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Southern Ocean County Hospital would like to thank everyone who e-mailed questions for this edition of Ask-The-Expert and would like to especially thank Dr. Victor Ruiz for taking part in the program.

July : Skin Cancer

Question 1
My son had a coffee colored flat lesion on his arm which was identified as cafe au lait macule - it was biopsied and showed basal layer hyperpigmentation consistent with the above name. It has been 9 yrs. - would there be any reason for this lesion to be checked again? Thank you.

Café au lait spots can be associated with uncommon diseases like pheochromocytoma and other conditions but they can also be present without any other associated diseases. These skin lesions are not associated with melanoma. I believe that your son should be checked by his primary care physician.

Question 2
With all the hype around sunscreen and skin cancer prevention I wonder which is worse? The sun, or the sunscreen? I try to protect myself and my two young daughters from sunburn and over exposure by being vigilant about sunscreen, however I question how it can be better to regularly slather chemicals all over your face and body. I worry that the sunscreen is toxic and will cause worse damage in the long run. What is your expert opinion? Do children get skin cancer as well as adults?

Although half of melanomas occur in people over the age of 50, young people, (ages 20 to 30) can be found to have melanoma and it is one of the most common cancers in people under the age of 30.

Certain groups of patients with a rare, inherited condition called Xeroderma pigmentosum, organ transplant patients on immunosuppressive therapy and large congenital nevi (moles present at birth) are at risk for development of melanoma at an early age.

The protection of young children is one of the most important goals in the prevention of melanoma, since most of the sun exposure that an individual gets in his/her lifetime happens in the first couple of decades of life. The education of children and yound adults is very important in the prevention of melanoma.

Current evidence suggests a strong link between excessive sun exposure and melanoma. About two thirds of melanomas may be attributed to excessive sunlight exposure and therefore reducing sunburn should be the primary objective in skin cancer prvention.

Safe sun guidelines suggest:

• Minimization of sun exposure during peak UVB (ultra violet B) mid day hours, between 10:00 am and 4:00 pm.
  
• Use of sunscreen with a SPF (Solar Protection Factor) of 15 or greater
  
• Use of wide-brimer hats, sunglasses, (label may say “UV absorption up top 400n,” or “Meets ANI UV Requirements) and protective clothing like tightly woven fabrics or shirts with long sleeves
  
• The FDA has approved a line of clothing, as a medical device, that possesses SPF values in excess of 30.

Sunscreen products are available as lotions, creams, ointments, gels and wax sticks. And when applied to skin offers protection against the sun’s ultraviolent rays. Experts recommend a product with an SPF of at least 15. When applied correctly (quantity and frequency) an SPF 15 blocks out 93% of the burning UV rays; and SPF of 30 blocks out 97% of the burning UV rays. Experts are concerned that the use of high SPF products by decreasing sun burning effectively, results in longer exposure to sunlight and further skin damage. So even if you are using a high SPF sun screen, it is still advisable to limit sun exposure.

It is very important to apply sunscreen properly. Apply sunscreen 20 to 30 minutes before going outside and be generous. Once ounce should be used to cover arms, legs, neck and face of an adult. You need to reapply most sunscreens every two hours or sooner if you get wet or towel yourself dry.

Sunscreens should not be used in children younger than six months. Sunscreens contain various chemicals such as benzophenones, aminobenzoic acids, and salicylates. Patients may be allergic to any one of these chemicals but serious allergic reactions are rare.

Patients who must avoid sun exposure completely can use physical agents such as titanium dioxide or zinc oxide.

Health experts also advise people to avoid sunlamps and tanning booths.

Question 3
My husband is 51, and had a stage 2 melonoma this year on his chest. We own a boat, and live on the water, and he has been afraid to go out boating and fishing. What's your view on him going out in the sun? Do you have any sugestions? This has totally changed our life, and we're afraid to take any changes. Please advise! Thank you for your help.

If your husband has an established diagnosis of melanoma, his risk of a second melanoma is greater than someone without such a diagnosis. However it is not a practical consideration to remain indoors indefinitely. If he follows the guidelines spelled out in question number two, it would be possible for him to return to many of his previous daily activities.

Dr. Ruiz's answers are informational only and should not be used as a diagnosis or for treatment. Please talk to your physician about official diagnosis of your condition and treatment.