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When regarding sunburns, most people would categorize the burn as the problem, while the pain, discoloration, and peeling are considered the “symptoms”. This common misconception is present because a sunburn’s short term side effects are tangible and visible, and therefore easily recognizable. However, people fail to realize that sunburns themselves are symptoms of skin damage and indications of increased risk of skin cancer.

The nervous system of the human body produces pain as a communication system. It is the brain’s method of telling the body that there is something wrong, and that special care is necessary. In the same way a broken leg makes us stop walking, a sunburn is the body’s reaction to too much sun exposure, and the pain associated with it is intended to communicate that the skin needs a hiatus from the sun. Just like there are types of breaks or fractures in bones, there are types, or degrees, of burns. While the short term, supposed “symptoms” of first and second degree burns differ, the lasting effects of the two, and, in fact, any burn, are identical.

Burns are classified according to the amount of tissue they affect and how deep they are. A first-degree burn is considered the least serious type of burn because it injures only the top layers of skin, called the epidermis. Skin with a first-degree burn is red, sore, and sensitive to the touch. It may also be moist, slightly swollen, or itchy. When lightly pressed, the reddened skin whitens, which is called blanching. First-degree sunburns do not usually blister or leave a scar.

The side effects of a second degree burn are more severe than those of a first degree, tricking people into thinking it does more damage. Also called partial-thickness burns, these are identified by the penetrated depth of the skin’s layers. This type of sunburn can swell and blister, which may indicate damage to deep skin layers and nerve endings. Second-degree burns may also radiate heat from the skin’s surface and produce fluids from the blisters. In severe cases, an individual with a second-degree sunburn may experience fever, vomiting, dehydration and secondary infection, which often lead to hospitalization.

Although the side effects of varying degrees of burns are vastly different, the lasting impact is the same. UVR has been absorbed, which causes damage to the cell’s deoxyribonucleic acid (DNA), which in turn triggers a cellular response such as proliferation, toxic change, mutation or death. Although the degree of the burn impacts the likeliness of spreading to further levels, all types of burns create a biological change in the skin’s DNA; A sunburned skin cell viewed under a microscope, regardless of the layer from which it is taken, looks like a cancer cell. 

Protect yourself and your family by understanding the difference between short and long term symptoms. Be safe. Be SunAWARE.

Alicia Walker

Summer InternSunburn CellsSunburn Diagram

A recent survey of tanning salon operators within the state of Missouri revealed that 65 percent of personnel would allow pre-teens to use their facilities. The findings, originally published in the Journal of Pediatrics (2012), indicated that Missouri was one of 17 states openly permitting youngsters to use tanning beds without a minimum age restriction. How young is too young to indoor tan?

When Patricia Krencil, a mom in New Jersey, was accused of taking her six-year-old daughter to a tanning salon people were aghast. I wonder why, we don’t feel the same shock and horror when teenage girls are indoor tanning for prom? Why do parents give consent for teenagers to indoor tan? Don’t they know that exposure to ultraviolet radiation in tanning beds increases their child’s risk of developing the two deadly forms of skin cancer. The Center for Disease Control (CDC) recently reported that 6,200 cases of melanoma are caused each year by indoor tanning.

There are now twelve states with under age eighteen tanning bans in America. I believe that legislation is an important part to protecting children from skin cancer. However, I believe that skin cancer can best be prevented with education, and the earlier the better. Efforts are underway by organizations like ours to reach into the classroom with on-going lessons about prevention and early detection. We developed Glenna’s Gift, a video that shares one young women’s struggle with a tanning addiction and melanoma diagnosis, to educate teenagers about the real impact of this disease. We have been fortunate to gain access to school children with our SunAWARE K-12 Curriculum. However, I realize that it will only be when government makes health education in the schools a priority, like obesity and bullying, that all children will learn the important facts about indoor tanning and skin cancer.

I agree with the Society for Public Health Education that health education must become a core subject in our schools. Without this educational priority, health education will continue to be marginalized by schools and eliminated in budgets. Please support the Elementary and Secondary Education Act (ESEA) reauthorization vehicle, known as the Every Child Achieves Act (ECAA). This bill is in final stages and will be going to a vote by the Senate soon. ACT TODAY: Contact Your Senator to Request "Health" be Included as a Core subject in ECAA.

