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Staying in the Shadows

September 22, 2005

Sun exposure ages the skin and is the primary cause of skin cancer

The French fashion designer Coco Chanel said, "Nature gives you the face you have at twenty; it is up to you to merit the face you have at fifty." David was mulling over these words last week as he sat in the waiting room of a dermatology clinic. He was there because his face was a bit of a mess and the pamphlets and posters on display seemed to suggest he merited it. The message was simple: expose yourself to the sun and pay the price in terms of wrinkles, blotches, lesions, and -- possibly -- skin cancer. In David's case, a persistent bump on his lower lip was likely the result of too much UV. The dermatologist who examined him wasn't very sympathetic. She's probably not a boater. "What do you expect if you spend your days out on the water in the tropical sun and don't use enough sun block?" she said.

The blemish was officially diagnosed as a type of actinic keratosis or AK, the most common form of precancer caused by excessive UV exposure. It's usually not life-threatening and is 100 percent treatable: it took all of about five seconds for the dermatologist to zap it with some liquid nitrogen. But she wasn't going to let David off that easily. She pointed to the other marks and blotches on his limbs and body. "You've got sun damaged skin. You're taking a big risk by not protecting yourself more from the sun," she warned.

David, dim as he is, got the message after reading the skin care pamphlets and checking out the Skin Cancer Foundation web site (www.skincancer.org). Nothing instills the fear of God like a bunch of colour photos of crusty, oozing lesions. Skin cancer is the most common form of cancer; one out of every three new cancers is a skin cancer. And its rate of incidence is increasing; over the past 10 years, the number of cases of melanoma -- the most deadly form of skin cancer -- has increased more rapidly than that of any other cancer, with 51,000 new cases now reported in the US each year. The American Academy of Dermatologists calls it "an undeclared epidemic". Both of us have fair skin and burn easily, so we're at higher risk, but everyone -- and especially those who spend a lot of time outdoors -- should take precautions.

We used to think we were pretty good about protecting ourselves from too many rays, but David's AK is clear evidence that he, at least, isn't. Apparently, he isn't the only boater who is deluded into thinking a few globs of sunscreen lotion are all that's needed. A few years ago, David participated in a sun exposure study conducted by the University of West Indies dental school in Trinidad (see our September 27, 2001 entry "Southern Exposure"). The good news coming out of the preliminary results was that virtually all of the visiting cruisers who participated in the study were aware of the dangers of too much sun and claimed to be taking precautionary measures. The bad news is that one-quarter of them were diagnosed with precancerous facial lesions. Good intentions aren't enough.

Eileen wears sun glasses, a hat, and long sleeves when she goes shelling

Eileen is better than David at protecting herself from the sun. She typically wears sunglasses, a broad-brimmed hat, and long-sleeved shirt when she walks the beach. She's also more fastidious than him in applying broad spectrum SPF 15-plus sunscreen (Parsol 1789 seems to be the ingredient of choice these days). Compared to David, she's fish belly white; she hasn't warranted any stern lectures from a dermatologist.

Unfortunately, even Eileen's preventive actions might not be sufficient. Typical summer shirt fabrics have a sun protection factor of only 6.5. And just because she doesn't usually burn herself in the sun, doesn't mean she isn't damaging her skin. Any sort of tan is evidence of sun damage. Moreover, for at least some skin cancers, the occurrence of cancer is related to cumulative sun exposure over a lifetime. In other words, every time you soak up more rays, you increase your overall risk of developing skin cancer -- which is why the majority of people who live to the age of 80 have AK. The best means of protection is to avoid being in the bright sun altogether. Count Dracula had it right.

David cruised the south Pacific with a makeshift awning and too much bare skin

David cruised the south Pacific with two other single guys in the mid-1980's on a boat with no dodger, no bimini, and no awning. In the drizzly Pacific northwest, their point of departure, overexposure to bright sunlight was rarely an issue. They found that the tropics were a different story. At various times they rigged makeshift awnings from tent flies, plastic drop sheets, and whatever other scraps of material they could scrounge together. When Eileen first met David a couple of weeks after his return to Canada he was deep red, a colour he retained well into the boreal winter.

With the Pacific grilling experience in mind, we decided at the outset of our cruising adventures on "Little Gidding" to invest in lots of canvas sun protection. We have a dodger and a bimini with side curtains to keep the sun out of the cockpit. There's a panel that joins the dodger and bimini that can be removed when we're underway so that we can see where we're going and still be in the shade. When we're at anchor, we have a foredeck awning we can rig for additional shade. Other boats we know have even more complete enclosures. Long term survival in the tropics, at least for pale skinned folks like us from the high latitudes, means hiding from the sun.

This cruising boat has good sun protection provided by awnings and a bimini

When we DO venture out into the sun, we try not to do it around midday, demonstrating that neither of us is English or, for that matter, a mad dog. We've noticed, however, that the beaches at popular resorts are rarely empty during the day. There's lots of baking flesh out there and some of it is pretty scary. Somehow the message about the dangers of UV radiation is not getting through to, or is being ignored by, the masses. The problem is that tans are fashionable, and have been for some time. In fact it was Coco Chanel, whom we quoted at the outset, who first popularized sun tanning in the 1920's. Prior to that, it was "in" to appear as if you had just crawled out from under a rock -- witness the Impressionist paintings of pallid ladies promenading with sun hats and parasols.

Perhaps it's appropriate to conclude with another quotation from Ms Chanel: "Fashion is made to become unfashionable." Now that David's had his encounter with the dermatologist, he's determined to be at the vanguard of a new "pale is chic" movement. You're encouraged to join; don't forget to bring your sun block.

David & Eileen