Preventing skin cancer year round.
Summer is long gone, tan lines have faded, and patients with darker pigment are worried about the white spots that have reappeared over the summer.
The reality is that darkening — whether from tanning, freckles or moles — and even white spots are a sign of skin damage. White spots or hypopigmented areas are the effects of sun damage on darker skinned individuals, while damage on the fair-skinned often shows up as freckles. Those with both skin types experience an increase in the development of moles with sun exposure.
Skincare protection should begin within the first six months of life. Parents put their babies on their backs to sleep and use properly fitted car seats. However, when it comes to preventing ultraviolet (UV) exposure, a study by the American Academy of Dermatology (AAD) in August 2015 found that parents just don’t use the same care. In fact, one third of parents reported exposing their infants (younger than six months) to the sun in order to “develop tolerance” to the sun’s rays.
The majority of the parents surveyed were Hispanic and African American. They were unaware that those of darker skin still need sunscreen or protection, despite the known higher rates of skin cancer in Caucasians with red-haired, blonde-haired or blue-eyed children who tend to burn and rarely tan. These apparent traits do indeed increase the odds of skin cancer, and there is an identified genetic link to melanoma. We know that exposure to UV radiation, sunburns and blistering by far exceeds a risk of melanoma in any stage of life or ethnicity. The more UV exposure, the more common non-melanotic lesions will appear later in life — such as basal cell and squamous cell carcinoma — and the risks are rising among adolescents using tanning beds.
Fortunately, skin cancer is rare among children younger than ten and is almost 100 percent curable when detected early. Between 1973 and 2009, pediatric melanoma cases had risen yearly, nearly doubling in size for a total of 250 in 1973 to 500 cases today.
In an effort to prevent skin cancer, the AAD recommends keeping infants younger than six months out of the sun — seeking shade and/or protective clothing. After six months, sunscreen is not only safe, but encouraged for all ethnicities. Apply water-resistant sunscreen with an SPF of at least 30 to a child’s exposed skin. Sunscreens containing zinc oxide or titanium dioxide are most appropriate for an infant and toddler, and should be reapplied every one-to-two hours.
Some children may have certain conditions that may predispose them to develop skin cancer at any age, regardless of sun exposure. Most healthcare providers have identified birthmarks such as giant melanocytic nevi or dysplastic nevus syndrome.
Such birthmarks, moles and freckles can confuse parents and mimic skin cancer. To make matters worse, pediatric melanoma lesions differ from those found in adults. This proves to be challenging when trying to identify melanoma. Most importantly, the lesions often occur in non-sun exposed areas such as the scalp, feet (soles) — even the buttocks or genitals. They can be whitish, yellow or red in color, as opposed to the adult dark-pigmented lesions. Because cancer grows faster in children and the risk of skin cancer increases with each year of life, early identification is key. Becoming familiar with your child’s moles and freckles and the changes since birth is crucial in identifying suspicious lesions. Reporting any recent change of any parameter of a nevus — such as color, shape or size — to your provider is paramount. Any of these changes should be evaluated, as should any new onset of pain, itching, ulceration or bleeding. A biopsy of the lesion may be recommended for diagnostic and possible therapeutic purposes.
Kelly Ruemmele, MSN, RN, CPNP, is a public voices fellow with The OpEd Project at Texas Woman’s University. She has more than 20 years of experience as a bedside nurse, nurse manager and a PNP, and is currently practicing as a PNP in Pasadena, TX. She is also an adjunct clinical nursing professor at Texas Woman’s University in Houston.