Baby with sunglassesHelen Keller once wrote that “sight must be the most delightful of all senses”. Most of us appreciate good vision but may not always do enough to protect our eyes from overexposure to dangerous ultraviolet radiation (UVR). This overexposure may result in both short and long-tem eye problems. Because children are at increased risk for eye damage secondary to increased exposure related to reflected UV light, they must take extra precautions to ensure eye health.

The iris is the pigmented circular band surrounding the pupil. It is a muscle that controls the diameter and size of the pupil and thus the amount of light reaching the retina. Melanocytes are the cells in the eye that are genetically programmed to produce eye color.  Light colored eyes are associated with greater sensitivity of the skin to UVR, however, they are not an indicator of increased risk for overexposure to the inner eye. It is important to remember that overexposure to UV radiation is problematic for everyone—regardless of eye color.

Severe short-term overexposure to UV radiation can cause photokeratitis, a “sunburn” of the eye. The symptoms include red eyes, excessive tearing, gritty feeling in the eye, and sensitivity to light. Symptoms usually last a few days and damage is rarely permanent but can certainly be uncomfortable in the short term.

Long-term exposure to UV radiation may contribute to cataracts, a clouding of the eye’s lens. Exposure is based on a number of factors including environmental conditions (e.g., UV Index or intensity, altitude, reflected light, cloud cover) and personal factors such as the extent and nature of our outdoor activities.

The lens of our eye is primarily made up of water and proteins. Overexposure to UV radiation can contribute to the lens drying out and becoming cloudy. The lens focuses light onto the back of the eye or retina and it must be clear in order to work properly. More than 3 million cataract surgeries are performed each year in the United States.

Some contact lenses contain UV-absorbing filters that help protect against transmission of harmful UV radiation to the cornea and into the eye. However, manufacturers warn that these lenses are not substitutes for sunglasses because they do not completely cover the eye and surrounding area. Research has not yet demonstrated that wearing UV-blocking contact lenses reduces the risk of developing cataracts or other eye disorders. Therefore, UV-absorbing eyewear continues to be the best method of eye protection. 

Although there are mandatory UV rating systems for sunscreen (SPF or Sun Protection Factor) and clothing (UPF or Ultraviolet Protection Factor), there is no mandatory system for sunglasses. Therefore, it is imperative that you look for labels that denote UV protection. The American Optometric Association (AOA) recommends wearing quality sunglasses that absorb ultraviolet light up to 400nm. This translates to blocking out 99% of UVA (aging) and UVB (burning) rays. AOA also recommends using wrap around sunglasses while in bright sunlight and choosing polycarbonate materials that are impact resistant.

The Environmental Protection Agency recommends that individuals wear sunglasses daily to protect the eye from the long-term effects of UV radiation. Children’s Melanoma Prevention Foundation (CMPF) recommends wearing a wide brimmed hat along with quality sunglasses to protect the inner and outer eye from sun damage. Sunscreen sticks are great products for use around the outer eye. These stick balms may be applied to the eyelids and do not run into the eye when sweating.

Children should be taught to avoid “unprotected” exposure to UV light and to wear sunglasses, hats, and sunscreen daily. Quality sunglasses are an essential piece of gear for all young boaters to promote eye health. Healthy eyes are so important to our good vision and quality of life that they should be protected at all costs.

Parents often ask me which sunscreen products they should be buying for their children.  Many are aware that UV rays are strongest in late Spring and early Summer and voice concerns about keeping them safe at the beach and lake. The secret to protecting young skin against sun damage using a sunscreen is a two-pronged approach requiring high quality sunscreens AND proper application.

High Quality Sunscreen Selection

High quality sunscreens display three important pieces of information on their product labels: BROAD SPECTRUM, WATER RESISTANT, and SPF. The Food and Drug Administration (FDA) regulations on sunscreen labeling require manufacturers to substantiate their claims. For example, a BROAD SPECTRUM claim requires laboratory testing that shows protection against 90% of UVA (tanning/aging rays) and 93% of UVB (burning rays). WATER RESISTANT claims now provide a clear timeframe of protection, (80 MINUTES). SPF claims require that the sunscreen provide a proportionate degree of protection against UVA and UVB.  Higher SPF ratings, therefore, provide greater protection against both forms of UV radiation known to cause skin cancer.

Sunscreens come in different formulas, including creams, lotions, gels, sprays, sticks, and powders. Boys usually prefer gels and lotions, while girls often prefer creams. Sprays have gained great popularity, probably because of the ease of application, but they have a downside because of the risk of inhalation. “Sport” formulations and stick balms are great for active children because they usually stay in place when sweating. Zinc oxide and titanium dioxide, which are physical blockers of UV rays, are often recommended for children because they work quickly and do not penetrate the skin.  That said, the FDA has added a warning in the Drug Fact Box for all sunscreens stating:  “Do not use on damaged or broken skin.”

