Ask the Flight Surgeon / By MAJ Jason MacDonnell, M.D: Q: Should I be concerned about sun exposure in myself and family and what should I do for sun protection?
U.S. Army soldiers participate in a 2.35-mile run to celebrate the U.S. Army’s 235th birthday on Forward Operating Base Farah, Afghanistan, June 14, 2010. The Soldiers are assigned to the 82nd Airborne Division’s Headquarters Troop, 4th Squadron, 73rd Cavalry Regiment, 4th Brigade Combat Team. U.S. Army photo by Senior Airman Rylan Albright
FS: With summer in full swing, taking a second to address the risk of sun exposure and skin cancer is a good idea. Skin cancer is one of the most common cancers in the United States with approximately one in five Americans developing skin cancer in their lifetime. While this is a significant number, many forms of skin cancer are easily treated and highly curable if detected early. Even more serious cancers like melanoma can have a high survival rate if caught early.
There are several factors known to be associated with skin cancer, some that are controllable but some that are not. A genetic predisposition and family history are factors that play a role but currently there is no intervention to address this issue. Persons that are light skinned, have light color hair or eyes, burn easily or have a large number of moles are also more likely to develop skin cancer. However, factors that we can control include not using tanning beds, limiting sun exposure during work or leisure activities and the use of protective measures.
Not all skin cancers are the same and not all sun damage to skin is cancer. Sun exposure is responsible for most of the changes that are seen in the skin over a life time. Solar lentigo, also known as liver or old age spots, can range from a few millimeters to over a centimeter in size, are usually tan to dark brown in color and are often found on sun exposed skin. While these are sometimes a cosmetic concern, they are considered benign or non-cancerous lesions. Red patches of dry, scaly skin with varying diameter presenting on sun exposed areas are a common presentation of actinic keratosis. While this is not a true cancer, it is considered a pre-cancerous lesion and should be evaluated.
Basal cell carcinoma is a common cancer usually on the face that can be locally invasive but usually does not spread outside the local area. The most common lesion is a pink to flesh-colored spot with a pearly sheen. Squamous cell carcinoma is a skin cancer commonly found on the head and neck that can also be locally destructive but has a high rate of spreading to other areas of the body. It usually looks like a more developed form of the actinic keratosis, a red scaly dry patch of skin. Luckily both of these cancers are easily and effectively treated if recognized early.
A more concerning skin cancer is melanoma. Even though melanoma accounts for 3 to 5 percent of skin cancer, it is responsible for approximately 75 percent of skin cancer deaths. These lesions are more likely to invade and metastasize to other areas without notice. Also, unlike basal cell and squamous cell carcinomas, melanoma is more likely to appear on non-sun exposed skin (so look between your toes!).
Protection is Key
Simple steps can be taken to reduce the risk of developing skin cancer. Discontinuing the use of tanning beds is a good first step. While many think tan skin is cosmetically pleasing, tanning is actually an injury response of the skin. Consistently wearing a large brimmed hat and sunscreen of at least spf 15 is another easy step to reduce lifetime exposure. Remember to move activities into the shade if possible and wear sunglasses to protect your eyes.
While yearly full body skin exams are not needed for the general population, people with increased risk should be aware of lesions on their skin. If there is any significant change in color, size or shape of existing lesions, set up an appointment with your primary care doctor for an evaluation. Aeromedical guidance does allow for waivers to be considered for an aircrew member with a history of skin cancer. Since basal cell carcinoma is easily treated and rarely spreads, no waiver is needed when it is adequately treated. Due to the increased risk of spread with squamous cell carcinoma, waivers are considered on a case by case basis. Melanoma’s ability to invade and affect other organs increases aeromedical risk, but can meet waiver requirements if caught early and treated.
Take some time to get out and enjoy the summer weather with your friends and family, just remember to grab a hat, sunscreen and protect yourself from the sun.
Question for the Flight Surgeon?
The views and opinions offered are those of the author and researchers and should not be construed as an official Department of the Army position unless otherwise stated.
MAJ (Dr.) Jason MacDonnell is a flight surgeon at the U.S. Army School of Aviation Medicine, Fort Rucker, AL.