Keep an Eye on the Sky
Block the sun for healthy skin
Farmers spend the majority of the warm months outside and welcome the longer days of spring and summer. However, the average age of today's farmer is 57, which means that he spent many childhood days outside in the sun long before the risks of sun exposure were well-defined.
The number of newly diagnosed skin cancers has continued to rise over the past 40 years, especially the incidence of melanoma, the most deadly skin cancer. Although new treatments for melanoma are improving the long-term survival rate, it's a serious skin cancer.
This farmer's wide-brimmed hat affords good sun protection for both the face and neck.
Photos by Sally Colby
One melanoma survivor, Catherine Poole, grew up like many young women - she loved being outside and wanted a tan. However, the fair-skinned Poole burned more than she tanned. "I got a lot of sun and also used a tanning lamp when I was in high school," she said. "I'm also a gardener, and I swam." What Poole didn't realize at the time was how her exposure to the sun would affect her health. After she noticed that an existing mole had undergone changes, she was diagnosed with melanoma.
As Poole underwent treatment for melanoma, she worked with her oncologist to write a book that would be a source of accurate information for melanoma patients. "I wanted to help others to get the right information, and that's my mission today: to keep people up to date on treatments and keep people away from false information," Poole said. She also founded the Melanoma International Foundation (www.melanomaintl.org) to help melanoma patients find information and support that she didn't have while undergoing treatment.
Poole says that the important first step for anyone who is diagnosed with melanoma is to see a dermatologist who is a melanoma specialist. "It can mean your life, even in the beginning when you first have the biopsy done. Someone who specializes in dermatopathology should read the report," she said.
Today, as a 22-year melanoma survivor, Poole works as a patient advocate, keeping people up to date on treatment options. As a melanoma educator, she knows that although farmers may be aware of the dangers of sun exposure, they don't always take the steps necessary to protect themselves.
"Farmers should dress for sun exposure, with a broad-rimmed hat, long sleeves and long pants," said Poole. She knows farmers like wearing cap-style hats, but says they don't afford adequate sun protection. "The brims aren't wide enough to protect the face, and the ears and neck are totally exposed," she explained. "People think they're protecting themselves, but they aren't."
Men tend to have a lot of ear melanomas, which are caused by excessive, chronic sun exposure. "Men over the age of 50 have the highest mortality rate from melanoma, mostly due to the fact that they don't examine their skin," said Poole. As a result, by the time their melanoma is discovered, it is more advanced.
Melanoma is the number one cancer in young women ages 20 to 29, because they don't develop a lot of other types of cancer at this young age. However, of all the women who will get a melanoma, most will be diagnosed when middle aged or older. Poole warns of the danger of using tanning beds to get a jump on a summer tan or to "prevent sunburn" prior to the season. "Fifteen minutes under a tanning lamp is equal to a whole day laying out on the beach," she said. "There's so much unregulated tanning bed use; people can stay in one all day if they want."
Although this tractor is equipped with a covered cab, the driver's face, neck, arms and legs are exposed to sunlight throughout most of the day.
Poole says that people who examine their skin regularly have the best chance of catching melanoma or other skin cancers. "Any change in a mole, or any new mole that appears should be checked," she said. A video guide for self-examination can be found at www.melanomaintl.org/melanoma_info/examine.html.
Dr. Michael Ioffreda, dermatologist at Penn State Hershey Medical Center, says that melanoma is the most deadly form of skin cancer. It's treatable if caught early, but difficult to treat once it spreads. "The incidence of melanoma is increased as a result of sun exposure," said Ioffreda, "and it's that intense, blistering sunburn early in life that increases the risk. Melanoma can appear as a new mole, or it can come from an existing mole that is changing. That's why we tell people to watch moles for changes in color, shape or size, or if a mole starts to bleed or itch. Those are signs that they should be checked by a dermatologist." Ioffreda says that some people may have a genetic defect that predisposes them to melanoma, which is why it's important to be aware of relatives who have been diagnosed with melanoma.
