancers such as basal cell carcinoma
and squamous cell carcinoma have reached critical levels, with
squamous cell carcinoma killing 2,500 people each year.
Ninety percent of nonmelanoma skin cancers are associated
with exposure to ultraviolet radiation from the sun. A person’s
risk for skin cancer doubles if he or she has had five or more
sunburns. Just one blistering sunburn in childhood more than
doubles a Caucasian’s chances of developing melanoma later in
life. however, the incidence of skin cancer can be dramatically
76
reduced through education, behavior modification, and early
detection. Skin cancer is primarily a lifestyle disease which is
why The Skin Cancer Foundation emphasizes public awareness
and education campaigns.
puBLIC EduCATION AROuNd ThE WORLd
www.SkinCancer.org
More than two million visits annually are made to the Foundation’s
website. With a #1 ranking on major search engines, the site is the
leading patient information resource on skin cancer for millions
of people around the world. In addition, SkinCancer.org features
skin cancer information in several languages and the Foundation
recently launched SkinCancer.com.mx and SkinCancer.ar.com to
bring life-saving sun protection and skin cancer information to
people in Mexico and latin America.
Public Information
The Foundation’s educational materials are distributed by dermatologists and at screening clinics, health fairs, and at community
wellness programs by nurses, educators and schools. Several retail
chains also distribute our sun protection information; millions of
brochures, posters, books, newsletters, manuals, public service announcements, and audiovisual materials are distributed annually.
SK I N C A NCER FoU N DAT IoN JoU R NA l
Media
The Foundation is recognized as a major resource on skin cancer
for print and electronic media and generates more than 600 million media impressions a year. Coverage of the Foundation and
information about skin cancer has been generated on local and
national news programs such as Good Morning America and
Today, on websites, in magazines from Vogue to TIME, and in
newspapers including The New York Times, USA Today and The
Wall Street Journal. Coverage of the Foundation’s biannual World
Congress on Cancers of the Skin has been secured in Spain, Greece,
Argentina, Italy, Israel, and other countries.
The Seal of Recommendation
for Sun Protection Products
As a valuable guide to consumers, the Foundation’s Seal
of Recommendation is granted to sun protection products
that meet the stringent criteria of an independent Photobiology Committee. One of the first programs offered by the
Foundation, it quickly gained acceptance from consumers
for setting the standard for effective sun protection with
sunscreen products, sunglasses, specially
treated auto and residential window film,
umbrellas, clothing and laundry products
that wash UV protection into clothing.
Currently more than 800 products carry
the Seal nationally and internationally.
Grassroots Program
The Foundation’s Road to Healthy Skin Tour is a travelling skin
cancer screening and resource center that visits nearly 80 cities in
the U.S. and reaches thousands of people annually. The Sunsational
Guide to Smart Sun Safety / Fun in the Sun 101 initiative is a
children’s education program comprised of both in-school and
online components. The Foundation’s public service advertising
campaign, Go With Your Own
GlowTM, focuses on how tanning is no longer in fashion.
The ads have been featured in
more than 15 magazines.
Research
Funding is provided annually for basic research and clinical studies
related to skin cancer. Over ninety research grants, totaling almost
$1 million, have been awarded since 1981.
Advocacy
Historically, government funding for research on melanoma and
the prevention of skin cancer has been disproportionately low.
However, the Foundation, along with the National Council on
Skin Cancer Prevention, was successful in securing $4 million for
melanoma research from the Department of Defense in 2009. In
2010, the goal is $5 million. Recently, the Foundation has gotten
very involved in anti-tanning bed advocacy on the federal level
by urging the U.S. Food and Drug Administration to enact stricter
tanning bed regulations.
International Outreach
The Skin Cancer Foundation is committed to stopping skin
cancer on a global basis and has been a catalyst for the establishment of skin cancer organizations in many countries. Public
education abroad is sponsored by the International Advisory
Council, representing 26 countries. The Council supports and
guides the Foundation’s mission to implement prevention and
detection programs for high risk populations, to disseminate
vital information in many languages, and to conduct and
co-sponsor national and international conferences for the medical
profession and the general public on this most common cancer.
The Foundation’s World Congress on Cancers of the Skin has
taken its message around the world, providing an opportunity
for physicians from many countries to exchange ideas on the
prevention, diagnosis, and treatment of skin cancer.
The National Council on Skin Cancer Prevention
The Council is a coordinating body that seeks to establish a national
action agenda on skin cancer. The Skin Cancer Foundation serves
as a core member along with the American Cancer Society, the
American Academy of Dermatology, the Melanoma Research
Foundation and the SHADE Foundation.
Inside the Foundation
President
Perry Robins, MD
Corporate Secretary
Mitzi Moulds
Senior Vice Presidents
Rex A. Amonette, MD
C. William Hanke, MD
Elizabeth Robins, Esq.
Deborah S. Sarnoff, MD
The Dr. Rex and Johnnie Amonette Circle, formed in 2004 to
mark the Foundation’s 25th anniversary, is comprised of physician
members who are making a lifetime commitment of support to
the Foundation.
Professional Members:
Members and other distinguished physicians form a network of
close to 700 dermatologists, Mohs surgeons, plastic surgeons and
residents who play a critical role in the organization’s educational
outreach.
Corporate Partners:
The Corporate Leadership Council works in close partnership
with Foundation management to help achieve its mission. The
Corporate Council is a larger group of companies that support our
mission and are eligible to apply for the Seal of Recommendation.
The Skin Cancer Foundation has been honored with the American
Academy of Dermatology’s Excellence in Education Award and
fourteen Gold Triangle Awards for Community Service.
77
BOARD OF DIRECTORS
PHOTOBIOLOGY COMMITTEE
EXECUTIVE DIRECTOR
President
Perry Robins, MD
Warwick L. Morison, MB, BS, MD
Chairman
John H. Epstein, MD
Heidi Jacobe, MD
Henry W. Lim, MD
Steven Q. Wang, MD
Mary Stine
Senior Vice Presidents
Rex A. Amonette, MD
Elizabeth Robins, Esq.
Corporate Secretary
Mitzi Moulds
Vice Presidents
Daniel C. Baker, MD
Leonard H. Goldberg, MD
Allan C. Halpern, MD
Susan H. Weinkle, MD
ADVISORY Board
Anne Akers
Mindy Gorman
Anand Khubani
Kenneth Kolker
Anthony P. Leichter
Dennis P. Lynch, Esq.
Dr. Marcia Robbins-Wilf
Axel Stawski
Bennett Weiner, Esq.
William Wiener
PUBLICATIONS EDITORS
The Skin Cancer
Foundation Journal
Pearon G. Lang, Jr., MD
Medical Editor
The Melanoma Letter
Editor-in-Chief
Ashfaq A. Marghoob, MD
Associate Editor
Alfred W. Kopf, MD
Consulting Editor
Sun & Skin News
Ritu Saini, MD
Medical Editor
RESEARCH GRANTS COMMITTEE
Jean-Claude Bystryn, MD
Chairman
Jeffrey Dover, MD, FRCPC
David J. Leffell, MD
Bijan Safai, MD, DSc
DR. MARCIA ROBBINS-WILF
AWARDS SOCIETY
Clark A. Johnson
Steve Laumas
Leonard Mazur
Neil S. Sadick, MD
FOUNDATION STAFF
Veronica Barlow
Assistant Manager
of Sponsorship Administration
Melissa Colvin
Receptionist
Steven Estrada
Fulfillment Coordinator
Susan Henry
Web Associate
Dan Latore
Director of Corporate Partnerships
Jo Ann Perrino
Executive Assistant
Paul Melia
Director of New Media
Pamela McLaughlin
Manager of Corporate Partnerships
Elizabeth Michaelson
Associate Editor
Victoria Moran
Assistant Manager of Operations
Erin Mulvey Stoeber
Director of Communications
Jessica Shaffer
Director of Development
Matt Sheehan
Director of Programs
Jamie Sylves
Communications Manager
Mark Teich
Executive Editor
Evan Watkins
Development Associate
Steven Q. Wang, MD
Medical Editor
78
Thanks to the efforts of our dedicated staff, board
members, donors, and volunteers, 2009 was The Skin
Cancer Foundation’s most successful year to date.
The American Academy of Dermatology (AAD) acknowledged
our fine work in educating the public about sun protection
when it presented us with 5 Gold Triangle Awards, which set
a record for the number of wins in one year in the Health
Community Organization category.
With the continued growth of our International Advisory
Committee and expanded U.S.-based education programs,
we will continue to make progress in combating the
world’s most common cancer.
PERRY ROBINS, MD
President
2010 Research Grants Awarded by
The Dr. Patricia Wexler Research Grant Award
A one-year, $10,000 grant, for a research project, “DNA Damage-Mediated Sirtuin 1
Inhibition as Novel Survival Mechanism in Skin Cancer” Arianna L. Kim, PhD, Herbert
Living Assistant Professor of Dermatology, Columbia University Medical Center, New
York, NY.
