Summer traditionally sends people in search of a tan. But now, the growing evidence that prolonged exposure to the sun can cause skin cancer, or at least result in the premature aging of the skin, has led trendsetters to declare that the sun-kissed look is out. Pale is in. And to achieve the fashionable pallor of the so-called library look, or “untan,” an increasing number of people are applying sunscreens, covering up or simply staying in the shade. And although dermatologists say that vanity, more than medical concerns, is motivating people to take those measures, they are greeting that development with relief. The reason: the dedicated sunbathing so prevalent in the past has resulted in an alarming epidemic of skin cancer. Declared Dr. Gary Sibbald, a Mississauga, Ont., dermatologist: “The whole idea that you are only healthy if you’ve got a tan is right out the window.”
Medical experts have known since the 1950s that overexposure to the sun causes skin cancer. But because it is one of the most curable forms of the disease, it provoked relatively little concern. Indeed, even malignant melanoma—the most dangerous type—is potentially curable if treated in time. But 23 per cent of the people who develop melanoma die because the cancer has progressed beyond the possibility of effective treatment. And now doctors say that because skin cancer has become so widespread— it is now the most common form of cancer—it is posing a serious health hazard.
Victims: The rise in the incidence of melanoma and the lack of early detection is leading to needless deaths. According to Sibbald, of the 40,000 cases of skin cancer that will be diagnosed this year in Canada, 2,200 will be melanoma. Of its victims, he said, 500 will die—and most of those deaths would have been
preventable. For that reason, dermatologists have launched campaigns to make the public aware of the importance of recognizing the symptoms of the disease and the need for early diagnosis. Declared Sibbald: “The biggest hope is to reduce the death rate. That is where we expect to make our dent.”
Hot: In the 1930s, the incidence of melanoma among Canadians was about one in 10,000. Now, one Canadian in 135 will develop melanoma in his or her lifetime. Sibbald, who says that he is seeing one new case of melanoma every four to six weeks, said that if that trend continues, the incidence will rise to one in 100 by the turn of the century. Some medical experts attribute the phenomenon in part to the thinning of the earth’s protective ozone layer. Although the issue is a subject of hot debate among dermatologists, Sibbald acknowledged, “For every one-per-cent decrease in the ozone layer, expect a two-per-cent increase in
skin cancer.” And in an encouraging development last week, federal Environment Minister Thomas McMillan announced that Canada will ban—with all possible speed—all nonessential uses of the chemicals that destroy the ozone. Those chemicals include chlorofluorocarbons, which are found in aerosol sprays and refrigerants.
Risk: Despite that decision and the protective measures that people are taking, Sibbald said that the projected statistics will likely stand up because many people have already overexposed themselves to the sun in the critical period— the first 20 years of life—and will develop the cancer later. And as the average age of the population rises, he said, more people will contract the disease. Still, Sibbald and his colleagues are strongly advising people to take preventive measures, which include wearing protective clothing, applying sunscreens with an SPF (sun protection factor) of 15 or more and avoiding overexposure (page 39). “It is just common sense,” said Sibbald. “The more exposure, the more at risk you are.”
The active agent in sunlight is ultraviolet radiation—high-energy rays that provoke the skin to disperse the protective pigment melanin. It is melanin that produces a tan and absorbs and scatters subsequent doses of ultraviolet rays. But the substance does not absorb all of the rays—and, as a result, overexposure can create cancerous lesions called carcinomas and the deadlier tumors called malignant melanomas. Carcinomas appear mostly on the exposed areas of the body—especially the face and upper arms. Malignant melanomas, rarer but far more dangerous, usually appear on the upper back, and also on the backs of the legs, particularly in women. There are two types of carcinomas: basal cell, affecting one in seven Canadians, and squamous cell, affecting one in 50. The signs of basal cell carcinomas vary: the lesions might be translucent pink or white bumps or reddish spots that tend to ooze, bleed and crust over. Squamous cell carcinomas usually appear as lumps with a thick, scaly surface.
Fuzzy: The major warning sign of melanoma is a change in a mole, normally a small, medium-brown mark or protuberance. If a mole grows larger— to more than one-quarter of an inch in diameter—or assumes an irregular shape or an odd color—such as black, blue or white—or acquires an ill-defined or fuzzy border—that could mean that it has developed into a melanoma. Most carcinomas and melanomas are easily removed: depending on the type and stage of the cancer, doctors either scrape out and burn the malignant area, surgically remove the lesion or mole, or treat the cancer with radiotherapy. And
early treatment is usually tantamount to a cure.
Dr. Alastair Carruthers, a Vancouver dermatologist, said that there is evidence that melanoma is not so much provoked by the cumulative effects of sun exposure as it is by the short, intense bouts that lead to bad burns. People who work indoors but who spend their weekends and holidays burning and peeling are more susceptible to malignant melanoma than those who work outdoors and are
routinely exposed to the sun.
