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Fun in the Sun, Safely

Soaking up the sun can be beneficial to well-being, from turning up levels of serotonin (think “happiness hormone”) to providing much of the vitamin D we humans need to be healthy. But, as the old adage saying goes: everything in moderation. Excessive sun exposure can be harmful, with skin cancer being a serious potential side effect, and damage begins accumulating in infancy and childhood. “In the United States, up to half of a lifetime’s worth of ultraviolet exposure happens before the age of 20,” says Susan Boiko, MD, a dermatologist at Rady Children’s Hospital-San Diego and an associate clinical professor for the Departments of Dermatology and Pediatrics at UC San Diego School of Medicine. “When UV light goes through our skin, it can affect our DNA and increase our chances of developing skin cancer later in life.”

More immediately, although skin cancer in childhood or adolescence is relatively rare, cases do happen. According to a 2017 article published in Pediatric Health, Medicine and Therapeutics, approximately one in a million children ages 1 to 4 develop melanoma, jumping to about one in 100,000 for teens ages 15 to 19. In addition, cases have been on the rise from the 1970s forward, increasing between 2 and 3 percent each year. Melanoma, which can manifest from an existing mole or appear as a new dark spot on the skin, “has the most likely potential for metastasis, or spreading beyond the local tissues,” Dr. Boiko explains. Along with it, the most common types of skin cancer are the following:

  • Basal cell carcinoma: Typically develops on the arms, head or neck — but can happen on all areas of the body — as a “flesh-colored round growth, pearl-like bump, or a pinkish patch of skin,” says the American Academy of Dermatology Association.
  • Squamous cell carcinoma: “A red firm bump, scaly patch, or a sore that heals and then re-opens,” describes the AADA. SCC is generally found on the face, neck, arms, ears, back and chest.

“Children with rare genetic syndromes and children who have had chemotherapy and radiation for internal cancers may develop other skin cancers, so these children are followed by dermatology yearly,” adds Dr. Boiko.

When it comes to skin cancer, early intervention is key, whether removing potentially problematic moles before an issue arises or catching cancer in its beginning stages. “Parents can think of ‘Sesame Street’ — ‘which of these things is not like the others?’” suggests Dr. Boiko, “[Look for] any spot that is bleeding, changing, growing, painful or just different.” She recommends parents of young children conduct skin checks after bath time, while parents of older children and teens can do regular assessments when their children are in a bathing suit, or guide them through steps to check themselves. If something seems off, start with their pediatrician. “All children can have their skin checked by their health care providers,” she says. “If a problem is identified, dermatologists may get involved.” Children who have a family history of skin cancer, or a family or personal history of conditions or therapies that may increase a risk for developing cancer, should be evaluated on a regular basis at intervals determined with their physician and family.

The most effective measure against skin cancer of all, however, is prevention. Dr. Boiko recommends a four-step system that is fun and easy for kids and parents to remember: slip, slop, slap, wrap. Before heading outside

  • slip on a long-sleeved shirt;
  • slop on sunscreen with SPF 30 or more and reapply every two hours;
  • slap on a broad-brimmed hat that covers the ears and shades both the face and neck; and
  • wrap on 100% UV-blocking sunglasses.

She recognizes that kids may be resistant to gearing up against sun protection, and notes that decorating hats and sunglasses in expressive ways and having adults and older siblings model sun-safe behavior are both good ways to get children on board.

For more information on dermatology services at Rady Children’s, visit https://www.rchsd.org/programs-services/dermatology/.