A one-year, $10,000 grant, for a research project, “The Utility of Src-kinase Inhibitors
in Preventing the Formation of Precancerous Lesions and Squamous Cell Carcinomas”
John T. Seykora, MD Assistant Professor, Department of Dermatology, University of
Pennsylvania Medical School, Philadelphia, PA.
Funding for these Awards was provided by the Brown Foundation.
The Dr. Marcia Robbins-Wilf Research Award
A one-year, $10,000 grant, for a research project, “Delivery of Topical siRNAs for
the Prevention and Treatment of Squamous Cell Carcinomas and other Skin Cancers”
Thanh-Nga Trinh Tran, MD, PhD, Graduate Assistant, Department of Dermatology,
Massachusetts General Hospital, Charleston, MA.
Funding for this Award was provided by the Dr. Marcia Robbins-Wilf Research
Award Society.
The Melissa K. Bambino Memorial Award
A one-year, $10,000 grant, for a research project, “Determining Benign or Malignant
Behavior of Spitzoid Neoplasms Through Deep Molecular Profiling” Arlo Miller, MD,
PhD, Resident in Dermatology, Mayo Clinic Rochester, New York.
Funding for this Award was provided by the Melissa K. Bambino Melanoma
Foundation.
The Dr. Alfred W. Kopf Research Grant Award
A one-year, $10,000 grant, for a research project, “Role of Immune Modulation and
Surveillance in Sentinel Lymph Node Positivity in Melanoma” Farbod Darvishian, MD,
Assistant Professor of Pathology, New York University School of Medicine, New York, NY.
Funding for this Award was provided by the donors of
The Skin Cancer Foundation.
The Live Love and Laugh Research Award
A one-year, $10,000 grant, for a research project, “Proteomic Characterization of
Benign Melanocytic Lesions and Melanoma: A Pilot Study” Adar Berghoff, MD, Chief
Resident Dermatology, University of Pittsburgh Medical Center, Pittsburgh, PA.
Funding for this Award was provided by Mindy Gorman.
80
The Skin Cancer Foundation Professional Members in 2009
Medical Council
Michelle Abadir, MD
Rye Brook, NY
Steven Franks, MD
Weston, MA
Richard Miller, MD
Port Richey, FL
Debra Abell, MD
Wexford, PA
Bernard Gasch, MD
Portland, OR
Robert Miller, MD
Long Beach, CA
Max Adler, MD
Dallas, TX
Roy G. Geronemus, MD
New York, NY
Gary D. Monheit, MD
Birmingham, AL
Kathy Anderson, DO
Clearwater, FL
Gervaise Gerstner, MD
New York, NY
Michael Mulvaney, MD
Albany, NY
Kathleen Behr, MD
Fresno, CA
Jordana Gilman, MD
New York, NY
Howard Murad, MD
El Segundo, CA
Robert S. Berger, MD
White Plains, MD
Kimberly Grande, MD
Knoxville, TN
Douglas Naversen, MD
Medford, OR
Diane Berson, MD
New York, NY
Dennis Gross, MD
New York, NY
Mark Nestor, MD, PhD
Aventura, FL
John Binhlam, MD
Brentwood, TN
Brian Harris, MD
Fort Myers, FL
David Orentreich, MD
New York, NY
Christine D. Brown, MD
Dallas, TX
Andrew Hendricks, MD
Lumberton, NC
Diamondis Papadopoulos, MD
Atlanta, GA
Vivian Bucay, MD
San Antonio, TX
Alysa R. Herman, MD
Miami, FL
Kurt Pickus, MD
Torrance, CA
Katarina Chiller, MD
Atlanta, GA
Terrance Hopkins, MD
Bradenton, FL
Gangaram Ragi, MD
Teaneck, NJ
Elvira Chiritescu, MD
Apex, NC
Julie Karen, MD
New York, NY
Heather Rogers, MD
Seattle, WA
Noel Chiu, MD
Antioch, CA
Andrew J. Kaufman, MD
Thousand Oaks, CA
Amy Ross, MD
Palm Harbor, FL
Anir Dhir, MD
Lexington, KY
Arielle Kauvar, MD
New York, NY
Beata Rydzik, MD
Portland, OR
Patricia A. Dickerson, MD
Centerville, OH
John Kayal, MD
Marietta, GA
Michael A. Scannon, MD
Tampa, FL
Jeanine B. Downie, MD
Montclair, NJ
Candace King, MD
Pinehurst, NC
Maral Kibarian Skelsey, MD
Chevy Chase, MD
N. Fred Eaglstein, DO
Orange Park, FL
Joseph Kolb, MD
Richmond, IN
James Spencer, MD
St. Petersburg, FL
Samuel Ejadi, MD
Scottsdale, AZ
Kent Krach, MD
Clinton Township, MI
Margaret Sutton, MD
Lincoln, NE
Craig Elmets, MD
Birmingham, AL
James G. Lahti, MD
North Brook, IL
Leonard J. Swinyer, MD
Salt Lake City, UT
James O. Ertle, MD
Hinsdale, IL
Larry Landsman, MD
Vero Beach, FL
Elizabeth Tanzi, MD
Washington, DC
John Exner, MD
Sterling, IL
David Lane, MD
Rock Hill, SC
Amy Taub, MD
Lincolnshire, IL
Jessica Fewkes, MD
Boston, MA
Mark Lebwohl, MD
New York, NY
Carl Thornfeldt, MD
Fruitland, ID
Theodore Fotopoulos, MD
New Port Richey, FL
Eugene Mandrea, MD
Palos Heights, IL
Michael Tomcik, MD
San Ramon, CA
Joshua L. Fox, MD
Fresh Meadows, NY
Michael Margolin, MD
Palos Heights, IL
Jennifer Walden, MD
New York, NY
E. William Frank, MD
Nashua, NH
Robert Marsico, MD
Akron, OH
Ingrid Warmuth, MD
Elmer, NJ
Ellen Frankel, MD
Cranston, RI
Flor Mayoral, MD
Coral Gables, FL
Scott Warren, MD
Jacksonville, FL
Linda Franks, MD
New York, NY
Madhavi Menon, MD
Syracuse, NY
Karen Weismantle, MD
Islamorada, FL
81
The Skin Cancer Foundation Professional Members in 2009, Continued
William Welborn, MD
Sheffield, AL
Jennifer Baron, MD
Palo Alto, CA
Howard Brooks, MD
Washington, DC
Gregory Wilmoth, MD
Raleigh, NC
Frank Barone, MD
Toledo, OH
Robert Brown, MD
Jacksonville, FL
Marc Zimbler, MD
New York, NY
William Baugh, MD
Fullerton, CA
Richard Brown, MD
Medford, MA
John Zitelli, MD
Pittsburgh, PA
David S. Becker, MD
New York, NY
Gerardo Brual, MD
Apache Junction, AZ
James H. Beckett, MD
Soquel, CA
Audrey Bruell, MD
Livonia, MI
Robert Beer, MD
Brentwood, CA
Enid Burnett, MD
Daytona Beach, FL
Frederick R. Behringer, Jr., MD
Ocala, FL
David Byrd, MD
Rochester Hills, MI
Daniel Behroozan, MD
Santa Monica, CA
Francis Caban, MD
Brandon, FL
Michael Bell, MD
Murfreesboro, TN
Paul Cabiran, MD
Highlands, NC
Betty Bellman, MD
Miami Beach, FL
Valerie Callender, MD
Mitcheville, MD
Laura Benedict, MD
Atlanta, GA
Sharon Camden, MD, PhD
Glen Allen, VA
Edward Benjamin, MD
Enfield, CT
Daniel Carrasco, MD
Austin, TX
Richard Berger, MD
Somerset, NJ
Albert Cattell, MD
Ann Arbor, MI
Allen Berliner, MD
Norwood, MA
Alix Charles, MD
Hinsdale, IL
David Berman, MD
Palo Alto, CA
Timothy Chartier, MD
Farmington, CT
Mindy Berstein, MD
Plainview, NY
Mark Chastain, MD
Marietta, GA
Judith Arluk, MD
Forest Hills, PA
Ashisha Bhatia, MD
Naperville, IL
Tommy Chen, MD
Pasadena, CA
Alan Arnold, MD
Las Vegas, NV
Rajiv Bhatnager, MD
Redwood City, CA
Thomas Chin, MD
New York, NY
Arash Asadi, MD
Houston, TX
Renuka Bhatt, MD
Burr Ridge, IL
Lisa Chipps, MD
Los Angeles, CA
Robert Ash, MD
Dothan, AL
Joseph Bikowski, MD
Sewickley, PA
Susan Chon, MD
Houston, TX
Anna Asher, MD
Flowood, MS
Carey Bligard, MD
Fort Dodge, IA
William Chow, MD
San Leandro, CA
Robin Ashinoff, MD
Hackensack, NJ
