Published March 1, 2006, in the Wyoming Tribune Eagle, “Consider it your war paint: Outdoors people should be extra guarded in the battle against skin cancer.”
2014 Update: I’m still going every six months for checkups, but finding nothing cancerous. Most outdoor clothing companies now carry items with SPF ratings.
By Barb Gorges
At the end of last August, a zit appeared to have formed on my upper lip.
As a survivor of teenage acne, I thought, “No big deal.”
But several weeks later I was getting tired of it bleeding every time I blew my nose. Eventually, it healed and all that was left was a permanent, flesh-colored bump.
In November, when another family member had a dermatologist appointment, I decided to make one too. “It’s a basal cell carcinoma,” proclaimed dermatologist Sandra Surbrugg, after she took one look at the spot.
Surbrugg, who owns the Cheyenne Skin Clinic, said it was the result of fair skin being inadequately protected from too much sun over too many years.
An unwelcome diagnosis
Typically, skin cancers appear to be weirdly shaped moles that are off-color or changing in size. But the bleeding was a tip-off for mine.
Surbrugg sent the biopsy sample to a lab for confirmation, and two weeks later deftly removed the growth and surrounding tissue before neatly stitching me up.
The surgery should be 95-99 percent effective. But I have a 40-percent chance of growing another basal cell carcinoma. Considering a few horrible sunburns I got as a child and my years working outdoors, my chances may be higher.
Surbrugg has a lot of sewing experience, performing six to eight surgeries a day.
“Basal cell is most common, about 1,000 cases a year just in our office, plus 300-400 squamous cell and 50 melanoma cases,” she said.
Skin cancer accounts for close to 30 percent of her practice, and while she thinks the high numbers are because there’s more cancer now, people are also more aware.
Wyomingites are particularly prone to skin cancer, she says. “We live at 6000 feet,” Surbrugg explained. “There’s a five percent increase in ultra violet for every 1,000 feet so we get 30 percent more (than people at sea level). Then we have many, many sunny days. And we’re an outdoorsy bunch.”
Ultra violet rays are the destructive light waves in sunshine.
The three bands of UV light are UVA, UVB and UVC. UVC are absorbed by the upper atmosphere and do not reach the Earth’s surface; UVA and UVB rays do. It’s these rays that burn the skin and the eyes with too much exposure.
Those with fair complexions face the highest risk of developing skin cancer.
At Christmas I showed off my nearly healed incision. My mother and sister both informed me they’d been there and done that. Both have blue eyes and were blonde as children.
Surbrugg said it’s a great advantage to have darker skin. It’s the people with Celtic heritage–red hair, light eyes and freckles–that are most at risk. The best research on melanoma is from Australia, she said, where the government takes an active role in promoting skin cancer prevention.
She said natives of the British Isles, immigrating from such a cloudy climate to Australia, have had no natural defenses against a landscape overflowing with sunshine.
Slip, Slap, Slop
Slip on a shirt, slap on a hat and slop on sunscreen. That is a good mantra for those who want to avoid future incisions—even if our dermatologist could win needlework awards at the fair.
When you want to protect your skin with clothing, any fabric will offer some sun protection. But Surbrugg recommends the tight weave supplex nylon clothing developed by dermatologists.
Nylon clothing is anathema to those of us spoiled by the breathability of natural fibers, but the designs I’ve seen are well vented. Surbrugg said she finds the clothing cool and light weight—and in the long run, cheaper than applying high SPF sunscreen all the time.
Companies like Sun Precautions carry long-sleeved shirts, pants and a selection of gloves for covering the hands, another key location for skin cancers.
The company even carries masks to protect the lower part of the face that may not be completely protected by the shade of a hat brim.
Birdwatcher and retired pediatrician Jim Hecker is never without a hat. His first brush with skin cancer happened in his 20’s, while in medical school.
The suggested hat brim depth for sun protection is four to five inches all the way around, a size he finds is sometimes incompatible with Wyoming’s wind.
