Melanoma Advocacy and the Return of Dr. Oz

The melanoma advocacy community has really spoken up lately.  In May, we did our part in increasing melanoma awareness in the general population.  I’ve never seen or read so many corporate-sponsored ads and Twitter chats regarding sun safety and skin cancer.  From L’Oreal Paris and Neutrogena to Glaxo Smith Kline and the Melanoma Research Foundation, it was difficult to venture into social media without seeing some hint of melanoma awareness advocacy.

After the dust settled, well, it didn’t.  Someone spotted a contest on Ellen DeGeneres’ website soliciting “funny sunburn photos.”  This is apparently an annual event on Ellen’s website, but this year we got wind of it and expressed our concern.  In some cases, outrage was expressed!  Melanoma warriors and survivors sent in photos of their scars and excisions rather than “funny” sunburns.  Emails were sent and Ellen’s Facebook page was flooded with concerned comments.  Within 48 hours (or less?) the request for sunburn photos disappeared.  Perhaps this was merely a coincidence or maybe it was a direct result of our efforts.  Whichever, it seems we were heard.

Before the last virtual champagne bottle was opened, another fly in the ointment appeared.  The infamous article from RealFarmacy.com (and posted in other sites) was posted, offering alleged proof from a “major study” that sunscreen causes skin cancer.  The only problem was, the data was cherry-picked, extremely misleading, based on decade old research (long since obsolete) and just down-right full of incorrect information.  In this case, the melanoma advocates didn’t address the source, but chose to share opposing views via their Facebook pages, blogs and articles.  Not only did simple bloggers like me address the issue, major websites such as IFLScience, Snopes and the Melanoma Research Foundation issued statements including supporting evidence of the original articles falsehoods.  As this event is recent, I’m sure there will be even more comments in support of sun safety.

It finally looked like things were going to quiet down, but then I saw another small article today.  It’s not as blatantly anti-sunscreen as the RealFarmacy article or as blissfully ignorant as the Ellen contest, but in my mind, it can be just as damaging to efforts in melanoma and sun-safety advocacy.  And it originates from our old friend Dr. Oz.

Dr. Mehmet Oz may have been the first to create a true outcry from the melanoma advocacy community.  You may recall that back in 2012, Dr. Oz hosted Dr. Joe Mercola, an FDA-cited, tanning bed selling “medical expert” who talked about the benefits of UVB tanning beds (which again…he sells) and how mainstream media was skewing the true melanoma statistics and that the cancer was not indeed increasing in society.  At the end of the interview, Dr. Oz stated that he would “rethink” the use of tanning beds.  Immediately, Dr. Oz became melanoma advocacy public enemy number one!  In my view, Dr. Mercola was the true “evil” in our midst.  Dr. Oz offered up a statement after the show to convey his strong stance against tanning beds, so I personally gave him a little bit of a break.  A little.  (Here’s my assessment of the two doctors).

That” break” has finally dissolved with the airing of his television show on July 7. 

During this episode, Dr. Oz addressed summer health myths, such as “Are mosquitoes attracted to sweet blood?” “Do you have to wait 20 minutes after eating before swimming?,” “ and “Does peeing on a jellyfish sting reduce the pain?”  The first myth addressed was “Does a sunburn fade into a tan?”  When I saw this introduction, I hoped that this would be a great opportunity for the good doctor to share good sun safety tips.  I figured he’d address the myth, and then mention that both sun burns and sun tans are signs of skin damage…just as is stated by the Skin Cancer Foundation and so many other fine medical organizations.

As anticipated, he addressed the myth first.  In short, no, a sun burn does not fade into a tan.  He states, “When the sun hits your skin, it doesn’t just tan – it destroys.”  He and an audience member (who he leads creepily around by the hand) perform a demonstration on how UV rays kill skin cells and tans the few remaining cells.  (This demonstration involved shattering glass for which each wore safety glasses, and scolding hot water, for which no protective gear was worn.  I could swear the audience member may have been burned by spattering hot water).  After the demonstration, Dr. Oz explains the mechanics, and then states, “that’s why burning is never a good idea if you want to get a tan.”  At this point, the audience member smartly states, “Just stay out of the sun unless you’re wearing sunscreen.  End of story.”  Okay…this is the perfect segue for the doctor to explain the damaging effects of burning as well as tanning.