David Blum, MD
Canton, MI
Sabatino Ciatti, MD
Westfield, NJ
James Auerbach, MD
Santa Fe, NM
Jennifer Boldrick, MD
Redwood City, CA
C. Drew Claudel, MD
Goodlettsville, TN
Gary Augter, MD
McAlester, OK
Barbara Bopp, MD
Metairie, LA
Mark Cleveland, MD
West Burlington, IA
Robert Aylesworth, MD
Rhinelander, WI
John Boyer, MD
Honolulu, HI
Missy Clifton, MD
Bentonville, AR
Haleh Bakshandeh, MD
Beverly Hills, CA
Robert Breedlove, MD
Stillwater, OK
Joel L. Cohen, MD
Englewood, CO
Joseph P. Bark, MD
Lexington, KY
Mitchell Bressack, MD
Crown Point, IN
Kendra Cole, MD
Duluth, GA
Louis Barich, MD
Hamilton, OH
Gregory Bricca, MD
El Dorado, CA
Lewis Collins, Jr., MD
Savannah, GA
Walter Barkey, MD
Flint, MI
Bruce Brod, MD
Lancaster, PA
Coyle Connolly, DO
Linwood, NJ
Fellow
Mark Abdelmalek, MD
Philadelphia, PA
Glynis Ablon, MD
Manhattan Beach, CA
Neera Agarwal-Antal, MD
Hudson, OH
Shino Bay Aguilera, DO
Fort Lauderdale, FL
Murad Alam, MD
Chicago, IL
Corie Alford, MD
Atlanta, GA
Dima Ali, MD
Reston, VA
Jeffrey Altman, MD
Arlington Heights, IL
David Amato, MD
Harrisburg, PA
Prapand Apisarnthanarax, MD
Webster, TX
82
Michael Contreras, MD
Albuquerque, NM
Adolfo Fernandez-Obregon, MD
Hoboken, NJ
Bruce Gordon, MD
Hyannis, MA
Gregory Cox, MD
Atlanta, GA
Edgar Fincher, MD
Los Angeles, CA
Annalisa Gorman, MD
Seattle, WA
Marguerite Critelli, MD
Newport Beach, CA
Helen Fincher, MD
Los Angeles, CA
Sanjiva Goyal, MD
Ponte Vedra Beach, FL
Lynora Curtis, MD
Lake Worth, FL
David Finkelstein, MD
Vorhees, NJ
Gloria Graham, MD
Morehead City, NC
Peter S.C. d’Aubermont, MD
Atlanta, GA
Steven Fishman, MD
Monticello, NY
James Graham, MD
Pine Knoll Shores, NC
Doris Day, MD
New York, NY
Diane Ford ,MD
Frederick, MD
Deetta Gray, MD
Bellevue, WA
James Del Rosso, DO
Henderson, NV
Peter Ford, MD
Santa Barbara, CA
Steven Greenbaum, MD
Philadelphia, PA
Gloria D’Hue, MD
Atlanta, GA
Rutledge Forney, MD
Atlanta, GA
H. L. Greenberg, MD
Las Vegas, NV
Anna Di Nardo, MD, PhD
San Diego, CA
Jayne Fortson, MD
Anchorage, AK
David Greenstein, MD
Andover, MA
Lynn Dimino, MD
Newport Beach, CA
John Fox, MD
Austin, TX
James M. Grichnik, MD
Miami, FL
Danya Diven, MD
Austin, TX
Joyce Fox, MD
Beverly Hills, CA
Ned Gross, MD
Greensboro, NC
Melissa Dixon, MD
Hazlet, NJ
Kathryn Frew, MD
New York, NY
Esti Gumpertz, MD
Mayfield Heights, OH
Glenn Dobecki, MD
South Weymouth, MA
Bruce E. Fuller, MD
Newport News, VA
Richard Gunning, MD
Beltsville, MD
J. Lawrence Dohan, MD
Hudson, MA
Bruce W. Fuller, MD
Bradenton, FL
Christopher Ha, MD
Roseville, CA
Susan Dozier, MD
Austin, TX
Mark Garcia, MD
New Braunfels, TX
Monica Halem, MD
New York, NY
Kristina Duffin, MD
Salt Lake City, UT
Jorge Garcia-Zuazaga, MD
Cleveland, OH
Russel Harris, MD
Atlanta, GA
H. Michael Duke, MD
Dayton, OH
Sharon Gardepe, MD
Huntsville, AL
Nicole Hartsough, MD
Loves Park, IL
Deason Dunagan, MD
Huntsville, AL
Claudia Gaughf, MD
Savannah, GA
Karen Hastings, MD, PhD
Phoenix, AZ
Jeff Eaton, MD
San Diego, CA
Bryon Gaul, MD
Spencer, IA
Patrick Hatfield, MD
Batesville, AR
Michael Ebertz, MD
Burnsville, MN
Susanne L. Gee, MD
Seattle, WA
Adrianne Haughton, MD
Long Beach, NY
Christine Egan, MD
Media, PA
Shelly Gibbs, MD
Houston, TX
Sarah Haydel, MD
Houma, LA
Khaled El-Hoshy, MD
Livonia, MI
Erik Gilbertson, MD
La Mesa, CA
Benjamin Hayes, MD
Spring Hill, TN
Merrick Elias, MD
Hollywood, FL
Scott Glazer, MD
Buffalo Grove, IL
Laura Haygood, MD
Tyler, TX
Darrel Ellis, MD
Nashville, TN
Ronald Glick, MD
Mesa, AZ
Harley Haynes, MD
Boston, MA
Jeffrey Ellis, MD
Jericho, NY
Hugh Gloster, Jr., MD
Cincinnati, OH
Adelaide Herbert, MD
Houston, TX
Rebecca Euwer, MD
Dallas, TX
Mona Gohara, MD
Woodbridge, CT
James Herndon, Jr., MD
Dallas, TX
Jeffrey Evanson, MD
Duluth, MN
Roger Golomb, MD
Clearwater, FL
Howard Hines, MD
Salisbury, MD
Adrienne Feasel, MD
Austin, TX
Virnalisis Gonzalez, MD
San Antonio, TX
Lisa Hitchens, MD
Houston, TX
Lori Fedoronko, MD
Troy, MI
Susan Goodlerner, MD
Torrance, CA
Pamela Hite, MD
Newport Beach, CA
Brian Feinstein, DO
Delray Beach, FL
Anita Goodrich-Licata, MD
South Burlington, VT
Alfred Hockley, MD
Live Oak, TX
83
Sharon Hrabovsky, MD
McMurray, PA
Lynn Klein, MD
Wynnewood, PA
Emmanuel Loucas, MD
New York, NY
Jeffrey Hsu, MD
Naperville, IL
Jay Klemme, MD
Strongsville, OH
Mary Lupo, MD
New Orleans, LA
Larry Hudson, MD
Johnson City, TN
Todd Knapp, MD
Springfield, OR
Frederick A. Lupton, MD
Greensboro, NC
Allison Hughes, MD
Mercer Island, WA
Brett Kockentiet, MD
Dublin, OH
Frederick F. Lykes, MD
Victoria, TX
Kimberly Hurvitz, MD
Santa Barbara, CA
Robert Kolbusz, MD
Downers Grove, IL
Megan Machuzak, MD
Paradise Valley, AZ
Edward Hurwitz, MD
Houston, TX
Stephen Kovacs, MD
Brighton, MA
Albert MacKenzie, MD
Encino, CA
William James, MD
Philadelphia, PA
Avery Kuflik, MD
Toms River, NJ
Stephanie A. Mackey, MD
Lancaster, PA
Farhana Jan, MD
Boston, MA
Ann LaFond, MD
Canton, MI
Diane C. Madfes, MD
New York, NY
Anthony Janiga, MD
Naperville, IL
Kathy Laing, MD
Ann Arbor, MI
Erick Mafong, MD
Chula Vista, CA
Shang I. Brian Jiang, MD
La Jolla, CA
David Lambert, MD
Columbus, OH
Diane Maiwald, MD
Huntington Station, NY
Kay Johnston, MD
San Angelo, TX
Maeran Landers, MD
Tualatin, OR
Heidi Mangelsdorf, MD
Cary, NC
Kastas Jucas, MD
Chicago, IL
Richard Lanthrope, MD
Warren, NJ
Christine Marcuson, MD
Newport News, VA
Karen Kade, MD
Miami, FL
Christine Law, MD
Marietta, GA
Kenneth Mark, MD
Southampton, NY
Ralph M. Kamell, MD
Thousand Oaks, CA
Deirdre Leake, MD
St. Augustine, FL
Donna Bilu Martin, MD
Miami Beach, FL
Sherri Kaplan, MD
Ardsley, NY
Stanton Lebouitz, MD
York, PA
Louise Martin, MD
Warren, MI
Gary Karakanishan, MD
Sea Girt, NJ
Brian Lee, MD
New Orleans, LA
Sandy Martin, MD
Boca Raton, FL
Cheryl Karcher, MD
New York, NY
Meeyoung Lee, MD
Boston, MA
Marlene Mash, MD
Plymouth, PA
Brian Katz, MD
Miami, FL
Eyal Levit, MD
Brooklyn, NY
D. Neal Mastruserio, MD
Columbus, OH
Mandeep Kaur, MD, MS
Greensboro, NC
Stephan Levitt, MD
St. Petersburg, FL
Patricia McCormack, MD
Staten Island, NY
Mary Kegel, MD
Lancaster, PA
Elie Levy, MD
Seattle, WA
Michael McCracken, MD
Denver, CO
Sharon Kelly, MD
Bellevue, WA
Michelle Lewis, MD
Pawtuchet, RI
Mark McCune, MD
Overland Park, KS
Daniel Kenady, MD
Lexington, KY
Wennie Liao, MD
Soquel, CA
William McDaniel, MD
Lexington, KY
Holly Kerr, MD
Troy, MI
Katherine Lim, MD
Chandler, AZ
Harrison McDonald, MD
