After years of seeking that just-back-from-Fiji tan, the trend for the new millennium has swung back to more subtle first impressions. Time to review the dangers of the savage tan, and to see how easy it is to keep your skin young looking and safe from skin cancer.

Your Skin
The outer layer of your skin contains three types of cells which can be affected by cancer: squamous cells, the ones that flake off when your skin gets dry; basal cells, the round cells underneath the top layer; and melanocytes, which gives your skin its color. When your skin is exposed to the sun, the melanocytes in your skin produce more melanin, a brown protein that makes you "tan" and helps keep your skin cells from burning. (And we all know what that feels like.)

Types of Skin Cancer
Cancers of the squamous cells or the basal cells are collectively known as "non-melanoma skin cancer". Non-melanoma cancers make up 90% of skin cancer incidents in the US, according to the National Cancer Institute, and are rarely malignant (that is, they do not tend to spread out of control into other parts of the body). However, basal or squamous cell carcinoma should be treated immediately, because the tumors could invade nearby tissues. The EPA reports that more than 1.2 million Americans will develop non-melanoma skin cancer in 2000, and at least 1,900 will die as a result.

Melanoma is the most serious cancer of the skin, and begins in the melanocytes. This type of cancer is malignant, and much more likely to metastasize, or spread to other parts of the body. According to dermatologists at the NYU Medical School, the incidence of melanoma in the US is rising faster than that of any other cancer. "At current rates, one in 74 Americans will develop melanoma during his or her lifetime."

Diagnosing Skin Cancer
Treatment for all three types of skin cancer is very successful, if the tumors are discovered early. You should examine your entire body's skin thoroughly in a full-length mirror (or with the help of a spouse or a really understanding friend) regularly, once every month or so. You're looking for changes in your skin's appearance, such as a mole that has grown larger or taller, or changed color. You should also watch for red, irritated, scaly-looking patches of skin, or sores that do not heal. Any changes should be brought to your doctor's attention immediately. See the American Cancer Society's online brochure about self-exams for more information.

How Do I Prevent Skin Cancer?
Although anyone can get skin cancer, the risk is greatest for those with fair skin and light eyes. Luckily, the reasons for developing skin cancer are well known, and prevention can be simple, with a little willpower and a good routine.

Skin cancer is caused by ultraviolet (UV) radiation that is present in sunlight and in the bulbs in tanning beds. The longer your skin is exposed to UV radiation, the higher your likelihood of getting skin cancer. Therefore, people who live or spend time in warmer climates, where the sun's rays are more direct and skin is more likely to be exposed, are more likely to contract skin cancer in their lifetimes.

The easiest way to prevent skin cancer is to avoid exposure to the sun altogether. In a warmer climate where your skin is exposed, stay out of the sun between 10am and 3pm, or when your shadow is shorter than you are tall. Even in colder climates, like while skiing, exposed skin such as face and hands is still at risk for prolonged sun exposure. And clouds provide little or no protection from the sun's UV rays.

Checklist
Here are some other tips on avoiding risk factors for skin cancer:

• While wearing long clothing and a terrific hat will help screen your skin, a t-shirt or wide-brimmed hat only has a relative sun protection factor (SPF) of 8.
• Always apply a waterproof high-SPF sunscreen lotion (SPF 15 or higher) to your entire body before any sun exposure. Keep in mind that even winter sports and window shopping can include lots of sun exposure.
• Make sure you cover sensitive areas like eyelids and ears, and use a lip balm with sunscreen as well.
• Don't forget sunglasses! You can get skin cancer in your eyes. Also, besides getting that mysterious-movie-star look in your shades, no squinting equals fewer wrinkles around your eyes and forehead.
• Reapply even waterproof sunscreen as often as recommended, especially after swimming or perspiring; read the label for instructions.
• Wear a hat if possible, or remember to massage some sunscreen into the part of your hair or on your scalp under areas where hair is thin.
• Clouds offer little protection from UV rays - apply a sunscreen, even on a cloudy day.
• Being underwater will NOT protect you from sun damage; the water will in fact magnify the sun's rays, and will also wear away even waterproof sunscreen.

The side benefit of protecting your skin from sun exposure is that you will avoid the damage that leads to dry, leathery, and wrinkly skin and premature aging. And, although most skin cancers are diagnosed after age 50, according to the National Cancer Institute, damage to your skin begins with childhood exposure to the sun. Over 80 percent of lifetime sun exposure occurs before age 18. Make sure you coat your children liberally with sunscreen lotion before they go out, too, and try to plan an indoor or shaded activity for the middle of the day.

So remember, if you're spending time in a warm climate this winter, cover up or stay out of the sun as much as possible. It could save your life. And wrinkles are so "out".

Visit these Web Pages:

• CancerNet
• EPA Stay Healthy in the Sun
• CDC Cancer Prevention and Control

Bibliography

1. Rigel DS, Carucci JA. Malignant melanoma: prevention, early detection, and treatment in the 21st century. CA Cancer J Clin 2000 Jul-Aug;50(4):215-36; quiz 237-40
2. National Cancer Institute. Skin Cancer. NIH Publication No. 95-1564 Posted: 9/28/1998
3. U.S. F.D.A.. Safer Sunning in Seven Steps. May 1997. Publication No. (FDA) 97- 1279
4. U.S. E.P.A., Health Effects of Overexposure to the Sun. Last updated 11/8/00. http://www.epa.gov/sunwise/uvandhealth.html