Sunscreen products may vary dramatically in price yet offer the same degree of protection and cosmetic appeal. Parents can check out Consumer Report’s sunscreen issue for product reviews including “Best Sunscreens” rated for price and protection reviews and comparisons.

Proper Application

Despite the thousands of excellent sunscreen products available, half of all American children reportedly experience sunburn each year.  This is most likely due to application errors and lack of understanding.   Because the FDA guidelines simply recommend the terminology apply “generously” or  “liberally”, most people do not apply adequate amounts of sunscreen. The Children’s Melanoma Prevention Foundation advises using a handful of sunscreen per application per child.  This is the proper dose or amount needed to cover the entire body surface when wearing a bathing suit. As a general rule of thumb, re-application is advised at least every 2 hours.   Since sunscreen absorbs or reflects UV rays, it is important to realize that the higher the UV Index the faster sunscreen will dissipate off the skin.  When properly used, sunscreen products should be exhausted quickly, not lasting all summer.

Practical Tips

·      Read your sunscreen label, front and back

·      Use the BEENS Acronym to help remember commonly missed areas when applying sunscreen

§  Back of Knees,

§  Eyes,

§  Ears,

§  Nose,

§  Scalp

·      Keep sunscreen products out of excessive heat or direct sunlight by placing them in a shaded area or a cooler.

·      Check out the Environmental Working Group App for sunscreen’s active and inactive ingredients

·      Get a free UV app or UV meter and learn about UV intensity variability

·      Wear sun protection clothing, with a UPF Factor >50+.

·      Always wear sunglasses to protect your inner and outer eye.

The sun protection clothing industry began in Australia over forty years ago when the Anti-Cancer Council of Victoria started working on finding fabric that would effectively block out the sun. They borrowed the concept of the surfer’s “rash shirt” (worn to protect against skin burns that result form lying on the surfboard) and began marketing the first sun protective swim shirts. The shirt was followed by “neck-to-knee” swimsuits, which look very similar to wet suits.    Alas a billion dollar industry was born. However, there were no industry standards to evaluate the quality of sun protective garments.

Again Australia took the lead, when in 1992 the Australian Radiation Laboratory, developed regulatory standards for garments claiming to be sun protective. Garments were now rated according to UPF or Ultraviolet Protection Factor, a rating system similar to SPF. UPF ratings provide the consumer with information regarding the degree of protection provided by a fabric against both the tanning and burning rays. UPF is a similar concept to SPF (Sun Protection Factor). If a fabric is rated UPF 30, then it is absorbing or blocking 29 out of 30 units of UVR, or 97%.

In 1998, the American Association of Textile Chemists and Colorist (AATCC) adapted the Australian UPF standard for use in the United States. Later, the American Society for Testing and Materials (ASTM) developed standard for simulating a sun protective garment’s life cycle and for labeling a garment claiming to be sun protective. Now, in the United States several million garments are tested each year using the AATCC and ASTM standards.

Once these standards were introduced, scientists began creating better fabrics to protect the skin. Some of the most innovative fabrics include ZnO SunTect® which has zinc oxide embedded into every fiber of the garment to safely deflect UV rays. Another is fabric made with all natural, cotton bamboo fiber that is both soft and durable while still providing UPF ratings of 50+. Chlorine and water resistant fabrics are made for swimwear with high UPF ratings. Ultra thin polyester microfiber, which is flexible and completely breathable, is used for sun protective gloves, hats and face guards.          

Good sun protective clothing is carefully designed for comfort and maximum protection. In addition, the cost of buying sun protective clothing is ultimately far less expensive than buying sunscreen over time. One sun protective shirt can last many seasons and maintains its UPF rating after thousands of washings. This specialized clothing can be found at local retailers or specialty shops. Steep discounts are often found online in the winter.

Dermatologists and other skin specialists highly recommend the use of sun protective garments because they provide the fastest and most effective method of sun protection. These garments are more effective than sunscreen because the degree of protection is constant and it is not impacted by human error including improper application, lack of reapplication, outdated product, etc. Health care providers also recommend slathering a water-resistant, SPF 50 sunscreen on all unprotected skin at least every 2 hours.

We must always remember that skin cancer prevention requires a multi-pronged approach and vigilance. Be safe, Be SunAWARE!