Encinitas, CA
ViKram Khanna, MD
Woodstock, IL
Allison Linquist, MD
Elkridge, MD
Caren Mikesh, MD
Naples, FL
Amy Kim, MD
Atlanta, GA
Judith Lipinski, MD
Grosse Point, MI
Indira Misra-Higgins, DO
Beverly Hills, MI
Caroline Kim, MD
Boston, MA
Keith Llewellyn, MD
Santa Barbara, CA
Christopher Moeller, MD
Wichita, KS
Don King, MD
Whittier, CA
Jason Lockridge, MD
Bessemer, AL
Brent Moody, MD
Nashville, TN
John Kinney, MD
West Palm Beach, FL
Norman Lockshin, MD
Silver Spring, MD
Meena Moosavi, MD
Livonia, MI
Paul Klas, MD
Tualatin, OR
Gwyn Londeree, MD
Columbus, OH
Janice F. Moranz, MD
Albuquerque, NM
84
Kelli Morgan, MD
Bardstown, KY
Harvey Penzinger, MD
Boca Raton, FL
Heather Roberts, MD
Los Angeles, CA
Kevin Mott, MD
Honolulu, HI
Jose E. Peraza, MD
Claremont, NH
Timothy Rodgers, MD
Frisco, TX
Kurt Mueller, MD
La Crosse, WI
Marina Peredo, MD
Smithtown, NY
Ana Rodriguez, MD
San Marcos, TX
Mark Naylor, MD
Live Oaks, TX
Charles Perniciaro, MD
Jacksonville, FL
Cynthia Rogers, MD
Stuart, FL
Kishwer Nehal, MD
New York, NY
Angela Peterman, MD
Annapolis, MD
Michael J. Rogers, MD
Sebring, FL
Christopher Nelson, Sr., MD
St. Petersburg, FL
Gerald Peters, MD
Bend, OR
Timothy Rosio, MD
El Dorado, CA
Kelly Nelson, MD
Durham, NC
James Petrin, MD
Woodinville, WA
Amy Ross, MD
Palm Harbor, FL
Ronald Nelson, MD
Murfreesboro, TN
John Pfenninger, MD
Midland, MI
Richard Rudnicki, MD
Mesquite, TX
Jessica Newman, MD, MPH
New York, NY
Kevin Pinski, MD
Chicago, IL
Bruce M. Saal, MD
Los Gatos, CA
Hank Nichamin, MD
Schaumburg, IL
George Poggioli, MD
Centennial, CO
Julia Sabetta, MD
Greenwich, CT
Thomas D. Nichols, MD
Houston, TX
Robert Polisky, MD
Elk Grove Village, IL
Ritu Saini, MD
New York, NY
Robert Norman, DO
Tampa, FL
Jeffrey Pollak, MD
Huntingdon Valley, PA
F. Paul Sajben, MD
Chico, CA
Christopher Norwood, MD
New Britain, CT
Leah Press, MD
Fresno, CA
Stacy Salob, MD
New York, NY
Janna Nunez-Gussman, MD
Beaumont, TX
Mark A. Price, MD
Houston, TX
Anita Saluja, MD
Melbourne, FL
Peter Odland, MD
Seattle, WA
Emily Prosise, MD
Austin, TX
Harry Saperstein, MD
Beverly Hills, CA
Michael O’Donoghue, MD
Boulder, CO
Janet H. Prystowsky, MD
New York, NY
Kathleen Sawada, MD
Lakewood, CO
David C. Olansky, MD
Atlanta, GA
Irene Questra, MD
Miami, FL
Dwight Scarborough, MD
Dublin, OH
Jesse Olmedo, MD
Scottsdale, AZ
Daniel Rabb, MD
Gainesville, GA
Jennifer Sceppa, MD
Lancaster, PA
Richard Ort, MD
Lone Tree, CO
Vicki Rappaport, MD
Beverly Hills, CA
Lori Schaen, MD
Atlanta, GA
Rebekah Oyler, MD
Raleigh, NC
Ronald Reece, MD
Redding, CA
Brent Schillinger, MD
Boca Raton, FL
Dimitry Palceski, MD
Orlando, FL
Charles Reed, MD
Hickory, NC
Erin Schoor, MD
Huntington Station, NY
Susan Pardee, MD
Chandler, AZ
Louis C. Rehlen, MD
Santa Ana, CA
Neal B. Schultz, MD
New York, NY
Anna Pare, MD
Atlanta, GA
Andrew Ress, MD
Boca Raton, FL
Keith Schulze, MD
Sugarland, TX
Kimberly Parham, MD
Texarkana, TX
Blas Reyes, MD
Miami, FL
Donald Scott, MD
Palm Springs, CA
William Parsons, MD
Live Oak, TX
Melissa Reyes-Merin, MD
Sacramento, CA
Riddell Scott, MD
Memphis, TN
Steven Partilo, MD
South Burlington, VT
Donald Richey, MD
Chico, CA
Alan Alexander Semion, MD
Roseville, CA
Carolyn Pass, MD
Baltimore, MD
Jennifer Ridge, MD
Middletown, OH
Charles Sevadjian, MD
San Diego, CA
Vikas Patel, MD
Raleigh, NC
Hal Ridgeway, MD
West Palm Beach, FL
Jessica Severson, MD
Batavia, NY
David Pegouski, MD
Livonia, MI
Christopher Robb, MD
Spring Hill, TN
Pramod Sharma, MD
Salt Lake City, UT
Michelle Pelle, MD
San Diego, CA
Elisa M. Roberts, MD
Asheville, NC
Toby Shawe, MD
Wyndmoor, PA
85
Richard H. Shereff, MD
Fayetteville, NC
Yardy Tse, MD
Encinitas, CA
George Woodbury, Jr., MD
Cordova, TN
Sherry Shieh, MD
New York, NY
Felix Urman, MD
Brooklyn, NY
Courtney Woodmansee, MD
Memphis, TN
Elisabeth Shim, MD
Santa Monica, CA
J. Nicholas Vandermoer, MD
Hyannis, MA
David Sire, MD
Fullerton, CA
Frank Victor, MD
Manasquan, NJ
Diedre Woods, MD
Philadelphia, PA
Boyd Skinner, MD
Pensacola, FL
Kimberly Dawn Vincent, MD
Nashville, TN
Steven Skinner, MD
Cullman, AL
John Vine, MD
Princeton, NJ
David Smack, MD
Chestertown, MD
Peter Vitulli, DO
Jupiter, FL
Cameron Smith, MD
Greenville, NC
Mark Waldman, MD
Louisville, KY
Sam Smith, DO
Mesa, AZ
Michael Warner, MD
Frederick, MD
Sidney Smith, MD
Kennewick, WA
Carl Washington, Jr., MD
Atlanta, GA
Kimberly Soderberg, MD
Newport News, VA
John Watson, MD
Hollis, NH
Vipal Soni, MD
Fountain Valley, CA
Debra Wattenberg, MD
New York, NY
Kerrie Spoonemore, MD
Seattle, WA
Bill Way, DO
Duncanville, TX
Karen Sra, MD
Webster, TX
Jeffrey Weaver, DO
Monroeville, PA
Jon Starr, MD
Palo Alto, CA
Amy Wechsler, MD
New York, NY
Jennifer Stein, MD
New York, NY
James Weintraub, MD
Westlake Village, CA
Daniel Stewart, MD
Parma, OH
Margaret Weiss, MD
Hunt Valley, MD
Robert Strimling, MD
Las Vegas, NV
Robert Weiss, MD
Hunt Valley, MD
Tina Suneja, MD
Centennial, CO
John Werber, MD
Brooklyn, NY
William Engstrom, PA High Point, NC
W. Patrick Teer, MD
Jackson, TN
Morris Westfried, MD
Brooklyn, NY
Jodi Logerfo, NP New York, NY
John A. Thompson, Jr., MD
Charlotte, NC
Jeffrey Whitworth, MD
West Patterson, NJ
Alison Pruim, PA-C Puyallup, WA
Sidney Thompson, MD
Fayetteville, NC
Scott Wilhelmus, MD
Bloomington, IN
Sheri Rolewski, NP Washington, PA
Stacy Thurber, MD
Fullerton, CA
Marlene D. Willen, MD
Cleveland, OH
William Ting, MD
San Ramon, CA
Andrea Willey, MD
Sacramento, CA
Huntley Sanders, PA-C Macon, GA
Michael Todd, MD
Lansdowne, VA
John Williams, MD
Summit, NJ
Carol Trakimas, MD
Raleigh, NC
Mark Willoughby, MD
San Diego, CA
Linh Tran, MD
Atlanta, GA
B. Dale Wilson, MD
Hamburg, NY
Robin Travers, MD
Chestnut Hill, MA
Isabelle Wilson, MD
New York, NY
Leonid Trost, MD
Jupiter, FL
Diedre Wood, MD
Philadelphia, PA
86
Carol Woody, MD
Greensboro, NC
Douglas Woseth, MD
Salt Lake City, UT
Robert Wright, MD
Wheat Ridge, CO
Elisa Yoo, MD
Los Alamitos, CA
Joseph Zaladonis, MD
Bethlehem, PA
Larissa Zaulyanov-Scanlan, MD
Delray Beach, FL
Ibrahim Zayneh, MD
Portsmouth, OH
Nathalie Zeitouni, MD
Buffalo, NY
Kathryn Zeoli, MD
Pembroke Pines, FL
Jay Zimmerman, MD
Palo Alto, CA
AFILIATE
Joan Csaposs, NP
Albany, NY
Graciette Da Silva, PA
Bristol, RI
Susan Schooler, PA-C West Des Moines, IA
Brenda Wieseler
Kansas City, MO
®
The Skin Cancer Foundation would like to thank these companies
for supporting The Skin Cancer Foundation Journal.