How does Dr. Oz respond?  He replies, “…or get it gently.”   He explains that best way to get a tan is in small doses over time so that the skin cells that survive the burn will have the opportunity to darken and new cells will grow back to further darken through gentle tanning.  He doesn’t discourage tanning at all!  In fact, he’s trying to convince his audience that there’s a safe way to tan.

Let me repeat .  He is explaining a safe way to get a tan.  He never mentions that no tan is a safe tan, and he completely ignores his audience member’s comment that it’s best to wear sunscreen!

Here’s the video.

This entire discussion takes place in less than two minutes and it doesn’t have the wide distribution of the aforementioned RealFarmacy article, so I doubt there will be the same outrage.  But what upsets me is that Dr. Oz has millions of viewers.  As I stated in my earlier blog in 2012, when Dr. Oz talks, many impressionable viewers who trust his medical expertise will listen.  They now potentially believe that there is a safe way to tan, and are ignorant of the true facts of which Dr. Oz had the perfect opportunity to share.

We melanoma awareness advocates have our victories, but we have new and challenging battles every day.  Don't give up...and don't stop believing.  One day, people will know because they need to know.

Wrong Message Ellen

In case you missed it, the Ellen DeGeneres Show has asked the public to “Send us your bad sunburn photos!”  This is the photo they used as an example:

As a colleague of mine would say, from 50,000 feet, this seems funny.  I would equate the humor to someone writing “Dork” on a sleeping frat brother’s forehead.  Sure, it’s sophomoric humor, but it can be funny.

But in all honesty, this isn’t funny.  You and I both know that there is nothing funny about a sunburn.  One bad sunburn can significantly increase one’s chance of being diagnosed with skin cancer or melanoma.  Repeated sun exposure is even worse.  Of the top seven cancers, incidents of melanoma are rising while all others are declining.  Most skin cancer and melanoma can be attributed to UV radiation from the sun or tanning beds.  In short, sunburns are bad.  Very bad.

You might call me a hypocrite.  After all, I posted a blog a three years ago (almost to the day!) that made fun of “funny” sunburns.  Well, in all honesty, I was trying to showcase how improper sun screen application can result in sunburns.  Still, I used the words “every now and then I have to lighten things up” meaning that I thought the pictures in the blog were indeed funny.  In retrospect, they weren’t (although they still emphasize proper use of sunscreen). 

I do have a sense of humor.  Some would say I have a sick sense of humor that defies political correctness.  As I said before, from a distance, Ellen’s request seems funny…until you realize that some people may purposely subject themselves to “funny sunburns” so as to have their photo appear on TV.  This is what makes this so offensive to me.

If any sunburns are to be posted, let them be of sunburns that make attractive people look ridiculous. 

Make a statement that sunburns are not to be laughed at, but to be admonished with mutterings of “when will they ever learn?”  I would love to see a segment on Ellen start with such photos to cause the audience to laugh…and then show a picture such as one of these:

Imagine how the audience would grow silent.  Imagine how they would stop to think.  Imagine the message that could follow with important and substantial discussion about sun safety and melanoma.

Now THAT would put a smile on my face.

Is Blocking Sunburn Pain a Good Thing?

Yesterday, my colleague Elliot showed me an article in the local paper with the following headline:

“Cure for the sunburn blues?  It may be coming: scientists have uncovered the molecule that makes sunburn hurt.”

Something just didn’t seem right with this headline.  From a pain management point of view, this was great news.  My mother suffered from Lupus (one of the most obscure diseases) and she was in a lot of pain during the last years of her life.  Any advance in pain management is good news…but in this case, something didn’t quite feel right.

The article goes on to state that the TRPV4 molecule reacts to UVB rays and allows calcium and a protein associated with pain and itching to pass through the cell walls and cause the discomfort.  The scientists performed studies on mouse paws (who knew mouse paws were similar to our skin)…they took away the TRPV4 molecule and discovered the mice felt no pain from an imposed sunburn.  “They were a lot less sensitive and their skin tissue was significantly less damaged.”

Hmmm…that last statement barely snuck in, and disappeared almost as fast.  Let’s read it again. 

“…and their skin tissue was significantly less damaged.”

Okay, so this seems like a good thing…skin is less damaged.  But the article never goes on to explain what damage was actually less.  Was it less sunburn…did removing the TRPV4 molecule act as a pseudo sun block?  Was there still damage to the melanocytes?  Was there an increase or decrease in the potential for skin cancer?  It’s not clear.

