Does one sunburn matter? And is your SPF doing all that it promises? Skin cancer gets personal for Sarah Brown.
I’ve always been lucky with my skin. It’s porcelain-pale, generally clear, and doesn’t freckle much. It’s been compared to an Italian Renaissance painting (thank you) and a ghost (no thank you), and the sight of it consistently provokes apparently uncontrollable outbursts from others like “You must never go in the sun!” I do, of course, go in the sun. How else can one play tennis, plant flowers, collect seashells, or float on one’s back and look up at the sky?
But when I go in the sun, I am covered. With long sleeves, with an umbrella (on the beach; lunch alfresco), and with a hat. I swim in a hat. When I go on holiday, traveling with hand luggage is never an option due to the gallons of sunscreen I am dutifully carting along. If my bags were ever checked at Customs, the agents would probably think I was trafficking Neutrogena.
So when last summer I noticed a little scab by my hairline, I waited for it to go away. It wasn’t discolored or misshapen or particularly ominous-looking; I covered it with concealer. Over the next month it didn’t grow, it didn’t change, it didn’t bother me—but it didn’t heal, either.
“Looks like you’ve got a breakout,” a facialist told me. “It’s not a pimple,” I replied, eyes closed. After countless sun symposiums, skin cancer luncheons, and derm appointments over the years as a beauty editor, I knew that if a growth pops up out of nowhere, if you have a scab that doesn’t heal, it is something to take seriously. I pointed it out to a top New York dermatologist, who did not seem concerned and offered me some Botox instead. When I saw him again a month later, he still didn’t think it was anything to be worried about but agreed to a biopsy. “If it’s anything, we’ll just hit it with a laser,” he said cheerfully, plunging a needle filled with lidocaine into my forehead. Several days later, while I was getting my hair blown out before a black-tie, my phone rang. It was the doctor. “You were right,” he said, slightly embarrassed. That little pink dot was an early-stage squamous-cell carcinoma, the second-most-common form of skin cancer. It was slow-growing and confined to the superficial layers of the skin, in situ—a best-possible scenario. Beneath the roar of the hairdryer (I was so stunned I kept getting my hair styled), he explained that I could try a topical chemotherapy cream—which would make me look “really bad” for a few weeks but would likely do the trick—or I could elect to get Mohs surgery, which would cut the thing out once and for all. I’d have a few stitches, hopefully no scar. On the bright side, Halloween was coming up in the following weeks, so I immediately thought of how to work genuine sutures to my advantage. I called the next day and made the appointment.
I felt ashamed at first and told no one. If anyone should not get skin cancer, it’s me. Who is more careful? Who uses more sunscreen? And how ironic that in 2006 the Skin Cancer Foundation presented me with the Skin Sense Award, a huge faceted-crystal vessel from Tiffany’s that weighs about ten pounds and that I use for my collection of stray ribbons. If they heard the news, would they dispatch someone to take it back? Then again, if anyone should get skin cancer, it’s me. When I shop for stockings, my “nude” is Wolford’s white. “You barely have any melanocytes,” says the dermatologist Lisa Airan, M.D., referring to the cells that create pigment in the skin and serve as a natural line of defense against the sun. As my pediatrician told my mother when I was days old: “This child will burn under a lightbulb.”
But it’s a grave misconception that it is only the pale-skinned, fair-haired, and light-eyed who need to be careful. “It’s a myth that dark skin can’t get skin cancer just because it has more pigment,” says the dermatologist Patricia Wexler, M.D., who points to climbing mortality rates in African-Americans. Among Hispanics, one of the fastest-growing populations in our country, the incidence of melanoma has risen by almost 20 percent in the last two decades.
Skin cancer is the most commonly diagnosed cancer in the United States, with nearly five million people treated each year. With all that we know about how to prevent it, why are we facing these alarming statistics—that one out of every five Americans will develop one form of it or another in his or her lifetime? For one, a recent study found that nearly half of the nation’s top colleges have indoor tanning salons either on or near campus. (According to the Skin Cancer Foundation, people who first use a UV tanning bed before the age of 35 increase their melanoma risk by a staggering 75 percent.) Even the generally well intended continue to slip up: At his office on East Eighty-fifth Street, Philip Prioleau, M.D., who specializes in the early detection and treatment of skin cancer, sees a steady stream of women “who’d covered their faces but wanted tan legs.” As a result, “I see tons of skin cancer on legs,” he says. “All day long.” Some explanation for the growing numbers could stem from the introduction of the bikini, the crop top, and the recent penchant for cutout peekaboo dressing: “If you look at the way people dressed a century ago, they were almost completely covered,” points out Richard Granstein, M.D., chair of the department of dermatology at Weill Cornell Medical College. A less obvious factor, says David Bank, M.D., a dermatologist in Mount Kisco, New York, is time: “When life expectancy was shorter, people died of other things before they got a basal cell.”