87
The Skin Cancer Foundation Honors
The
Dr. Rex and Johnnie Amonette Circle
The Dr. Rex and Johnnie Amonette Circle is a lifetime membership
group comprised of physicians who make an outstanding commitment
to The Skin Cancer Foundation’s mission and programs.
Indicates new member
Rex Amonette, MD
Johnnie Amonette
Dale M. Abadir, MD
Shawn Allen, MD
Darrick Antell, MD
Daniel C. Baker, MD
David E. Bank, MD
Jay Barnett, MD
Leonard Dzubow, MD
Robin Friedman, MD
Francesca Fusco, MD
Pierre M. George, MD
Michael H. Gold, MD
David J. Goldberg, MD
Robert H. Gotkin, MD
Bruce E. Katz, MD
Leon H. Kircik, MD
David J. Leffell, MD
Albert M. Lefkovits, MD
Jennifer L. Linder, MD
Joseph Masessa, MD
Ronald L. Moy, MD
Margaret E. Olsen, MD
Daniel M. Siegel, MD
Ronald J. Siegle, MD
Stephen N. Snow, MD
John R. Steinbaugh, MD
Michael W. Steppie, MD
Domenico Valente, MD
Susan H. Weinkle, MD
William A. Steele, MD
Amonette Circle members pledge a minimum of $25,000 to the Foundation.
Benefits of membership in this prominent group are:
• Local and national media opportunities
• Exclusive opportunity to serve as the expert in the “Ask
the Expert” column on the homepage of the Foundation’s
website and in the Sun & Skin News newsletter
• Premier recognition in the annual Skin Cancer
Foundation Journal
88
• Special recognition on the Foundation’s website and on the
Physician Finder service with photo, biography, and link to
practice website
• One complimentary ticket to The Skin Sense Award Gala
• Listing on the Foundation’s official letterhead
• 1,000 free patient education brochures
Craig S. Birkby, MD
Michele S. Green, MD
Norman A. Brooks, MD
Forrest C. Brown, MD
Karen E. Burke, MD
Roger I. Ceilley, MD
Maribeth Chitkara, MD
Brian Cook, MD
Robert Durst, Jr., MD
Elizabeth K. Hale, MD
William Heimer, MD
Amy Huber, MD
John Huber, MD
Evelyn Jones, MD
Perry Robins, MD
Steven M. Rotter, MD
Neil S. Sadick, MD
Ariel Ostad, MD
Maritza I. Perez, MD
Harold S. Rabinovitz, MD
William P. Werschler, MD
Patricia Wexler, MD
Ronald G. Wheeland, MD
Bryan C. Schultz, MD
Please keep in mind that patient donations and/or foundation grants made in your
honor can be credited towards your Amonette Circle pledge.
For more information on the Amonette Circle, please contact the Development Office
by phone at 212-725-5176, or by email at [email protected].
89
The Skin Cancer Foundation 2009 Donors
Founders $100,000+
Beiersdorf, Inc.
AVEENO®
Lita Annenberg Hazen Foundation
Rite Aid Corporation
Sephora USA, Inc.
Leaders: $50,000 - $99,999
Columbia Sportswear Company
DUSA Pharmaceuticals
Johnson & Johnson Beauty Care
Kao Brands Company
The Procter & Gamble Company
Schering-Plough HealthCare Products, Inc.
Vision-Ease Lens
Benefactors: $25,000 - $49,999
Bare Escentuals
Bekaert Specialty Films
Clinique Inc.
Dowell Group
Elizabeth Arden
F. M. Kirby Foundation, Inc.
Garnier Nutritioniste
Graceway Pharmaceuticals
Jafra Cosmetics Intl.
Kenneth and Anne Griffin Foundation
Mary Kay
Niadyne, Inc.
The Rona Jaffe Foundation
Shiseido Cosmetics America Ltd.
90
Patrons: $10,000 - $24,999
3M Company
Allergan, Inc.
Allure
Arizona Sunwash, LLC
Atico International USA
The Brown Foundation, Inc.
Coca Cola
Colorescience
Condé Nast
Cosmo International
CPFilms
Ellis Family Foundation
Energizer Personal Care
Estée Lauder Companies, Inc.
Excito Ltd.
Fischer Pharmaceuticals
Frito-Lay
Galderma USA
Glen Raven Custom Fabrics
Mindy Gorman
Gotham, Inc.
Groupe Clarins
The Hain Celestial Group
Hearst
Iredale Mineral Cosmetics
JGR Copa, LLC
Kimberly-Clark
Kenneth Kolker Foundation
Lancôme
LensCrafters
L’Oreal Paris Dermo-Expertise
L’Oreal USA, Inc.
Mana
Robert & Lauren Manning
MD Formulations
Meredith Corporation
Murad
Nissan Soap Co., Ltd.
Obagi Medical Products
Pearle Vision
Pharma Cosmetix Research
Phoenix Brands LLC
Publicis NY
Rohto Pharmaceuticals
Sears Optical
Skin Effects by Dr. Jeffrey Dover
SunSetter Products
Time, Inc.
Valeant Pharmaceuticals
Vichy International
Sponsors: $5,000 - $9,999
American Greetings
Avon Products, Inc.
DDF - Doctors Dermatologic Formula
DSM Nutritional Products, Inc.
ECRM
I Hate Cancer Foundation, Inc.
La Roche-Posay
The Litwin Foundation, Inc.
Macy’s, Inc.
Majestic Drug Company, Inc.
Marc USA
Melissa K. Bambino Foundation
MerchSource, LLC
Roger Michaels
NACDS Foundation
Pierre Fabre Dermo-Cosmetique USA
Robin and Bob Paulson Charitable Fund
The Sadie & Louis Roth Foundation, Inc.
Sanofi-Aventis Dermatology/Dermik
Maxine Shegog
Todd Nagel Open / Linda Nagel
Wallaroo Hat Company
Woodbourne Foundation, Inc.
Contributors: $2,000 - $4,999
Alberto Culver
Dr. and Mrs. Rex Amonette
BASF Corporation
Beth Israel Deaconess Medical Center
The Bobby McCann Memorial Golf Tournament
BTC Innovations LLC
Conair Corporation
Elle
Frederick Loewe Foundation, Inc.
Fusion Brands Inc.
Glaceau
Gordon Flournoy Charitable Lead Annuity Trust
Arnold Greenberg
The Hershey Company
Aurelia Lewis
LVMH Perfumes & Cosmetics
William Matteson
Michael Moffett
PCA SKIN
Redbook Magazine
William Scroggie
Simon & Eve Colin Foundation, Inc.
Spectrum Printing and Lithography Co.
Star Magazine
StoreBoard Media, LLC
Tyco International, Ltd.
Vertra, Inc.
Vix Swimwear
Friends: $500 - $1,999
Abby & George O’Neill Trust
Anne Akers
AMA Laboratories, Inc.
Mr. & Mrs. James Averill
Daniel C. Baker, MD
Belair Instrument Company, Inc.