What is clear is that the pain associated with sunburn can be reduced.  But is this really a good thing?  My first thought was echoed in the article by dermatologist Dr. Margaret Boyle.  She said that a sunburn is nature’s way of telling is to get out of the sun.  “Sunburn pain acts as a warning system.  We need that trigger to help keep us safe.”

I couldn’t agree more.  I still get the occasional burnt spot because I missed it when applying sunscreen and I suffer some pain because of it.  Yes, I’d like immediate relief.  But I’m not sure it’s smart to incorporate TRPV4 blockers into sunscreen so that sun exposure doesn’t come with a little pain. 

We already rely too much on sunscreen to protect us from the sun.  We should be savvier in wearing hats and protective clothing and in seeking shade during peak sun hours.  We should seek shade as much as possible.  We don’t need a sunscreen that removes nature’s way of letting us know we’ve been in the sun too much.

Let’s hope there’s more to this study than that.

The Popular Mechanics of Sun Exposure

While it’s interesting to see which key word searches led people to my blog, it’s equally interesting to see where else those same words lead me.  Today I followed the key words “sunburn time chart.”  There were a few sites regarding the UV Index, but one site in particular seemed like the obvious choice for all things sunburn related.

Popular Mechanics.

The article is called “Anatomy of a Sunburn: A Timeline ofDermatological Destruction.”  It breaks down the details of the sunburning process within the skin in fairly layman terms.  Feel free to read the article yourself, but here’s a summary of the more interesting points.

Some of the warmth you feel as you step into the sun is literally the absorption and conversion of UV rays to heat by the melanin.

As you’re exposed to the sunlight and UV rays, the melanin goes on the defensive and spreads itself around to cover the cell nuclei where the DNA resides.  But for lighter skin folks, there’s simply not enough melanin to go around. (Note…darker skin people can have gaps in their melanin coverage as well, so they also need sunscreen).

When there’s no melanin, the UVB rays sneak in and cause INSTANT damage to the DNA cells.  As one spokesperson from the Skin Cancer Foundation stated, “the nice spiral staircase (of DNA) is knocked off-kilter.”

As the DNA gets damaged, the blood vessels dilate in the dermis (the layer below the epidermis) to nourish the outer layer of skin.  Meanwhile, the melanocytes that are located in the basal layer of the epidermis are working overtime to develop more pigment for protection.  Well, not really overtime because it takes anywhere from one day to three days for these pigments to deploy (explaining why skin “tans” after the burn).

So essentially, the tan is a sign that the body is trying to repair damaged skin and DNA…or in other words, a tan is a sign of bodily harm…NOT a “good” thing at all.

As one roasts longer in the sun, the DNA damage gets more extensive and deeper.  Cells on the outer layer (epidermis) are self-programmed to die and peel away.  But those cells deeper in the skin cannot shed or peel.  Enzymes can repair most of the DNA damage, but the occasional spot gets missed and leads to mutations.  This is how basal cell and squamous cell carcinomas are formed.

In extreme sunburning, second degree burns can result.  These burns are the same as if you stuck your hand on a hot iron…it is heat and seared flesh.  Blisters form and separate the dermis from the epidermis.  Such blisters are a risk factor for developing melanoma.  (Note that this is not the only cause of melanoma, just the only one mentioned in the article).

Eventually keratinocyte cells are created in the basal layer and migrate to the outer surface.  This in turn causes the attractive massive peeling process.  And in many foolish cases, the process is repeated every season if not more often.

I found that understanding the DNA damage and the body's attempt to repair itself fascinating.  It only stands to reason that if one subjects himself to such a cycle over and over, serious, cancerous damage could result.

If you take nothing else away from this posting or the related article, remember the one line. 

Though suntans are seen as attractive, actually they are signs of bodily harm!

The Earlier They Learn, The Less They'll Burn

A new study by the Memorial Sloan-Kettering Cancer Center in New York states that pre-adolescent kids (pre-teens to teens) are not regularly using sunscreen, despite the fact that many had suffered earlier sunburns.  It was noted that the kids (yes, kids) felt that they looked better with a tan.  In fact, some claimed that they looked healthier with a tan.

This has to change. 

