Vail Daily health feature: Protect your skin this summer
July 1, 2013
Although Dr. Urquhart recommends that everyone have annual skin cancer screenings starting in their teens, she said there are several risk factors to pay extra attention to:
- Multiple sunburns as a child
- Family history of skin cancer
- History of tanning bed use
- Fair skin
- Greater than 50 moles
Modern society is no stranger to sunscreen, but recent studies about premature aging and skin cancer are making it hard to ignore the importance of preventative protection. A May article in The New York Times points out that Melanoma diagnoses have risen nearly two percent since 2000 and are increasing even more among young white women.
The article, titled "The New Rules of Sunscreen," focuses on not only using sunscreen, but using the right kind and in the right way. Local dermatologist and dermatopathologist Dr. Jean Urquhart, of Mountain Dermatology Specialists in Vail and Eagle, says the mountain lifestyle puts this community at definite risk for sun damage.
"Eagle County has a very healthy and active outdoor population, with a lot of people who work outside and recreate outside," Dr. Urquhart said. "What I see in our community is a lot of sun damage, as you would expect."
Dr. Karen Nern, of Vail Dermatology and Aspen Dermatology, is a certified dermatologist and Mohs surgeon. She said she also sees how skin takes a hard hit from mountain living.
"We have such intense sun exposure here that we see sun damage earlier in our patients, compared places that have less intense sun," Dr. Nern said. "I operate on about 50 skin cancers a month, and about 40 of those surgeries are done on the head, neck and ears, so people really need to protect those areas."
Pay attention to your skin
Dr. Urquhart said her practice of dermatopathology — a sub-specialty within dermatology that specializes in skin diagnoses — allows her to see what skin looks like on a microscopic level.
She has been practicing for eight years in Colorado and in the Vail Valley for six years. Amidst such a sun-worshipping state, Dr. Urquhart said people need to take preventative measures to protect their skin against sun damage. She said she is seeing an increase in skin cancer appearing on patients throughout a wide age range — those in the final decades of their lives, as well as those in their teens and 20s.
"I am talking about the three most common skin cancers — basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma — which are all sun-damaged based," Dr. Urquhart said. "The other trend I am seeing is the melanomas are not typical. I am starting to see more amelanotic forms of melanoma — this is a melanoma that does not have pigment and may appear pink instead of brown, which may cause the spot to not appear very suspicious."
Dr. Nern specializes in a type of surgery known as Mohs, which is a special technique that allows her to check around the edges of a skin cancer after she removes it. Then, before she stitches up the skin, she can decide if she needs to go in and take out more.
"Mohs surgeries have the highest cure rate, at 98 percent," Dr. Nern explained. "And this technique leaves the smallest scar."
Sun damage prevention
Dr. Urquhart said there are two main ways individuals can be proactive about skin cancer and premature aging prevention: sun protection and screening.
Three elements of sun protection:
1. Sun avoidance: Dr. Urquhart said UV light is most intense between 10 a.m. and 3 p.m. She said if someone has a choice, it is better spend time outdoors early in the morning or late in the afternoon.
2. Protective clothing: If possible, wear long-sleeved shirts, long pants, wide brim hats and sunglasses if you are out in the bright sun.
3. Sunscreen: Those unable to wear protective clothing out in the sun should protect all exposed skin with sunscreen. Dr. Urquhart recommended an SPF of 30 or higher and reapplication every two hours.
"It is important to have sunscreen that is broad spectrum, which means it protects you from UVA and UVB sunlight," she said. "It's important for people to pay attention to the active ingredients listed"
Types of sunscreen
There are two types of sunscreen: physical blockers and chemical absorbers.
Physical blockers, with active ingredients like zinc oxide and titanium oxide, sit on the surface of the skin and physically block the sunlight from accessing the skin.
"The challenge with zinc and titanium is they make people look white, so cosmetically they are not as appealing," Dr. Urquhart said. "But many new micronized formulations help sunscreens that contain zinc and titanium appear more clear."
Chemical absorbers, with active ingredients containing avobenzone, absorb the sunlight so UVA and UVB rays don't get to the skin.
Dr. Urquhart said her favorite facial sunscreen brands are sold in doctors' offices, including Elta MD and Skinceuticals. For body sunscreens, she likes Elta MD, and Neutrogena and Vanicream for over-the-counter options.
"Those with sensitive skin should steer more toward physical blocker sunscreens," she said.
Skin cancer screenings
The second element of prevention is skin cancer screening. Dr. Urquhart said that according to a German study, if you get your skin checked annually your risk of dying from melanoma goes down 50 percent, compared to when you come in and have a problem. She said it's compelling evidence for the importance of getting your skin checked ever year.
"Skin cancer can initially be asymptomatic," she explained. "It may be growing on your skin, but it may not itch, burn or bleed, and you may not know it's there. There is about 30 percent of your skin that you can't see closely yourself."
Dr. Urquhart recommended starting annual screenings around puberty in the teenage years, and she said the screenings should continue throughout an individual's life, because early detention leads to better outcomes.
"BCC and SCC (basal cell carcinoma and squamous cell carcinoma) are most commonly found on the face; for melanoma, the leg is the number one area for women, and the trunk is the number one area for men," she said. "Everyone, no matter what your background or what your skin looks like, should be checked annually."
Dr. Jean Urquhart is a board certified dermatologist and board certified dermatopathologist. Her practice is Mountain Dermatology Specialists. She has offices in Vail and Eagle, and can be reached at 970-926-1800 to schedule an appointment for skin cancer screening. Dr. Karen Nern of Vail Dermatology and Aspen dermatology is a certified dermatologist and Mohs surgeon. Call 970-926-9226 to schedule an appointment or visit vaildermatology.com for more information.