Birdie Day Spa
Boehringer Ingelheim USA Corporation
Centex Materials, LLC
Norma Cohen
The Craig R. and Julie N. Oechsel Charitable Fund
Daymon Worldwide Inc.
DBA South Side
The Dennis Neely Memorial Fund
The Detleff Bolthoff Memorial Fund
The Diamondston Foundation, Inc.
Jeanine B. Downie, MD
Drug Store News
Audrey Gerson
John Gleason, MD
Daniel Green
Mr. & Mrs. Leonard Gryn
John & Elaine Hayes
Laurie Jacoby
Jean & Henry Pollak Foundation
The Jewish Communal Fund
Kevin Johnson
The Juliet Rosenthal Foundation, Inc.
Frank Keane
Latina Media Ventures
MillerCoors
Mirabel Promotions, Ltd.
Sheila Natbony
O, The Oprah Magazine
Office Automation System
Sean O’Halloran
Karen Oliver
John O’Malley
Kathy O’Malley
Optima Sun Lab Ltd.
David Orentreich, MD
The Patricia Ann & Robert D. English Fund
Peck Family Foundation
Pharmavite, LLC
Pierre Fabre Dermo-Cosmetique USA
Diane Riley
Perry Robins, MD
Ronald & Lillie Ades Foundation Inc.
Sacramento Area Mustang Club
Paul & Christine Scheele
Shape Magazine
Roderick M. Sherwood, III
Skinfo, LLC
Students With a Purpose Swap
Robert I. Toussie
James M. Webster
Westwood College Online
Marc Zimbler, MD
91
Corporate
Leadership
Council
The Skin Cancer Foundation gratefully
acknowledges the leadership role of
AVEENO®
Beiersdorf Inc.
Limited Brands
P&G Beauty
Schering-Plough HealthCare Products, Inc.
Sephora USA Inc.
Their support and counsel will enable the Foundation to
develop strategies with a powerful and effective impact
on reducing the incidence of skin cancer, a disease that
has reached epidemic proportions.
92
U.S.
Corporate
Council
International
Corporate
Council
3M Company
Allergan Skin Care
AMBI
AVEENO
Banana Boat
Bare Escentuals
Bath & Body Works
Beiersdorf, Inc.
Bekaert Specialty Films, LLC
BTC Innovations
Clinique
Colorescience
Coolibar, LLC
Coppertone Lenses
CPFilms, Inc.
DDF (Doctor’s Dermatologic Formula)
Eagle Vision Sun Defense
Elizabeth Arden
Galderma Laboratories
Glen Raven, Inc.
Groupe Clarins
Guardian Industries Corp.
Hain Celestial Group
Hawaiian Tropic
Jafra Cosmetics International
Jergens
JGR Copa, LLC
Johnson’s Baby
La Roche-Posay
Lancôme USA
Lubriderm
L’Oréal Paris Dermo-Expertise
Mary Kay Inc.
MD formulations
NIA24
NO-AD
Ocean Potion
PCA Skin
Phoenix Brands, LLC
Physicians Formula, Inc.
Priori
The Procter & Gamble Company
PURPOSE
Rio Brands
Schering-Plough
HealthCare Products, Inc.
Sephora USA
Shiseido Cosmetics America Ltd.
Solar Protective Factory
SunSetter Products L.P.
Therapeutix by dr luftman
Valeant Pharmaceuticals
International
Vertra, Inc.
Vichy Laboratoires
Vision-Ease Lens
3M Company
Bare Escentulas
Banana Boat
Bel Star
Elizabeth Arden
Fischer Pharmaceuticals, Ltd.
Glen Raven, Inc.
Hawaiian Tropic
Jafra Cosmetics International, Inc.
Labo Cosprophar AG
Lacer S.A.
Mary Kay Inc.
Nissan Soap Co., Ltd.
O’Neill Wetsuits
Perrigo Israel
Procter & Gamble ANZ
Rohto Pharmaceuticals
Yanbal (Unique)
93
Seal of Recommendation
U.S.
Sunscreens/Moisturizers/Cosmetics
Alba Botanical
AMBI
American Girl
AVEENO
Banana Boat
Bare Escentuals
Cetaphil
Clarins
Clinique
C.O. Bigelow
Colorescience
Coppertone
DDF (Doctors Dermatologic Formula)
Elizabeth Arden
Eucerin
Hawaiian Tropic
Jafra Cosmetics
Jergens
Johnson’s Baby
Kinerase
Lancôme
La Roche-Posay
L’Oréal Paris Dermo-Expertise
Lubriderm
Mary Kay
MD Formulations
MD Forte/Allergan Skin Care
NIA24
NO-AD
Ocean Potion
Olay
PCA SKIN
Physicians Formula
Priori
Pure Simplicity
94
PURPOSE
Rite Aid
Shiseido Cosmetics
Therapeutix by Dr. Luftman
True Blue Spa
Vertra
Victoria’s Secret
UV Fabric Protection
Sun Guard
UV Fabric/Umbrellas/ Awnings
Coolibar
JGR Copa
Rio Brands
Sunbrella Brand Fabrics
Sunsetter
Sun Protective Clothing
Boy Scouts of America
BTC Innovations
Coolibar
Columbia Sportswear
O’Neill Wetsuits
Solar Protective Factory SPF
Sunglasses
Coolibar
Coppertone Lenses
Eagle Vision Sun Defense
UV Film
3M UV Films
CPFilms
SolarGard and Panorama
UV Glass
ClimaGuard SPF – Guardian Industries
INTERNATIONAL
Sunscreens/Moisturizers/Cosmetics
Banana Boat
Bare Escentuals
Bel Star
Careline Skingard
Dr. Fischer
Elizabeth Arden
Hawaiian Tropic
Jafra Cosmetics
Labo
Lacer
Mary Kay
Orezo – Rohto Pharmaceuticals
Olay
Vichy
Yanbal (Unique)
UV Fabric Protection
Nissan Soap Co, Ltd
UV Fabric/Umbrellas/Awnings
Sunbrella Brand Fabrics
Sun Protective Clothing
Columbia Sportswear
O’Neill Wetsuits
UV Film
3M UV Films
To view a complete list of
products that currently carry the
Seal of Recommendation, please
visit www.SkinCancer.org/seal
Highlights from
The Skin Cancer Foundation’s
2009 Events
1
2
4
5
7
6
8
1 CELEBRATING OUR MEMBERS… The Dr. Rex and Johnnie
Amonette Circle members: Ronald L. Moy, MD; Leonard H. Goldberg,
MD; Deborah S. Sarnoff, MD; Perry Robins, MD, Johnnie Amonette,
Rex A. Amonette, MD; Albert M. Lefkovits, MD; Karen E. Burke, MD;
Neil S. Sadick, MD; Michael H. Gold, MD; Robert H. Gotkin, MD;
Shawn Allen, MD. Back row from left to right: Allan C. Halpern,
MD; Jay Barnett, MD; Steven M. Rotter, MD; Robert Durst, MD;
Jennifer L. Linder, MD; William Heimer, MD; Amy Huber, MD
and John Huber, MD.
3
FUNDING RESEARCH…
9
5 Perry Robins, MD, speaks at the Foundation’s Skin Cancer in Skin
of Color press event.
6 The Skin Cancer Foundation’s Diversity Task Force: Mona A. Gohara,
MD, Perry Robins, MD, Ivis Febus-Sampayo, and Maritza I. Perez,
MD.
FUNDRAISING…
7 Maribeth Bambino Chitkara, MD, Founder of the Melissa Fund,
kicks off the 5th Annual Sun Run benefitting The Skin Cancer
Foundation.
2 The Skin Cancer Foundation’s Executive Director, Mary Stine and
Research Grants Committee Chairman, Jean-Claude Bystryn, MD.
8 The start of the 5th Annual Melissa Fund Sun Run in New York
City’s Riverside Park.
3 Dr. Marcia Robbins-Wilf presents a $10,000 research grant to James
E. Cleaver, PhD.
9 Dear friend and supporter of The Skin Cancer Foundation, Johnnie Amonette toasts Perry Robins, MD, at the Foundation’s 30th
anniversary celebration.
MEDIA OUTREACH…
4 Allison Slater, VP of Sephora Retail Marketing, welcomes top
health and beauty editors to the Foundation’s “Your Skin — All
Day, Everyday” press event.
THIRTY YEARS OF ACHIEVEMENTS…
95
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TANNING ADDICTION: the new form of substance abuse (p.28)
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2002; 146(s61):1-6.
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5. Australian Institute of Health and Welfare, Health System Expenditures on Cancer
and Other Neoplasms in Australia, 2000-01. Health and Welfare Expenditure Series
No. 22. 2005, Canberra, Australia: Australian Institute of Health and Welfare.
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Skin cancer control and 20 years of population-based campaigning. Health Education
& Behavior 2001; 28(3):290-305.
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in frequent indoor tanners. Journal of the American Academy of Dermatology 2004;
51(1): 45-51.
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subtypes for skin cancer prevention. Archives of Dermatology 2008; 144(11):1505-1508.
