No Safe Tan

by Food and Drug Administration (FDA)

Ever since fashion empress Coco Chanel sported her new tan after a yachting vacation in the 1920s, many Americans have equated tanned skin with good health, great wealth, leisure time, social status, beauty, and high fashion.

In the January 1991 issue of Vanity Fair magazine, writer Bob Colacello interviews Hollywood heartthrob George Hamilton. Hamilton may well be most famous for his perpetual tan, which Colacello describes as perfect, not too shiny or too dull, not too orange or too brown, but the same cinnamon wash he's had since he was sixteen.

During a television program, Hamilton tells viewers of how he grabs a tan whenever and wherever he can. One can only wonder why Hamilton and others like him have ignored the outpouring of information in the last decade from such sources as the Food and Drug Administration and the American Academy of Dermatology, the National Cancer Institute, and the American Cancer Society, which have been repeated by many fashion magazines. With a consistent message, experts are warning Americans of the hazards of exposure to ultraviolet radiation, the sun's UVA and UVB wavelengths. These imperil all sun worshippers regardless of natural skin color in ways that Coco Chanel could never have imagined.

To understand why sun damages, says Warwick Morison, M.D., associate professor of dermatology at Johns Hopkins University, think of yourself sitting unprotected on the beach for four hours. This sunbathing process kills skin cells by UV radiation and alters the function of collagen and elastin, the connective tissue in the skin. It also causes blood vessels to dilate. That's why people turn red, he says. Days after you leave the beach burnt and blistered, you lose a layer of skin as it peels off. You may even freckle as a result of local changes in pigment cells. And those are only the acute, immediate changes.

Even tanning slowly and carefully is dangerous. Darrell Rigel, M.D., clinical assistant professor of dermatology at New York University, Manhattan, maintains, There's no such thing as a safe tan. That's the key point. You have to think about why you tan. The body senses that it is being injured by UV radiation and, to protect itself, it produces melanin. (Melanin is the body's natural sun block, the dark pigment that skin cells produce to block out damaging rays and that cause tanning.)

But further damage occurs at the cellular level, he explains. When the sun hits the skin, the DNA in the skin cells gets distorted. Think of the DNA in the cell as a spiral staircase," he says. What happens is that the two chains of the DNA are no longer connected and the stairs go off at a funny angle. Normal people have the enzyme that attempts to repair the damage.? But, he adds, the repair is never total; some damage always remains, and it accumulates over the years.

While the immediate harm, the burning, blistering and peeling, is painful, what people should fear are the long-term consequences of regular sun exposure and tanning those skin and other body changes that may appear as many as 20 or 30 years later, long after even the memories of carefree days of sunbathing have faded. Skin cancer is one consequence.

Most experts attribute the dramatic rise in skin cancers to America?s love affair with the sun and to Americans' changed lifestyles that put people outdoors for longer periods, for more months of the year, and often in skimpier outfits that leave more skin exposed.

Skin Cancer Increases

There are three main types of skin cancer: melanoma, basal-cell carcinoma, and squamous-cell carcinoma. The deadliest of these is melanoma, but squamous-cell carcinoma is also a killer, and the most common form of skin cancer among black Americans, reports Ted Rosen, M.D., associate professor of dermatology, Baylor College of Medicine at Houston.

According to the American Cancer Society, more than 600,000 people were diagnosed with basal-cell and squamous-cell carcinomas in 1990, up from 400,000 in 1980. Thirty-five thousand more were diagnosed with melanoma in 1990.

The rate of melanomas has doubled in less than a decade, says Vincent DeLeo, M.D., assistant professor and director of environmental dermatology, Columbia Presbyterian Medical Center, Manhattan. It's already the number one cancer in young women under 35. And it's increasing rapidly. If not removed in the earliest stages, deadly melanomas do not carry a very good prognosis.

Melanomas can metastasize and appear in many sites, says Paul Bergstresser, M.D., chairman of the department of dermatology, University of Texas Southwestern Medical Center, Dallas. Or they can migrate down the lymph system and can be in adjacent sites, so even if the original melanoma is removed, others may still be present. Or the original melanoma can be entirely removed and that's it. But, he adds, even someone who has had a melanoma successfully removed remains at risk of developing a second one.

Why is melanoma on the increase. It has been associated with sun exposure," says Bergstresser, but the link to sunlight is not as logical. It is more complicated. Indeed, patients with melanomas are more common with more sun exposure in southern latitudes, but, also, melanomas may appear on body sites that are protected. Those people with the highest light exposure appear to have a lower frequency of melanomas than those who get sunlight more episodically," he says. Finally, those people who have had severe sunburns at an early age are also at higher risk for melanomas.

Not all melanomas seem to be related to sun exposure, however. The evidence linking sun exposure to melanoma is the strongest for the least common type of lentigo maligna melanoma. But the cause of melanomas in general, adds Arthur Sober, M.D., associate professor of dermatology at Harvard University, is still a controversial topic.

Sun Ages Skin

Cancer aside, sun exposure also ages the skin. Bergstresser tells the tale of a former neighbor, a 67-year-old woman whose face was marked with fissures, crags and wrinkles. It was very sad," he says. She had been married to some movie distributor leader, and he had always encouraged her to get a tan. When she got old looking, he left her. Well, one day my father was visiting me, and spied her picking up her morning paper. He came back in the house, calling her the old lady across the street. The thing is, she was the same age as he. With suntans and skin aging, he adds, "There is a tomorrow. ... These debts will be paid."

Premature skin aging follows a certain course, says Rigel. At one end of the spectrum, you have freckling, and freckles are a sign of sun exposure. At the other end of the spectrum is skin cancer. These are not two separate processes. In between, you have lines, leatheriness, and precancerous actinic keratosis, he says.

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