In a recent New York Times article, a psychiatrist writes of the defensive, embarrassed or even angry reactions a physician can receive when approaching people in public with concerns about their health, such as an irregular-looking mole or a possibly enlarged thyroid gland.
On a number of occasions during my medical career, I, too, have put aside my inhibitions and attracted the attention of a complete stranger in the supermarket checkout line, the elevator of my office building or the gym to recommend that "you might want to have that checked out by your dermatologist". I'm happy to say that my well-meaning efforts have generally met with a positive response.
It's a different story, though, where tanning is concerned. I still remember apartment-hunting fifteen years ago in preparation for my move to Maryland to commence a post-doctoral research fellowship at the National Institutes of Health. The image that stands out most vividly in my mind is of the health club at the condo complex where I eventually chose to live. It was a bright, sunny summer day and the beach chairs were out in force beside the outdoor swimming pool, each occupied by a well-oiled and bronzed body.
"There are your future patients," my brother remarked ironically as we peered over a balcony at the pool. I bit my lip sadly and said nothing. I couldn't think of any way to open a conversation with any of the blissfully oblivious sunbathers on the patio beneath me. To this day, I reserve my lectures on the dangers of tanning for the safe sanctuary of my examination rooms. And I try to temper my warnings with a good dose of humor, lest my patients should feel like errant schoolchildren in the principal's office.
We all love the sun; it gives us a feeling of well-being. Who has not leapt out of bed with a spring in her step as the warm glow of the morning sun illuminated her face? But an overdose of the sun can destroy you as surely as an overdose of drugs or alcohol would do. Gone are the times when a tan symbolized health and wealth. Now we understand that a suntan, like a sunburn, is a sign of skin damage.
If you want to know how the sun has affected your skin, look at the inside of your upper arm, which has had little sun exposure and is relatively undamaged. Now look at your face, neck, chest or the backs of your hands. If they're wrinkled, rough or discolored, that's sun damage from ultraviolet light exposure, not "normal" aging. So are spider veins and the precancerous red, scaly growths known as actinic keratoses. Shockingly, it's been reported that the number of wrinkles on your face is directly related to the total hours of sun exposure you've had in your life.
In a previous post, I discussed the fact that an increase in the time we spend outdoors in recreational activities combined with the thinning ozone layer has resulted in our being exposed to more sun damage and protected less than in previous generations. The resultant explosion in skin cancers is well-documented by The National Cancer Institute and the Centers for Disease Control and Prevention (CDC), which report that skin cancer is now the most common cancer in the United States, with more than 1 million cases diagnosed annually. Based on these statistics, The American Cancer Society predicts that 5 Americans and 1 in 3 Caucasians will develop skin cancer in the course of a lifetime.