There are many great skin cancer awareness PSAs and anti-tanning campaigns, but most seem to be aimed at teens and young adults (mostly women).  That’s not a bad thing at all, but I think this new study shows that education needs to happen earlier.  I’d personally like to see it start pre-pre-teen…beginning in early elementary school.  Or earlier from the parent to their child!  When a child is taught to look both ways before walking across a street, or not to talk to strangers, he should as routinely be taught about sun safety.  A child probably won’t understand skin cancer or wrinkly skin, but they might listen when one explains that the sun can provide bad sunburns.

My nine-year-old daughter asked me this past summer if the sun was bad.  She had seen my efforts regarding this blog site and the BITNP campaign and simply assumed that the sun must be bad.  I explained to her that the sun was life-giving and provided energy and warmth.  The sun is good!  “So why are you telling people to stay away from it?”  I tried to explain UV rays and got a blank stare.  Then I thought of an analogy.

“Think about water.  Is water good?”

“Yes…because you need to drink water and you can swim in water and the plants need water.  So yes, water is good!”

“But what happens if someone that doesn’t know how to swim goes into deep water?” 

She stared…thinking deeply.  “Well, I guess water is bad?”

“No…water is good, but you have to be careful around it.  If you aren’t careful, water can be trouble.”

“So…wearing sunscreen in the sun is kind of like wearing a life jacket in deep water?”

I couldn’t have worded it better myself.

I don’t know if my kids (both now 9 going on 18) will maintain daddy’s respect for the sun.  They’re entering pre-teens and already becoming a little rebellious.  But having taught them early in life, they have a fighting chance.  I would hope that they do not succumb to peer-pressure and that they stay away from tanning beds.  Better yet, I hope they become mini-advocates against tanning.  She’s in Girl Scouts now and has already asked me if there’s something she can do to help out BITNP within her troop.  Atta girl.

I’ve been working on a presentation for pre-teen classrooms…or Girl Scout troops.  It’s a work-in-progress and I hope to have at least a working draft in May when I plan to speak to the troop.  But for now, there are some great resources for educational material from the Melanoma Education Foundation and the Children’s Melanoma Prevention Foundation.  Check them out and try to spread the word to the kids in your life. 

The earlier they learn, the less they burn.  And yes, I just made that up.  :)

Chemicals in Sunscreen

I had a conversation with a good friend today who shared a story about her daughters' visit to the beach with their grandparents.  She said that they all had a good time and the grandmother had a glowing report on the girls' behavior in general.  But then she said one interesting thing...that one of her grand daughters uses too much sunscreen.  "I told her she just loads it on, she's not going to get a tan at all."  Needless to say, my friend responded to her mother with "Yeah, and she won't get burnt either, and therefore lessens her chances of gettng skin cancer."  (Atta girl)

She went on to mention to me that her fair-skinned daughter has "endured teasing from friends and people who just think their comments are funny, considered it, and at the cusp of teenagerhood has decided that fewer wrinkles and a lesser chance of skin cancer at 50 is more important than a tan now."  (Atta girl..again)  It's sad to think that we have to fight not only ignorance about skin cancer, but peer pressure as well.

But the point I wanted to bring up is that the grandmother apparently muttered something about "chemicals" when discussing the use of sunscreen.  This is an arguement/opinion that I've heard before, so it prompted me to dig into the article I linked in my last post.  Here's what the article had to say:

With regard to ingredients, many dermatologists recommend products with micronized titanium or zinc oxide as the most effective sun blockers that leave no white residue on the skin. There is some concern, based on animal studies, that the most popular ingredient in sunscreens, oxybenzone, may disrupt natural hormones, but the scientific evidence is scant.

Another chemical, retinyl palmitate, sometimes listed among the inactive ingredients, has been linked to skin cancers in animal studies. Because it is converted into a compound that can cause birth defects, it should be avoided by women who are pregnant or likely to become pregnant.

However, although more studies of these possible risks should be done, Consumer Reports concluded that “the proven benefits of sunscreen outweigh any potential risks."

- NY Times

Chemicals in any lotion or cream is a valid concern...so I won't downplay anyone's fears.  At the same time, one has to learn that sun exposure can be a deadly thing as well.  A "simple" sunburn can have major consequences.  So if you have a fear of sunscreen chemicals, seek reliable natural alternatives.  Stay in the shade...wear protective clothing...wear a proper hat...research "natural" sunscreens (if they exist and are reliable).  Don't assume a "base tan" provides ample protection...it doesn't.  Whatever your choice...be sun smart and sun safe!