Maryellen Maguire-Eisen RN, MSN

Dramatic increase in melanoma incidence among American Youth.

Melanoma has become a major health problem in our society because of our obsession with the "perfect tan".  Melanoma was once considered a cancer of adults because it was rarely diagnosed in young people. However, reports that melanoma had increased in children and young adults by 3% a year between 1973 and 2001 made it difficult to ignore this alarming trend (Strouse, 2005).  Melanoma may be missed in young patients because the health care provider does not appreciate that young patients are at risk for the disease or that it's clinical presentation may be different than in adults.  This lack of understanding or low index of suspicion may prove deadly for some patients.

There will be an estimated 76,380 new cases of melanoma (46,870 in men and 29,510 in women) diagnosed in the United States this year (ACS, Cancer Facts & Figures, 2016).   Melanoma has been increasing faster among children living in the northern US, as compared to those living in the South, probably because of the intense, sporadic exposures experienced in northern latitudes (Wong, 2012).  Although melanoma is not common among children, 72% of melanoma cases do occur in teenage girls between the ages of 15-19 (Maguire-Eisen, 2013).  In addition, melanoma is now the most common cancer diagnosed in white females, ages 20-24, and the fourth most common in young males of the same age (www.seer.cancer.gov/csr/1975_2001). There will be 9,940 deaths from melanoma this year with twice as many men dying of the disaese than women.  With one person dying every hour from melanoma, we must all work together to educate the public about this preventable disease and easily recognizable disease. 

Rising Melanoma Rates in children

* SEER Data 1975-2009

Skin cancer is clearly a growing health problem for children because of  the persistent reports of  sunburns  and the rising rates of pediatric  melanoma (Maguire-Eisen, 2014). Ultraviolet light was been a proven human carcinogens since 2002. The National Institute of Health reported that exposure to ultraviolet radiation  from either sunlight or artificial tanning sources was associated with skin cancer, cancer of the lip and melanoma of the eye. (10th Report on Carcinogens, 2002). Sunburns in childhood,  are a known acquired risk factor for melanoma (Tsao et al., 2004).  Reports that half of all American children experience  one summer sunburn and 12% of adolescents experience at least 5 sunburns is a clear sign of inadequate knowledge (Davis, 2002). In addition, the popularity of indoor tanning is increasing among teenagers with rates of indoor tanning doubling between 14-15 and 15-16 years of age (Geller, 2002).

Melanocytes are pigment producing cells that are genetically programmed to determine skin and eye color.  Moles are harmless growths that arise from melanocytes. The tendency to develop moles is inherited however sun exposure may increase the number of moles we acquire or develop during our lifetime (American Academy of Dermatology, 2006). Because half of all melanomas develop in moles it is important to prevent overexposure to UV radiation to limit the number of acquired moles. Sunburn prevention is important because it may protect children from acquiring new moles and therefore reduce melanoma risk.

Melanoma

Melanomas are usually pigmented and may include brown, black, blue, or grey pigments. Although, some melanomas lack pigment and appear red or pink. Melanomas in young children may appear as a red bump or pink papule on the skin (amelanotic). The classic ABCDE warning signs of melanoma include Asymmetry, Border irregularity, Color variability, enlarging Diameter or an Evolving growth. However, we recommend that any new or changing growth persisting for more than one month be evaluated by a health care provider.

Anyone can develop melanoma, although the risk is greatest for individuals with light eyes, pale skin, freckles, excessive sun exposure in childhood, a large number of common or atypical moles and a family history of melanoma. Female gender has become a risk factor for developing melanoma in young white Americans.  Melanoma is twice as common in young white females aged 20-24 as compared to males of the same age and ethnicity (Strouse, 2005).

Children's Melanoma Prevention Foundation was created to combat the dramatic increase in melanoma among American youth. We have partnered with schools and the community to educate, motivate and reduce skin cancer in our society. Our K-12 SunAWARE Program provides skin cancer prevention lessons to students, parents, nurses and teachers. Our skin cancer workshops are designed to educate nurses about skin cancer prevention and early detection. We use innovative technology to educate children about proper sun protection. We encourage students to identify the factors that effect UV intensity and skin sensitivity. We teach practical lessons on sun protection along with tips for early detection of skin cancer. We encourage children to have fun in the outdoors but to take appropriate precautions to protect their health. Our goal, is to prevent skin cancer one child at a time by teaching them to be SunAWARE!

Maryellen Maguire-Eisen RN, MSN
Executive Director

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