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Jan 4, 2008.
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Nov 30, 2008.
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Lip Cancer: Not Uncommon, Often Overlooked (p. 51)
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The Right Way to Treat Seasonal Depression (p. 56)
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PROTECT YOUR EYES: EVERYDAY STEPS TO SUN SAFETY (p.58)
1. Implications of the blue light hazard and (ROS) in the pathogenesis of age-related
macular degeneration, Dr. George Banyas, OD.
2. HEV Light and Macular Degeneration, Midwest Monthly, Vol. 5, Issue 3, March,
2008, http://mwlabs.cc/pdf/MMMarch2008.pdf.
3. National Eye Institute, National Institutes of Health, Age-Related Macular Degeneration, www.nei.nih.gov/health/maculardegen/armd_facts.asp
4. Rene S. Rodriguez-Sains, MD, The sun, the eyelids, and the eye, The Skin Cancer
Foundation Journal, Vol. 23, 2005, pp. 36-7.
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S, Kersey T, Thaller VT, Br J Ophthalmol, August 2005; 89(8): 992-994.
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and Orbital Tumors. http://www.eyecareamerica.org/eyecare/conditions/eye-tumors/
index.cfm
7. Emily Tierney, MD, and C. William Hanke, MD, MPH, The Eyelid: A High Risk
Area for Skin Cancer, Skin Cancer Foundation Journal, 2009; 27:53-54.
8. Intraocular (Eye) Melanoma Treatment—National Cancer Institute. http://www.
cancer.gov/cancertopics/pdq/treatment/intraocularmelanoma/patient/allpages/print]
9. Guo-Pei Yi, MD, Dan-Nin Hu, MD, Steven McCormick, MD, and Paul T. Finger,
MD, Conjunctival Melanoma: Is It Increasing in the United States? American Journal
of Ophthalmology, June 2003; 135:800-806. Elsevier, Inc.
10.Gies PH, Roy CR, Toomey S, McLennan A. Protection against solar ultraviolet
radiation. Mutat Res 1998; 422:15-22.
11. Tucker MA, Shields JA, Hartge P, et al. Sunlight exposure as a risk factor for
intraocular malignant melanoma. N Eng J Med 1985; 313:789-792.
12. American Cancer Society booklet, Eye Cancer – Intraocular Melanoma, page 5.
13.Sunlight exposure and risk of lens opacities in a population-based study, The
Salisbury Eye Evaluation Project, West SK, Duncan, DD, Munoz B, Rubin GS, et al.
JAMA Aug. 26, 1998, Vol. 280, No. 8, 714-718.
14.The content and cost of cataract surgery, Steinberg EP, Javitt JC, Sharkey PD,
Zuckerman A, Legro MW, Anderson GF, Bass EB, O’Day D, Arch Derm 1993; Aug;
111:1041-9.
15.FDA: Saving Your Sight—Early Detection is Critical, by Michelle Meadows. cites NEI
for over 1.5 million surgeries a year. http://www.fda.gov/fdac/features/2002/202_eyes.
html]
16.Blue Light and Macular Degeneration, from The Complete Guide to Saving and
Maximizing Your Sight, by Lylas G. Mogk, MD, and Marja Mogk, at Macular Degeneration
Support online, www.mdsupport.org/library/blulight.html
17. What are the effects of UV on the eye? World Health Organization: http://www.
who.int/uv/faq/uvhealtfac/en/index3.html.
18.CDC: Excite: Skin Cancer Module: Practice Exercises. Module 6: Ultraviolet Radiation.
http://www.cdc.gov/excite/skincancer/mod06.htm]
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2008; 58(2):71-96.
2. Ho WL, Comber H, Hill ADK, Murphy GM. Malignant melanoma and breast
carcinoma: a bidirectional correlation. Ir J Med Sci Mar 2009:10.1007/s11845-0090297-5.
3. Schoenberg BS, Christine BW. Malignant melanoma associated with breast cancer.
South Med J Nov 1980; 73(11):1493-1497.
4. Goggins W, Gao W, Tsao H. Association between female breast cancer and cutaneous
melanoma. Int J Cancer Sep 20 2004; 111(5):792-794.
5. Levi F, Te VC, Randimbison L, La Vecchia C. Cancer risk in women with previous
breast cancer. Ann Oncol Jan 2003; 14(1):71-73.
6. Rubino C, de Vathaire F, Diallo I, Shamsaldin A, Le MG. Increased risk of second
cancers following breast cancer: role of the initial treatment. Breast Cancer Res Treat
Jun 2000; 61(3):183-195.
7. Mellemkjaer L, Friis S, Olsen JH, et al. Risk of second cancer among women with
breast cancer. Int J Cancer May 1 2006; 118(9):2285-2292.
8. Galper S, Gelman R, Recht A, et al. Second nonbreast malignancies after conservative
surgery and radiation therapy for early-stage breast cancer. Int J Radiat Oncol Biol
Phys Feb 1 2002; 52(2):406-414.
9. Bhatia S, Estrada-Batres L, Maryon T, Bogue M, Chu D. Second primary tumors in
patients with cutaneous malignant melanoma. Cancer Nov 15 1999; 86(10):2014-2020.
10.Schmid-Wendtner MH, Baumert J, Wendtner CM, Plewig G, Volkenandt M. Risk
of second primary malignancies in patients with cutaneous melanoma. Br J Dermatol
Dec 2001; 145(6):981-985.
11. Borg A, Sandberg T, Nilsson K, et al. High frequency of multiple melanomas and
breast and pancreas carcinomas in CDKN2A mutation-positive melanoma families. J
Natl Cancer Inst Aug 2 2000; 92 (15):1260-1266.
12.Nagore E, Montoro A, Garcia-Casado Z, et al. Germline mutations in CDKN2A are
infrequent in female patients with melanoma and breast cancer. Melanoma Res Aug
2009; 19(4):211-214.
13.Monnerat C, Chompret A, Kannengiesser C, et al. BRCA1, BRCA2, TP53, and
CDKN2A germline mutations in patients with breast cancer and cutaneous melanoma.
Fam Cancer 2007; 6(4):453-461.
14.Cancer risks in BRCA2 mutation carriers. The Breast Cancer Linkage Consortium.
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15.Debniak T, Scott RJ, Huzarski T, et al. XPD common variants and their association with
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patient. J Am Acad Dermatol Dec 2007; 57(6):919-931; quiz 932-916.
97
Skin Cancer
Foundation Catalog
The Skin Cancer Foundation produces a wide
range of brochures, posters, books and clothing
to educate and protect the public. Many of our
materials are found in doctors’ offices. Clothing, books and more can be ordered from The
Skin Cancer Foundation by visiting our web
store at www.SkinCancer.org or by calling
(212) 725-5176 ext. 102.
BR-14 Skin Cancer In
People Of Color
Skin cancer can affect anyone.
Learn about the most common
skin cancers, and how they affect
African Americans, Asians, Asian
Indians, Latinos, and Middle
Easterners. Includes information
on the warning signs of different
skin cancers, including acral
lentiginous melanoma, and a
special section on the importance
of vitamin D.
6 pages, full color.
LIFESTYLE BROCHURES
BR-2 Preventing Skin Cancer
Presents general information
about skin cancer warning
signs, treatment and preventive
measures, including proper use
of sunscreens.
6 panels, full color.
BR-13 Skin Cancer: If You
Can Spot It, You Can Stop It
Step-by-step, illustrated
instructions for complete selfexamination of the skin. Includes
advice on where, how and when
to check yourself, and how to
recognize skin cancer warning
signs. Body maps provided so
that users can conveniently
record changes in skin marks;
detachable measurement
guide included.
10 pages, 3 panels, full color.
BR-6 SunSmart Kids
Teaches children smart sun habits
that will protect them all their
lives. Offers tips on sun safety at
school, during sports, and more.
Perfect for pediatricians, family
and general practitioners, parents
and child care professionals.
6 panels, full color. Also available
in Spanish and Italian.
BR-17 SunSmart Women
Addresses issues of interest to
women; specifically rates of
melanoma and the effects of
seeking a tan, both in terms of
skin cancer risk and photoaging.
Appropriate for dermatologists,
general practitioners, ob/gyn
practices.
8 pages, full color. Also available
in Spanish and Italian.
CLINICAL BROCHURES
BR-16 Understanding
UVA and UVB
Offers the latest information on
ultraviolet radiation, which is
emitted by the sun (and tanning
lamps) and is the main cause
of about 90 percent of all skin
cancers. The brochure covers
topics such as UVA and UVB
radiation and sunscreens, including the difference between UVA
and UVB-blocking ingredients.
10 pages, 8 photos and
illustrations, full color.
BR-4 The ABCDEs
of Melanoma
Identifies the most important
differences between common
moles and malignant melanomas:
Asymmetry, Border, Color,
Diameter and Evolving.
6 panels, 10 photos, full color.