And to my friend's mother, I'd say, "your grand daughter isn't the palest girl on the beach, she's the brightest girl on the beach!"

All About Sunscreen

I was going to write an information piece on the new sunscreen rules (to be applied next year) but I ran across an article in the New York Times that explains it far better than I ever could.  The important thing to realize is that we probably don't put on enough sunscreen now...so make sure to reapply it every two hours.  Also, don't just apply it when you go to the beach or an outdoor activity...make it a part of your daily routine.  If you work indoors like me, spray it on in the morning to prevent "commuter tan."  Take a can with you to spray if you go outdoors at lunch, and reapply before commuting back home.

But as I said, the following article has so much more to share, so please read!

http://www.nytimes.com/2011/06/21/health/21brody.html?_r=1

What's The UV Index Where YOU Live?

You may have noticed that I attached a UV Index gadget to the top left of this blog.  (Thanks to Melissa of “Melanoma Sucks” for sharing this).  If you enter your zip code, it’ll take you to the EPA website where it will present your UV index for the day.  Gadgets are cool.

But what exactly is the UV Index?  I consulted the Google-Gurus and found this excerpt from the NOAA and National Weather Service:

The UV Index is a next day forecast of the amount of skin damaging UV radiation expected to reach the earth's surface at the time when the sun is highest in the sky (solar noon). The amount of UV radiation reaching the surface is primarily related to the elevation of the sun in the sky, the amount of ozone in the stratosphere, and the amount of clouds present. The UV Index can range from 0 (when it is night time) to 15 or 16 (in the tropics at high elevations under clear skies). UV radiation is greatest when the sun is highest in the sky and rapidly decreases as the sun approaches the horizon.  The higher the UV Index, the greater the dose rate of skin damaging (and eye damaging) UV radiation. Consequently, the higher the UV Index, the smaller the time it takes before skin damage occurs.

Below is a chart showing the minutes to skin damage chart, depending on the UV Index and how easily you sun burn:

What this basically says is that if you “usually” burn and the UV Index is at “7”, you’ll start seeing sun damage at around 28 minutes.  If you “rarely” burn, then you’d start seeing sun damage at 70 minutes.

Anything that indicates that one should wear sunscreen is a good thing.  The UV Index for Raleigh today was 11+ (that’s as high as they post), so it was definitely a day to wear sunscreen.

What I don’t like about the chart above is the suggestion that it’s okay to wander around in the sun unprotected for the minimum time listed.  I think this gives a false sense of security.  It’s best to simply tell everyone to wear sunscreen despite the UV Index.  Anyone who ventured outside in Raleigh today at noon who might “sometimes” burn probably would not have wanted to be unprotected in the sun for the 30 minutes implied as safe.  It was hot, sunny and not a safe place to be without sun protection.

Below is another chart I found which seems a little better:

This one doesn’t distinguish between skin sensitivity, but it pretty much just says if the UV Index is high, seek protection.  What I don’t like is the recommendation for UV1 or UV12, “No protection required!”  I guess living in the south, I can’t imagine too many days where no protection is required…and if such a day does exist, I’d probably want to keep my shirt on anyhow.

One thing I read on the EPA site is that once the UV Index goes above 6, a UV Alert is issued.  Okay, when I imagine an "alert," I think of an announcement that's important and wide spread.  As I said, the UV Index today was 11+, and yet I saw no evidence of an alert.  I don’t get the daily paper, so it might have been in there.  But I do watch the local news and check out the websites.  Neither had one bit of information about the UV Index short of a link buried deep within other links such as local lake levels and historical hurricane maps.  I emailed one local TV station to ask why they don’t post the UV index…once I hear something, I’ll post their response.  I suspect that they might say that the UV Index is posted for only the noon hour each day (true) and that it’s not a true reflection of the entire day’s sun exposure, therefore they don't report it.  Or they might simply state that, at least in this area, there’s an alert every day in the summer months, so why constantly post it when there’s nothing “new” to report?  I certainly hope the latter is not the case.

The UV Index is not a perfect tool, but again, anything that gets a person to consider the consequences of going into the sun unprotected is a good thing.  So feel free to type in your zip code and determine how strong the “burn” is in your town.  Either way, wear the sunscreen!