As well, doctors say, even one serious, blistering sunburn suffered in childhood or adolescence can often lead to melanoma. Sibbald said that such an occurrence doubles the chance that the sufferer will contract skin cancer later in life. For that reason, dermatologists emphasize the need for children to be protected. Said Sibbald: “It is pretty sad to see kids on the beach who are a bright red color.” Cautious: Because there is a strong correlation between burning and melanoma, Carruthers said that modern sunscreens are effective preventives because “they allow you to do away
1 with the burn.” But Dr. Cheryl Rosen, a professor of dermatology at the University of Toronto, takes a more cautious stance. “No tan is a safe tan,” declared Rosen. “Tanning, even without burning, is harmful.” For his part, Sibbald said that “tanning is a response to injury in the skin—and it is not healthy.” For that reason, Sibbald said that he welcomed the promotion of what he calls the “peaches-and-cream look.”
Pale: Many modelling agency spokesmen say that they have always discouraged their models from tanning. And now that tans are growing unfashionable, more agencies are insisting that their models stay out of the sun. Said Sharon Dorais, the director of Sharon Dorais Modelling and Talent International in Vancouver: “The first thing I say to the girls is, ‘No suntanning.’ ” She added: “Today’s look is pale on pale, with very, very fair skin. This year, we are looking for people who have hardly ever exposed their skin to the sun. As a model, the more alabaster your look, the more work you will get.” Even in California, where the lean, bronzed body has traditionally epitomized the ideal of beauty, it is now sexy to be pale.
Said Jackie Collins, the author of several inside-Hollywood novels: “Hollywood wives have finally realized that their perfect skins are going to crack if they go out into the sun. The suntan is absolutely out. Un-
less, of course, you’re George Hamilton.”
Hamilton, 48, an actor who is almost as well known for his tanning regimen as his screen roles, follows the sun with legendary dedication. According to his publicist, Jeffrey Lane, the actor “suns every day.” Added Lane: “It is something he has done for years.” Indeed, all Hamilton’s movie contracts say that while he is filming on location, he must be flown to a sunny climate once a month. His friend, movie star Elizabeth Taylor, is also a dedicated tanner. Screenwriter William Stadiem recalls that when he met with the 56-year-old actress beside the pool of her Bel-Air home, “she conducted the entire meeting holding a sun reflector.”
Broil: There are many people—particularly young women—who enjoy the look of a tan so much that they dedicate themselves, like Hamilton, to achieving deep, even mahogany, perfection. To that end, they rub on oils and creams and broil themselves in the sun for hours. And, between bouts in the sun, they visit tanning salons. Despite the pale-is-beautiful trend, tanning salons are flourishing. Theo Van Der Gulik, president of the Success Sun Tan Salon in Toronto, said that his business has already increased about 40 per cent over last year. “People come in to look good,” he said. “If you’re white, it’s easy to look sick. If you’re tanned, even if you’re sick, you don’t look sick.”
As well, some people visit tanning salons on the assumption that artificially created ultraviolet rays pose less danger than those of the sun. Although dermatologists acknowledge that people are less likely to burn, they say that the
skin may still be damaged. Sibbald points out that there are two types of ultraviolet light: UVA and UVB. And most tanning salons, he said, use machines that generate only the longer UVA waves, which penetrate deep into the skin to induce a tanning response but which are only one-tenth as likely to
cause a burn as UVB waves. Still, he cautioned, UVA waves can lower the resistance of the body’s immune system by altering substances in the blood.
Lynn Martel, a 20-year-old Montreal student, used to visit tanning salons frequently. But in November, 1986, she developed melanoma. Doctors successfully removed a tumor on her right breast,
but Martel must now undergo re-examination every three months. She said: “My friends still go to the tanning salons. They don’t take it seriously, you know. They all think that if anything happens to them like cancer, then the doctors will take care of it.”
But as young people age, their sense of vanity will probably emerge as the best preventive against that possibility. Although tanning gives the skin a flattering glow, it eventually promotes wrinkles, lines and so-called crocodile skin. Vancouver secretary Diana Limer, 25, said that it was the rashes on her back, the wrinkles around her eyes and “horrible freckles and moles that were never there before” that finally discouraged her from sunbathing and visiting tanning salons.
Cheer: Limer recalled that on her final salon visit, “I got ^ into the booth and lay down and I started to feel like I was 5 being nuked.” Now, she says: “I I don’t lie out in the sun any| more. And I wear a hat, sunz glasses with good protection § and a sunscreen with an SPF of 15. If I have to be out longer than half an hour, I wear a sunscreen with a higher SPF.” Most dermatologists would applaud that regimen—and trendsetters will continue to cheer the tribute to pale power.
-MARY McIVER with
DWAYNE DESAULNIERS in Montreal,
MARK LEIREN-YOUNG and JAMES CARELESS in Toronto, DEBORRA SCHUG in Vancouver, and ANNE GREGOR in Los Angeles
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