More parents appear to be vigilant about protecting their children from the sun’s harmful rays—at least at Yale Dermatology-Middlebury where Brittany Craiglow, M.D. practices. Many parents tell Dr. Craiglow they’ve started applying sunscreen so early in their children’s lives that it becomes as much a part of their daily routine as brushing their teeth and putting on their shoes. When their kids head outside, the parents pop on their hats, sunglasses and sun protective water shirts, or rash guards.
“Kids don’t want to stick out and feel different, but when every kid is used to growing up wearing sunscreen and a shirt in the pool, it’s not such a big deal.” said Dr. Craiglow, who is one of only a few pediatric dermatologists in Connecticut.
It may sound like another example of parenting becoming more intense. But strict attention to sun protection is critical as rates of melanoma, the deadliest form of skin cancer have increased by 250 percent among young adults in the last 40 years. Melanoma is the most dangerous form of skin cancer, because it causes mutations that make the skin cells multiply, form tumors and, in the deadliest cases, spread to other parts of the body if it’s not caught early.
At the same time, more young people are being diagnosed with basal cell carcinoma, a form of skin cancer that almost never spreads, but can be disfiguring if it’s not treated right away. David J. Leffell, M.D., chief of Yale Dermatologic Surgery, a national and regional referral center, has seen an increase in young women referred to him for basal cell carcinoma because of his expertise in Mohs surgery. The Mohs technique was developed in the 1930s by surgeon Frederick Mohs to spare healthy tissue while removing basal cell and squamous cell skin cancers (found in the upper layers of the skin, but still potentially deadly).
Avoiding sunburns can help
“The increase in skin cancer in young people represents a change over the past 30 years I have been in practice,” said Dr. Leffell, who blames the rise on tanning bed use and “tan-seeking behavior,” in addition to sunburns in childhood.
Studies show five to six bad sunburns in childhood can double the risk of skin cancer, but Dr. Leffell said even one severe childhood sunburn can has far-reaching effects. “Sunburn is probably the single most important factor that people can control,” he said. “We can’t control inherited traits such as hair, skin and eye color, or intrinsic gene risk, but we can modify our environment through thoughtful and effective sun protection.”
Dr. Leffell has told parents, “Sun protection in childhood yields a return like compound interest, since it is said that 85 percent of lifetime sun exposure occurs in childhood—and we know that the mutations in skin cancer generally start in childhood. Appropriate sun protection during this period can, in fact, bend the curve of incidence of skin cancer later on.”
What can parents do when the sun is part of life in the summertime, when being active in sports means being on a field in the hot sun for hours, and when teens balk about wearing sunscreen? Dr. Craiglow encourages parents who find “ugly duckling” moles that look different from the others to show them to their pediatrician, who can make a referral to a dermatologist if necessary. Abnormal moles are quite rare in children, and a screening by a dermatologist can provide reassurance for parents. A baseline skin exam with a pediatric dermatologist may also be warranted for children with many moles or those with a first-degree relative who has had a melanoma.
Dr. Craiglow and Dr. Leffell shared these tips:
- Be sure children and teens use a broad spectrum sunscreen that is 30 SPF or higher. “For infants and young children, it is best to use physical sunscreens with the ingredients zinc oxide and/or titanium dioxide, versus chemical sunscreens, which can be irritating to skin and eyes,” Dr. Craiglow said.
- Reapply sunscreen every two hours, even on cloudy days, and more often if a child is in the water or sweating.
- Encourage children and teens to wear bathing suits with attached shirts, rash guards (close-fitting tops for swimming), sunglasses and hats. Use umbrellas and tents at the beach or parks, and try planning beach visits before 10 a.m. or after 4 p.m. when the sun is gentler.
- Discourage indoor tanning. UV rays in tanning booths have been found to be harmful, causing mutations in skin cells that can lead to cancer.
- If a parent has had melanoma, the child is at greater risk, so melanoma survivors should be especially vigilant about sun protection for their children.
- Know the ABCDEs of melanoma: asymmetry (if you draw a line through the mole, its two halves will not match); a border that is uneven; color that is varied, as opposed to a single shade; diameter larger than a pencil eraser (1/4 inch or 6mm); a mole is evolving in size or in any other characteristic.
- Talk frankly with teenagers who don’t want to wear sunscreen or who like to sunbathe with friends. They might be interested to know that basal cell cancer in particular can be locally destructive especially when it arises on the face and can create significant cosmetic issues.
Dr. Craiglow takes all of these precautions in her own family. She has a 10-month-old son who is “amazingly already so tolerant of sunscreen application. He generally doesn’t care to sit still for much of anything, but he’s really used to it by now and so he obliges. Hats are a different story, but we’re working on that.” Her family’s deck features three umbrellas and she’s a fan of strollers with UV protection. “It’s so important to be careful when kids are little,” she said. “You can’t turn back the clock on sunburns.”
Research: Yale University