Why is melanoma so dangerous? "Melanoma grows on the surface of the skin, then grows deeper," said Ioffreda. "When it gets to the blood vessels and the lymphatic system, it can spread to the lymph nodes and to other organs." Ioffreda says that people who have light-colored eyes (blue or green), fair skin and blonde or red hair have a higher risk of melanoma. Other risk factors include having a first-degree relative with melanoma and having a lot of moles, especially atypical moles. Melanoma is sometimes found on parts of the body that aren't exposed to the sun, such as the soles of the feet.
This farmer had a squamous cell carcinoma removed from the side of his face-one of the most common places for skin cancer in men- from years of not wearing a wide-brimmed hat or using sunscreen.
While melanoma is the most deadly form of skin cancer, basal cell and squamous cell carcinomas, while less fatal, are the most common. "Basal and squamous cell carcinomas are most often found on the neck up, on the trunk, chest, forearms and backs of hands," said Ioffreda. "They arise in the top layer of skin, and when caught early, don't spread to other organs, but if they're neglected, they can go deeper and cause disfigurement."
When it comes to skin protection, it's important to understand the two types of ultraviolet rays that can lead to skin cancers. "UVA light penetrates more deeply in the skin and has a role in causing wrinkles. UVB does not penetrate as deeply, but is responsible for sunburn. Both contribute to skin cancer. That's why we recommend a broad-spectrum sunscreen, which means it will protect against both UVA and UVB," explained Ioffreda. He notes that the SPF number found on sunscreen refers only to UVB protection, and that the label should state that the product provides broad-spectrum coverage.
Understanding the difference between sunscreen and sunblock is important for those who use such products. Sunblock products, such as titanium dioxide or zinc oxide, have reflective properties that guard the skin against the sun's rays. "This is the white stuff on the lifeguard's nose," he said. "It reflects the sun's rays and works immediately. A sunscreen relies on a chemical reaction on the surface of the skin, so it should be applied at least 15 minutes before going out in the sun."
The American Academy of Dermatology suggests using cream-based sunscreens for dry skin and the face, gels for hairy areas such as the scalp or male chests and sticks for around the eyes. Ioffreda cautions that if sunscreen products are not used properly, people may spend more time in the sun thinking they are protected, when in actuality they may be doing more harm. He noted that the American Academy of Dermatology recommends using a product with an SPF of at least 30 on all areas of exposed skin. "One ounce [2 tablespoons] is the amount needed to cover exposed areas of the body - face, arms and legs," said Ioffreda, adding that new labeling in 2012 will provide information on how long sunscreens will last in the water.
In addition to properly using sunscreens, it's also important to protect lips with a lip balm that's at least SPF 30. Eyes should be protected with sunglasses that block ultraviolet rays, which can contribute to cataracts. "Sunblock clothing is another good way to protect yourself," said Ioffreda.
For those who have been taught that exposure to sunlight is necessary for the body to synthesize vitamin D (important for bone health and immune function), Ioffreda says that the American Academy of Dermatology recommends that all vitamin D be obtained through a healthy diet and vitamin supplements. People who take prescription medications that include warning labels about limiting sun exposure should pay attention to those warnings and take extra precautions to protect their skin in the sun.
In some cases, medical professionals who are not dermatologists, such as dentists, ophthalmologists or ear, nose and throat specialists, notice precancerous lesions on patients simply because that professional is working close to the patient's face. In these cases, patients are referred to either a primary care physician or a dermatologist for conclusive diagnosis and treatment. One relatively common precancerous lesion spotted by such professionals is actinic keratosis (AK), which appears most often on the face, especially on the nose and lips, and on the backs of hands. AK lesions are usually raised, scaly plaques and may appear as a wart. Physicians usually treat AK in the office and will advise the patient about follow-up treatment.
Staying out of the sun between the hours of 10 a.m. and 4 p.m. is probably unlikely for most farmers, but wearing appropriate clothing, especially a wide-brimmed hat, and using sunscreen products can prevent skin cancer as well as other sun-related skin damage.
The author is a frequent contributor and freelance writer who farms and raises Great Pyrenees in south-central Pennsylvania.