Dermatologist: Failure to keep kids properly protected
increases skin-cancer risk now and in future

OK, the kids are out of school, summer officially arrives Tuesday, and families are making vacation plans, whether to head to a faraway location or just a local beach, lake or park.

That means it's time again for the warnings on protecting everyone from the sun.

Time again to relive the nightmare of the screaming child who swears the sunscreen is in his eyes, as you wrestle with his slippery body to make sure every inch of him is covered. Not to mention the pleading you do from the water's edge, begging your daughter to come out, for just a minute, so you can reapply that sunscreen.

If all that makes you want to put this story down, because you're sure you're doing the best you can, consider this from local dermatologist Dr. Yardy Tse (pronounced "chew"): "I have a patient, an 18-year-old girl, with basal cell carcinoma on her forehead," Tse recalls. "That takes years to develop. It grows very slowly. It means the amount of sun exposure has been intense, and this was growing since she was a young child."

Tse, who specializes in Mohs surgery, a form of treating skin cancer that she says has the highest cure rate and the least physical disfigurement, also told of the 21-year-old with skin cancer on his nose. It was surgically removed and was deep enough to require a skin graft.

And those are just two young people seen by one doctor, Tse points out. While skin cancer isn't rampant among young people, many are well on their way to a diagnosis later on, Tse fears.

The soft-spoken dermatologist with SkinCare Physicians & Surgeons in Encinitas raises her voice ever so slightly as she urges parents to do more to protect their children.

"I think it's really important for parents to remember that 90 percent of sun damage is done before puberty," Tse says. "That's about age 12, 13 or 14. So it's very important, especially for young children, to be taught about three things: sunscreen, sun protection and sun avoidance."

And half the battle is getting that message across to parents who are former or current sun worshippers in sun-drenched Southern California.

"Children learn what we teach them," Tse says. "And we have to teach them to protect themselves."

The American Cancer Society estimates 59,580 Americans this year will be diagnosed with melanoma, the most serious of skin cancers. Almost one in 10 of those people – 5,440 – will be Californians. The state leads the statistics, followed not surprisingly by Florida, nicknamed the Sunshine State, with 4,600 new cases.

"Just one blistering sunburn in childhood can double the risk of getting melanoma later in life," said Dr. Perry Robins, president of The Skin Cancer Foundation. "That risk can be avoided by following some simple, sun-safe guidelines."

Preventing that sunburn is key, Tse says. And in theory, simple to do.

"One of my colleagues had a baby," she recalls. "As a dermatologist, he knows all the evils of sun exposure and always made his little boy wear a hat. He got so used to it that he wanted to go to bed with a hat. Now, he's 2, and he won't leave the house without a hat on."

The bottom line, Tse says, "If you teach them to be careful, never burn, use sunscreen, limit their time in the sun, they can avoid skin cancer."

They have found that out in Australia, says John Barrow, a founder of Coolibar sun-protective clothing. The Australian native lives in Minnesota now, with his wife and three children, but he spent many years in a nation that's gone to war on skin cancer.

"In Australia in 1995, more people were diagnosed with malignant melanoma than with lung cancer," Barrow says.

That only added to the urgency of the situation. The problem had become so serious that the Australian government had decided not to wait for parents to teach their kids. It took its Sun Smart program straight to children. Developed about 20 years ago, Barrow says it has been so successful that the incidence of skin cancer in his country at first stabilized and, now, is beginning to decline.

The program's motto is "slip, slop, slap," which, like "stop, drop and roll" in this country for fire safety, becomes an easy message for kids to remember: slip on a shirt, slop on some sunscreen, slap on a hat.

"They have big containers of sunscreen at the schools, and it's applied to children before they play at recess. And they have to wear a hat or they don't go outside, and school uniforms are sun-protective fabrics. The government also does a formal review of shade availability at the schools."

He would like to see the same emphasis in this country. So would Dr. Tse.

"I have a lot of patients who are teachers," Tse says. "They talk about wanting to do something, but it's harder here. They would have to have a note to put on sunscreen; if there's a reaction, the school could be liable and the teacher could be liable. But parents should initiate it at their schools. They can talk to teachers and principals."