Also available in Spanish.
BR-15 Actinic Keratosis
An important new guide to
the appearance, causes and
latest treatments of this common
precancer. Tells who is most at risk
for the disease, what its dangers
are, and how to prevent it.
6 pages, 10 photos, full color.
Also available in Spanish, French,
German and Italian.
BR-7 Basal Cell Carcinoma
A concise guide to the most
prevalent skin cancer (and most
common of all cancers). Contains
vital information on risk factors,
prevention, early detection and
current treatment methods.
German and Italian.
BR-8 Dysplastic Nevi &
Risk of Melanoma
Compares normal and atypical
moles (dysplastic nevi), shows
how some moles can develop into
melanomas, and illustrates the
early warnings signs. Suggests
preventive measures for people
with atypical moles.
German and Italian.
BR-19 A Guide To Skin
Cancers & Precancers
This brochure explores actinic
keratosis in detail and presents a
concise introduction to the most
common skin cancers - squamous
cell carcinoma, basal cell
carcinoma, and melanoma. It
includes indispensable information on causes, hereditary risk
factors, warning signs, treatment,
prevention, and self-examination
of the skin.
BR-5 The Many Faces
of Melanoma
This brochure features 24 full
color 1-7/8”x3” photos of
melanomas of varying
thickness, representing
different stages of the disease.
This invaluable guide will
help both doctors and patients
identify suspicious moles.
The text offers melanoma
warning signs; information
about those at high risk, and
the all-important ABCDEs.
BR-3 Spotlight on Skin Cancer
A quick guide to skin cancer
that provides definitions and
photos of actinic keratoses, basal
cell carcinomas, squamous cell
carcinomas, and melanoma.
BR-9 Squamous Cell Carcinoma
Covers the causes, prevention
and treatment of the second most
common skin cancer. The photos
serve as a diagnostic tool for
physicians and an early detection
aid for the general public.
German and Italian.
98
CLOTHING
BOOKS BY PERRY ROBINS, MD
TS-1 Long Sleeve Sun Protective Shirt
with The Skin Cancer Foundation logo
The Skin Cancer Foundation offers durable
sun-protective shirts that block 97 percent of
the sun`s ultraviolet rays (UVR). Offers a UPF
rating of 40-50+. Made of premium 100% cotton,
these tees are pre-shrunk for a perfect fit. The
machine-washable tops are double-stitched for
extra strength. The shirts are UV finished in the US
and feature a 1/2” ribbed collar.
The SCF logo appears just below
the collar on the back of the shirt
and is 2” square.
M-5 Understanding Melanoma, What You Need to Know (3rd Edition)
Newly updated and now in its third edition, this handbook is written for melanoma
patients, their families and friends, health professionals, and every person with an
interest in the disease. This valuable book, written by two eminent dermatologists,
covers melanoma from the moment of diagnosis through state-of-the-art treatments.
Honest and straightforward, but reassuring in tone. Contrary to what many people
fear, there is an excellent chance for a long and healthy life after diagnosis. Early
warning signs and a step-by-step illustrated guide to self-examination of the skin
are presented along with answers to the 25 most frequently asked questions about
melanoma. There are specially-complied listing of information sources and support
groups, a glossary, and color photographs and drawings depicting typical melanomas.
72 pages.
HT-1 Sun Protective Hat
The Skin Cancer Foundation`s
microfiber hat with fishing cap
trim boasts a removable Velcro
backstrap providing extra
protection to the often-exposed
back of the neck. The khaki cap
comes with a Velcro Sunshield;
one size fits most (from 20 3/4”
up to 24 1/4”).
POSTERS
M-7 Understanding Basal
Cell Carcinoma: What You
Need To Know
This valuable handbook provides
comprehensive, up-to-date
information for patients, their
families, friends, and everybody
else interested in BCC. Includes
four-color illustrations, FAQ, a
glossary of medical terms and
more. 73 pages.
All posters available in 11”x17”; 20”x28” posters available as indicated.
M-6 Understanding Squamous
Cell Carcinoma: What You
Need To Know
This new book, perfect for
patients, friends and family of
people with SCC, covers all stages
of the disease, from diagnosis to
the latest treatments. Important
information on prevention and
sun protection is included, along
with full-color photos, a FAQ, a
glossary of medical terms and
more. 74 pages.
Go With Your Own GlowTM is the rallying cry of
The Skin Cancer Foundation’s public awareness
campaign. Developed to encourage women to love
and protect their skin, whatever its natural hue, the
campaign is relying not just on health and safety
information, but also on fashion. These stylish,
fashion illustration-inspired posters catch the eye
and inform the mind. These artworks are perfect
for any office, workplace, school or spa.
Available in 20”x28” Available in 20”x28” Available in 20”x28”
PS-6 Can You Spot a Killer
(20” x 28”)
The five large color photos on
this poster will familiarize the
layperson with the warning signs
of melanoma. The poster urges
frequent skin self-examination
and describes mole changes that
could be cancer warning signs.
Useful in any health care setting.
11”x17” Spanish version available.
PS-2 If You Worship the Sun
(20” x 28”)
Reveals that tanning is the
main cause of skin cancer.
11”x17” Spanish version
available.
PS-4 People Who Need the
Most Sun Protection
(20” x 28”)
Emphasizes that parents must
take responsibility for keeping
vulnerable children from being
harmed by the sun`s rays. Urges
parents to start sun protection
early to avoid skin cancer later.
11”x17” Spanish and Italian
versions available.
PS-3 One Blistering Sunburn
In Childhood (20” x 28”)
Informative poster with clear
instructions for parents for
establishing early and lifelong
sun safety habits.
11”x17” Spanish and Italian
versions available.
PS-11 Learn the
Body Language (20” x 28”)
Features attractive close-up photos of the body areas where skin
cancer is most likely to develop.
Describes the warning signs,
stresses the need for regular,
complete skin self-examination
and the lifesaving importance
of early detection. For doctors’
waiting rooms, clinics, schools
and health fairs.
PS-10 Skin Cancer:
If You Can Spot It You Can
Stop It (20” x 28”)
An 8-step illustrated guide
to self-examination of the
skin, designed for doctors`
offices, clinics and health fairs.
Explains the importance of early
detection and describes the
major warnings signs.
11”x17” Spanish version
available.
NL-1 Sun & Skin News
A quarterly newsletter for consumers
written in everyday language,
providing information on a broad
range of topics related to skin health.
Subjects include prevention and
treatment of skin cancers and other
forms of skin damage, sunscreen, and
the danger of tanning parlors.
Also available as a subscription.
JL-1 The Skin Cancer
Foundation Journal
An annual publication covering
beauty, lifestyles, health and
more. Written in an accessible,
easy to understand style, The
Skin Cancer Foundation
Journal is an award-winning
publication bringing the best
information on skin cancer prevention, advances in
treatment and tips from a wide range of experts to
both doctors and patients.
Periodicals
NL-2 The Melanoma Letter
A quarterly newsletter for
doctors, featuring articles by
prominent medical authorities.
Designed to keep clinicians,
scientists and other health
professionals up-to-date on
advances in diagnosis and
treatment, as well as research
breakthroughs.
Also available as a subscription.
99
Advertisers’ Index 2010
ADVERTISER
PAGE
Darrick Antell, MD
62
www.antell-md.com
Archives of Dermatology
53
www.archdermatol.com
AVEENO®
19
www.aveeno.com
Banana Boat
29
www.bananaboat.com
Bath and Body Works
55
www.bathandbodyworks.com
Clarins
27
www.clarins.com
Clinique
Inside Front Cover-1
www.clinique.com
Coppertone
36
www.coppertone.com
DSM Nutritional Products
6
Eucerin
Back Cover
www.eucerinus.com
Galderma
22
www.cetaphil.com
2-3
www.garnier.com
Hawaiian Tropic
16
www.hawaiiantropic.com
Jane Iredale
14
www.janeiredale.com
L'Oreal Paris
4-5
www.loreal.com
Perry Robins, MD
79
Revision Skincare
Inside Back Cover
www.intellishadespf45.com
Sephora
9
www.sephora.com
Shiseido
10
www.sca.shiseido.com
Skinmedica
50
www.skinmedica.com
Solise
31
www.solise.com
100
YOU CAN’T ALWAYS
AVOID THE SUN,
BUT YOU CAN
BE READY FOR IT.
PUT THE HEALTH OF YOUR SKIN FIRST
with daily moisturizer + daily SPF protection.
A healthy relationship with the sun means protecting your skin from
incidental exposure. That’s why there’s Eucerin EVERY DAY
PROTECTION SPF 15 body lotion and SPF 30 face lotion.
Both protect your skin from harmful UVA & UVB rays, yet feel
light and non-greasy for daily use. Feel great about a sunny
day with Eucerin, the brand dermatologists recommend.
EucerinUS.com/SKINFIRST
Skin science that shows.

Downloadable 2010 Skin Cancer Foundation Journal

Transcription

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