Hecker’s alternative on windy days is the ball cap style with a cloth drape around the neck. It catches less air and gives a little Lawrence of Arabia cachet.
And don’t forget dark, UV-filtering glasses to protect your eyes.
My first experience with sunscreens 25 years ago was that they felt like a layer of war paint on my skin. They smelled and, after a few sweaty hours, burned my eyes.
But as the wife of a freckled, red-haired man, I have adapted his habit of applying sunscreen whenever we head out to bird, fish, hunt or hike.
I think where I fell down on the job is not reapplying with the recommended frequency of every two hours. Also, drinking out of water bottles probably washes sunscreen off my lip prematurely.
Newer sunscreens seem to be absorbed better by the skin. Now I use an unscented product designed for babies or one that is sweat proof. Either of these plus washing my face when I come inside keeps my eyes happy. Hecker said he has supersensitive skin so his favorite is a cream called Solbarzinc, SPF 38.
For days at the office, Surbrugg recommends one application in the morning of a minimum of SPF 15. More regular skin products contain this level of protection.
What exactly does an SPF or sun protection factor number indicate? It means how many times longer you can stay out in the sun before burning. So if you would get sunburned in 10 minutes, SPF 15 gives you 150 minutes, or two and a half hours.
Surbrugg put it another way, SPF 15 blocks 93 percent of UV rays, SPF 30 blocks 95 percent and SPF 50 blocks 97 percent.
Seek shade at peak hours
Pamphlets from doctors’ offices recommend staying out of the sun from 10 a.m. to 4 p.m. to avoid the most UV damage. Luckily, outdoor activities in early morning, late afternoon and early evening are appealing at the height of summer heat or for the best light for photography.
These can also be the most productive hours of the day for fishing, hunting and birdwatching, though limiting for long hikes or winter recreation.
Summer is not the only sunburn season in Wyoming. Sun reflected off snow can be as potent as any day at the beach. When Surbrugg goes skiing, in addition to wearing a helmet and goggles, she wears a mask on the lower part of her face. She said she shrugs off the odd looks. Her sun protection probably also decreases her chance of frostbite and windburn.
“The message I try to give my patients is: You don’t need to be a hermit,” Surbrugg said. “I ski, bike, and jog. It’s just using common sense. I have many, many hats. Despite the hat hair they give me, I wear them.”
Types of skin cancers
Precancer or actinic keratosis is the name for a small crusty, scaly bump of any color that most frequently forms on skin exposed to sun or tanning machines. A precancer can develop into more serious forms of skin cancer.
Basal cell carcinoma and the more dangerous squamous cell carcinoma are most common. Left untreated they can cause major damage. Squamous cell has a greater chance of spreading and becoming life-threatening.
Melanoma is the deadliest form of skin cancer. Left untreated it will spread to vital organs.
For more extensive information on what to look for and treatments available, ask a dermatologist for a brochure or visit The Skin Cancer Foundation at http://www.skincancer.org.
Preventing skin cancer
The Skin Cancer Foundation recommends these sun-safety habits:–Avoid unnecessary sun exposure, especially during peak hours of 10 a.m. – 4 p.m.
–Seek the shade.
–Cover up with clothing, including a broad-brimmed hat, long pants, a long-sleeved shirt, and UV-blocking sunglasses.
–Wear a broad-spectrum sunscreen with a sun protection factor of 15 or higher.
–Avoid tanning parlors and artificial tanning devices.
–Examine your skin from head to toe every month.
–Have a professional skin examination annually.
UV sun protective clothing sources
A variety of companies specialize in offering clothing for kids and adults made from fabrics rated for the Ultraviolet Protection Factor, or UPF. Catalogs are also available from dermatologists. A few of the companies are:
— http://www.sungrubbies.com (also offers fabric yardage)
Locally, Sierra Trading Post carries some sun protective clothing, but it is difficult to search their Web site for it. Check the Sportif, Simms, Mountain Hardware and Ex Officio brands. Gart Sports carries the Columbia brand in sun protective shirts, pants and hats and will be getting more as spring progresses.