At the very least, Tse says, send your child to school with a note to the teacher that he or she needs to put sunscreen and a hat on before recess.

Meantime, she urges, do everything you can to protect your children, not just this summer but every day.

"All too often, young mothers take their children to swim lessons, to play soccer, and those are wonderful activities, but they need to be smart about it," she says. "First, apply sunscreen every single day, at least 30 minutes before going outside to do anything. I've been to soccer games for my friends' children, and I've seen the moms applying sunscreen to their children before they go on the field. That's too late."

Tse says, in order for the sunscreen to protect, it needs to be on the skin for a half hour before exposure. And it needs to be an SPF 15 or higher. That 15 SPF, she says, blocks about 93 percent of the UVA and UVB rays that can damage skin.

"And look at the ingredients on the back," she urges. "The sunscreen needs to have titanium dioxide or zinc oxide as the first or second ingredient."

Can't get your kids to put sunscreen on? You're not alone, Tse says. Her advice is to shop for it together, make a family project out of it. Have the kids read the label to see if key ingredients are contained. Then once they have several good choices, let them pick the one that smells and feels best to them.

When it comes to teenagers, Tse adds another risk factor: tanning booths.

"I would never recommend sunbathing, but tanning salons are worse," Tse says. "Instead, encourage the use of self tanners. And the so-called mystic tan is fine; that's just spraying on color."

She's also a fan of sun-protective clothing, especially hats and shirts and other item that have titanium oxide woven into the fibers.

"Wearing that kind of clothing is an excellent idea and can be very helpful," she says. "And it's always a good idea to have a child screened once a year just to check moles. Parents should know children develop more moles as they reach puberty and into early 20s, and there's a direct connection between sun exposure and the number of moles developed."

But most important, she says, "is the time spent in the sun. Don't let clothing and sunscreen give you a false sense of security."

But the weather's warming up, the kids are out of school and, realistically, families will be outside – a lot.

"Sure they will," Tse says. "So, don't go to the beach without an umbrella or some type of shade. Reapply that sunscreen – even the ones they say are waterproof and sweat-proof – every one to two hours. Wear long-sleeve, lightweight clothing with sunscreen woven in and a big hat, with a 3-inch brim. There are lots of correlations between the width of brim and incidence of skin cancer.

"You and your family can still enjoy yourselves, just cover up and try to go to the beach or be outside earlier or later in the day."

Tse acknowledges not everyone can or will avoid those peak hours of sun exposure between 10 in the morning and 4 in the afternoon. Her advice, in that case: Get the kids in the shade after 30 minutes, and keep them there as long as possible.

And instead of working on your tan, think about joining them.

"That idea that a tan looks good goes back to a time in American society where having a tan denoted wealth and prestige, or the healthy and active lifestyle here in California. But there is no such thing as a healthy tan."

Surefire ways to block rays

Here are some tips from the American Academy of Pediatrics (AAP):

BABIES UNDER 6 MONTHS

• Avoid sun exposure and dress infants in lightweight long pants, long-sleeved shirts and brimmed hats. Can apply minimal sunscreen to face and back of the hands.

CHILDREN

• Apply one ounce of sunscreen, SPF 15 or greater, at least 30 minutes before going outside. Reapply every two hours, or after swimming or sweating.
• Wear a hat with a 3-inch brim or a bill facing forward, sunglasses that block 99 percent to 100 percent of ultraviolet rays, and cotton clothing with a tight weave.
• Avoid the sun from 10 a.m. to 4 p.m., the hours of peak intensity.
• Information: www.aap.org/advocacy/archives/tanning.htm.

Slip. Slap. Slop.

American children can learn from the Australian government's sun protection education program, which uses the motto "slip, slap, slop":

• Slip on clothing, ideally things manufactured to be sun-protective.
• Slap on a hat with a wide brim to shade face and ears, and don't forget sunglasses to protect eyes.
• Slop on sunscreen.