An Earlier Warning
Teenagers and young adults increasingly are being diagnosed with skin cancer, according to doctors who warn that the development could herald a wave of deadly lesions later in these patients’ lives.
This onset is much earlier than in previous generations: Malignancies once thought to take 20 to 30 years to become noticeable are being removed from the faces, backs and necks of what one dermatologist described as “remarkably young” patients.
Melanoma--the deadliest form of skin cancer--now ranks as the most common cancer among people age 25 to 29. From the mid-1970s to the late 1990s, melanoma rates rose 60.5% among women age 15 to 29, according to figures from the American Cancer Society. That translates into 6.9 melanomas for every 100,000 women in that age group.
Among men in the same age group, the rate rose 26.7% in that period, to 3.8 for every 100,000.
While melanoma statistics can be tracked because doctors report cases to central cancer databanks, there’s no comparable tally of more common skin malignancies such as basal cell and squamous cell carcinomas, or of a pre-cancerous condition called actinic keratoses. But estimates from the American Cancer Society suggest rates of the skin carcinomas are also on the rise. No one disputes that skin cancer rates overall remain highest in the elderly, in whom tumors have had a lifetime to develop.
But doctors are especially disturbed by the numbers of younger people they’re treating, which suggest that messages about sun avoidance still aren’t getting through and that the tan made popular when French designer Coco Chanel dared to brown in the 1920s remains a sought-after look today.
Although doctors lack the data to know what exactly is behind the rise in skin cancers among young people, they suggest that several factors--more time in the sun, improper use of sunscreens and a rise in tanning salon visits--all play roles.
Dermatologists believe that young people are generally spending more time in the sun than their parents did and either not using enough sunscreen or failing to apply it properly. They also contend that many Americans, including the young, are spending more vacation hours in sunny climates than in previous decades--a result, they say, of increased leisure time and more affordable travel.
In a study published in 1997 in the Journal of the American Academy of Dermatology, a research team led by Dr. June K. Robinson at Northwestern University Medical School found that during the decade ending in 1996, the number of Americans who reported at least one severe sunburn rose from 30% to 39%. Bad sunburns, especially early in life, are one of the best-established risk factors for melanoma, along with fair skin and multiple moles.
And more Americans--roughly 1 million a day--are visiting tanning salons, according to the American Academy of Dermatology. The Indoor Tanning Assn., a trade group based in Jackson, Mich., estimates that 28 million Americans visit a salon at least once a year, said Joseph Levy, a spokesman for the group’s educational branch.
The nation’s 25,000 tanning salons and the 20,000 other businesses that offer tanning services are especially popular with younger adults, particularly younger women. Levy said a 1997 association survey found that about 30% of customers were women 20 to 30, and 5% were young women 16 to 20.
In an unpublished national study of nearly 1,200 randomly selected youngsters 11 to 18, Dr. Martin A. Weinstock of Brown University found that 40% of girls ages 17 or 18 said they used tanning beds, compared with about 11% of boys that age.
Although Levy said there has been no scientific evidence that using tanning beds without burning the skin increases skin-cancer risk, numerous studies over the years have linked the use of tanning beds to melanoma. In a study that appeared in the Feb. 6 Journal of the National Cancer Institute, Weinstock and Dartmouth researchers found that New Hampshire residents who used tanning beds regularly were 2.5 times more likely to develop squamous cell carcinomas and 1.5 times more likely to develop basal cell carcinomas than those who didn’t.
That same study found that the younger people were when they used tanning beds, the more likely they were to develop skin cancer.
Doctors also say that advances in sunscreen technology, while helping protect people from sun exposure, have an unintended consequence: People feel protected when they slather on sunscreens with an SPF of 45 or higher to avoid the blistering burns linked to melanoma. But this may produce a false sense of security because people think the added protection enables them to stay in the sun longer, so they absorb more radiation, some dermatologists say.
Is it possible that the increased numbers of young skin-cancer patients are largely the result of people seeing dermatologists more often for acne and other skin problems, so the disease is spotted earlier? Probably not, say most doctors.
“You can’t get increases like that just from better detection,” said Weinstock, the Brown dermatologist. Clearly, skin cancers aren’t getting caught as often as they could because doctors have seen melanoma deaths rising steadily for decades (although melanoma mortality has more recently dipped slightly in the young as some get care at a more treatable stage).
At the same time, though, Weinstock said the increases in basal cell carcinomas are real. Because these cancers grow and don’t go away, the patients that he and fellow dermatologists treat would seek care eventually.
The rise in curable skin cancers among the young could leave a major legacy: an increase in deadly skin cancers later on. That’s because one of the biggest known risks for melanoma is a history of other skin cancers and pre-cancers. David J. Leffell, a Yale University dermatologist, said the prospect that today’s young skin-cancer patients could develop more invasive cancers decades from now “represents a major public health problem.”
We get 85% of our lifetime sun exposure by age 18, during a time when skin cells in our growing bodies are particularly vulnerable to damage. Ultraviolet radiation begins penetrating the skin “the first time your mommy puts you in a stroller for a walk,” said Leffell.
Even in Connecticut, where the sun’s rays are not as strong as in Sun Belt regions such as Florida or California, Leffell said he routinely treats 20-year-olds for skin cancer. “That was unheard of a decade ago,” he said.
Dr. Ronald Moy, a Los Angeles dermatologist, reports a similar increase in skin cancers among the very young. He recently removed a large basal cell carcinoma from the nose of a 17-year-old Palm Springs girl. At a time when most girls her age are fretting about acne blemishes, this high school student was worried about her scars being undetectable by the time of her June prom.
As with many younger patients he treats for cancerous or pre-cancerous sun damage, Moy can’t be sure why this young woman developed problems so early. Maybe because of punishing desert sun. Skin cancer rates in Southern California outpace the U.S. average, and sunlight nearer the equator packs more punch. Or, perhaps she inherited from her parents some genetic inability to repair sun damage to her skin cells, which is another potential risk factor for cancer.
Such cases demonstrate why doctors increasingly stress the importance of prevention by protecting yourself from the sun’s harmful effects and why they stress education about the early warning signs of skin cancer.
Actress Sarah Paulson was headed to Puerto Rico for a vacation two years ago when her fiance asked her to see a dermatologist about a funny-looking mole on her back. It was as small as a pencil eraser and densely black “like someone used a black Sharpie” pen, she said.
Her dermatologist performed a biopsy. The diagnosis: melanoma.
“I was 25 years old. Who thought it could happen to me?” said Paulson, who recently starred in the television series “Leap of Faith.”
“When I was a child in Florida, my parents probably didn’t slather me in sunscreen,” she said. Being fair-skinned and blond also put her at additional melanoma risk.
The cancer surgeon who removed the mole found that it hadn’t invaded other parts of her body. “Had I waited six months,” she said, “there’s such a hugely increased possibility that it would have spread, and it would have been just disastrous.”
Doctors say public awareness of skin-cancer risks seems to have grown since the first Melanoma Month campaigns began in May 1985. “How many mothers brought their 10-year-olds in for skin checks 30 years ago?” said Paulson’s dermatologist, Dr. Glynis Ablon of Manhattan Beach.