Skin cancer catches up with you. I attribute mine to sailing camp, mid-1990s. Split up into racing teams, we’d go out on the water after breakfast every morning and return to land in time for lunch, after which we’d head out again. The instructors cared that our sailboats remained upright and that we were wearing life jackets—not sunscreen. We cared about wind and not much else. I recall one bad sunburn—across my forehead—that blistered. “Yeah, there you go,” says Anne Chapas, M.D., founder of Union Square Laser Dermatology.
“Sailing and you is not a good idea,” adds Airan when I visit her office on the Upper East Side one morning before work. “You should have picked my sport: ice skating.”
As it turns out, a squamous-cell carcinoma like mine can take up to 20 years to develop (ta-da). And they do tend to crop up in areas “near where you’ve gotten sun,” says Prioleau.
The good news is that when detected early, most forms of skin cancer—from basal and squamous cell to melanoma, the deadliest, fastest-moving type—are entirely curable, though one’s chances of developing another increase substantially.
Treatment depends on the case, and I chose Mohs micrographic surgery because, frankly, it seemed fast and easy, and the cure rate is around 99 percent. It’s a procedure during which tissue-thin slivers of skin—the offending splotch plus the surrounding edges, or margins—are very finely sliced away and analyzed after each layer (while you wait, probably reading a magazine) until the lab finds a sample free of any abnormal cells. It is the most “skin-sparing” surgical option since very little extraneous tissue is removed, and doctors like Airan find it preferable for delicate areas like the face where one desires the most invisible result possible.
For those who fear the scalpel, the option currently generating the most talk (and controversy) is eBx: surface electronic brachytherapy, which employs a short beam of radiation. While the jury is still out on long-term safety and efficacy—a multicenter study has been planned—one downside is that the treatment requires upwards of sixteen sessions in the space of about a month. Another: Radiation itself can potentially cause secondary cancers up to several decades later.
Hiding inside is the best way to protect one’s skin, but for those choosing option B (life), sunscreen, protective UPF clothing (Mott 50’s drapey cardigans are my favorite), and a wide-brimmed hat are still the best lines of defense. Broad-spectrum formulas containing titanium dioxide and zinc oxide, and bolstered by antioxidants, are the most reliable, but, regarding that chic friend who insists on buying her sunscreen at duty-free whenever she goes to Paris because “it’s so much better,” unfortunately, she’s on to something. And it’s infuriating: Whereas companies selling products within the United States have nineteen approved sunscreen ingredients to work with, Europe has 28 and Japan has 42. Among them are agents shown to work better, and longer, than anything we have access to here. The last time the FDA sanctioned a new sunscreen ingredient was in the 1990s. Since 2002, eight new applications—for ingredients that are widely used abroad—have been filed and still await approval. This past November, at the surgeon general’s urging, President Obama signed the Sunscreen Innovation Act, demanding that the FDA begin rendering decisions on these outstanding applications.
But for me and anyone else who’s ever gone out in the sun, the most compelling question remains: Can you undo past damage and what it might be bringing with it? As it turns out, maybe. Prioleau treats his patients and himself with a preventative course of Efudex, an aggressive chemotherapy cream that he says “turns precancerous things red, and they flake off.” He’s been using it faithfully once a year for a week since the nineties. Wexler recommends an annual Fraxel session, which she says “definitely decreases the incidence of precancers. And I believe in daily exfoliation, constantly turning over the superficial cells that have been exposed to the sun.” For anyone brave enough to show their face in her office with a sunburn, she parks them in front of an LED machine and recommends topical steroids and aspirin: “everything to decrease inflammation and abnormal activity in the cells.” And then there are the DNA creams, which contain enzymes and antioxidants that claim to repair DNA damaged by UV light. Clinical data so far are scant, but the hope is great, and innovation continues. “Who knows?” says Chapas. “Do we one day prevent that skin cancer from ever happening?”
Fashion Editor: Phyllis Posnick
Hair: Julien d’Ys for Julien d’Ys; Makeup: Val Garland; Set Design: Shona Heath for CLM; Produced by Padbury Production
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