The dark side of the sun | Lawrence Scerri

Dr Lawrence Scerri, Chairman, Department of Dermatology and Venereology, Sir Paul Boffa Hospital, says the sun's UV rays are highly damaging, emphasising that Malta has a high incidence of mortality rates due to skin cancer

"There's no doubt that long exposure to the sun's UV rays can cause permanent damage to our skin, and even kill," Dr Lawrence Scerri says. "Malta is still lagging behind when it comes to putting knowledge into practice".

"And this is reflected in the high incidence of mortality rates due to skin cancer in Malta. Besides, the tanning culture has been around for too long and is still very strong."

It is a fact that living things require exposure to sunlight. Plants need the sun for photo-synthesis. Humans need the infrared from the sun for warmth and for visible light.

However, Dr Scerri insists that UV rays are detrimental to our skin and eventually, even to our life. And those most susceptible to skin cancer are fair-skinned people, and individuals who have numerous moles, which is referred to as 'Atypical Mole Syndrome' - a disorder of the skin characterised by the presence of many moles. Scerri emphasises that damage to the skin due to sunburn isn't irreversible.

"Some people also have the wrong perception that ultraviolet light is the only way we get Vitamin D. We do in fact get Vitamin D and shouldn't underestimate its importance, as it helps our bones and teeth, but we must bear in mind that we also get the same vitamin from certain foods we consume.

"It's a fallacy that a person needs to expose themselves to the sun in order to get a good intake of Vitamin D."

Lawrence Scerri

Melanoma

Melanoma skin cancer, undeniably linked to sun exposure, is by far the commonest skin disease-related cause of death worldwide, and its incidence has been increasing progressively.

Scerri says that "there are many forms of skin cancer, but invasive melanoma is the most dangerous. Melanoma can occur on any skin surface but is rare in people with dark skin".

In Malta alone, according to official statistics published by the Health Information Department, melanoma claimed 98 deaths during the period 1993 and 2010, representing an overall mortality rate of 18%, meaning that about one in six people with melanoma in the Maltese islands are being diagnosed too late.

He says that "there is a strong link between episodes of sunburn in childhood and the subsequent development of melanoma. The cancer-inducing damage to the genetical material (DNA) in the skin sustained with each episode is irreversible."

Scerri says that "individuals with atypical mole syndrome - moles of which are unusual in size and structure - are at greater risk than others for developing cancer of the skin in the form of malignant melanoma," adding that "changes in the appearance of these moles must be taken seriously as changes may foreshadow the onset of skin cancer".

So how can skin cancer be prevented and what are the health authorities doing on a national level to educate the public and minimise the harm and above all, minimise the risks of skin cancer?

"Many campaigns are launched through the media, billboards, dissemination of printed material, skin cancer screenings at Boffa Hospital and clinical data collected from the Melanoma Screening Clinic entered in a European Euro-Melanoma database, annually."

Furthermore, "as part of Euro-Melanoma Day 2012, for the 13th year running, Malta joined the rest of Europe in this year's 'Beat Melanoma: Spot the Difference' campaign locally coordinated by the Maltese Association of Dermatology and Venereology (MADV) and the Department of Dermatology, in collaboration with the Health Promotion and Disease Prevention Department".

Dying for your vanity

Unfortunately, Scerri believes that the tanning culture has been around for too long and is still very strong, making it extremely difficult to reach out to people who feel that a tan makes them look slimmer and healthier, despite the well known dangers associated with skin cancer.

"At least the modeling world is finally acknowledging that exposure to the sun can do more harm than good, like age the skin faster. In this way, top models can serve as ideal role models too.

"Apart from skin cancer, the factor of skin aging shouldn't be forgotten, since exposure to the sun accelerates aging of the skin. There's chronological aging (the natural process of aging)  and there's photo aging - most common in sunny countries like Malta."
Photo aging is a term used for the characteristic changes induced by chronic UVA and UVB exposure.

He adds that sunscreens shouldn't be a justification to spending longer hours in the sun, since it does not block out all the harmful UV rays. Sadly, the reality is that nothing can block out the sun's rays completely. Scerri insists that when using a sunscreen, a 50 factor sunscreen should be applied to the skin.

The sun protection factor (SPF) is the amount of UV radiation required to cause sunburn on skin with the sunscreen on, as a multiple of the amount required without the sunscreen.

Scerri says that a safe alternative to a tan is fake tanning, which can be easily performed by beauticians or tanning moisturisers for a gradual tanning effect, but on the other hand, one shouldn't resort to tanning beds which emit UV rays just the same. It is for this reason that Dr Scerri is contributing to promoting the method of fake tanning.

Early detection

Scerri stresses that the surgical removal of a melanoma caught at an early stage (thin melanoma) leads to an excellent survival rate in the region of 90 to 95%. However, the chances of survival once a melanoma has spread beyond the skin are dismal.

"Despite an increase in awareness on melanoma on a national level - which causes the majority of deaths related to skin cancer - and more cases being diagnosed at an early stage, there are still a number of people who are being diagnosed too late."

Worldwide, doctors diagnose about 160,000 new cases of melanoma every year. The diagnosis is more frequent in women than it is in men and is particularly common among Caucasians living in sunny climates, with high rates of incidence in Australia, New Zealand, North America and northern Europe.

Scerri says that recent surveys conducted to adjudicate the public's perception and knowledge about the harmful effects of the sun, revealed that the Maltese public was quite knowledgeable but when it came to putting it to practice Malta still lagged behind in being 'sun smart', alongside our European counterparts whose mentality on 'safe sun' still leaves much to be desired.

"A fair amount of success has been achieved in getting the public to adopt sun protection measures."

UV Index

Scerri says that "generally, the closer you are to the Equator the stronger the UV will be. The main reason for this is that at the Equator the sun is more directly overhead, and therefore has less ozone and atmosphere in general to filter the UV rays while traveling to the earth's surface.

"But this is something nobody can do anything about. But protecting one's self from the sun by firstly staying away from it between 11am and 4pm, wearing appropriate clothing, and using a strong sunscreen factor should help diminish the chances of sun damage on our skin.

"It all boils down to the ultra violet rays. An international standard measure is the UV Index - a scale between zero and 11 . The UV index announced in weather forecasts is a prediction of how strong the actual UV will be at the sun's highest point in the day. In Malta, the UV Index is normally around 7 between April and October, and this is an indication that one must take the necessary precautions and take cover from the sun.

"Activities in or near reflective surfaces such as swimming, canoeing, sailing, surfing, snorkeling, fishing or any other activity where you are close to water (even sun bathing beside a pool), can also increase UV exposure. UV rays reflected by the snow puts skiers and snowboarders at an increased risk of sun damage as well."

When asked if cosmetic procedures can intensify one's sensitivity to the sun, Scerri says that such procedures can cause damage to the layers of the skin, increasing susceptibility to the harmful effects of the sun. A case in point is laser peeling of the skin, which can eventually lead to pigmentation.

"Anyone performing such procedures is duty bound to inform the person about to undergo the treatment of the risks involved and as a rule these procedures should be kept to a minimum during the summer season."