Skin and Sun 101- A Year Around Problem

By Aaron K. Joseph, M.D., F.A.A.D.

Several professional cyclists have made the news lately, not for their race results but for their pathology test results. Magnus Backstedt of Team Slipstream/Chipotle and Amber Neben of Team Flexpoint both were treated for melanoma in 2007. Former pro and lifetime cyclist Chris Carmichael has also had suspicious growths removed (thankfully they were negative for melanoma). Many more cyclists, triathletes, and outdoor enthusiasts are at risk, and it's time for a more vigilant approach to skin health, including sun protection and frequent self examination of the skin.

All cyclists should be aware of the dangers of moles that change shape or color, one of the earliest signs of melanoma. Melanoma is one of the most aggressive skin cancers, affecting more than 50,000 Americans each year, and the incidence is rising in young adults each decade. Melanoma is easily treated with minor surgery if caught early, but can be deadly if detected too late.

Remember ABCDE

The ABCDE rule is handy and easy to learn. Moles that break the rules are suspicious and should be examined by a dermatologist, a physician trained in diseases of the skin, hair, and nails. What's ABCDE?

A is for Asymmetry. Normal moles are like mirror images on each half. Dangerous moles often have a darker or larger area in one part.

B is for Border. Atypical moles have jagged or notched borders.

C is for Color. Normal moles are one, even, color. Concerning moles have dark brown, black, grey or red areas.

D is for Diameter. Common moles are less than 6mm in diameter, about the size of a pencil eraser. Dangerous moles are often larger.

E is for Enlarging. A rapidly growing mole or a sudden change in an existing mole can be a warning sign that dangerous cells are present in the mole.

Most melanomas are detected by patients. The easiest way to find suspicious moles is to know what common moles look like. A monthly self examination of the entire skin surface helps to provide baseline knowledge of existing moles and makes new or changing moles stand out more easily. This easy skin check can be done at the same time each month as breast exams for women or testicular exams for men. Any area of concern can then be brought to the attention of a dermatologist.

There is now ample research data to confirm the long-held belief that that those with the greatest sun exposure history are at higher risk of melanoma. An avid recreational cyclist may be on the road for 5 to 10 hours weekly. Professionals often spend two to three times that amount outdoors, but both categories of riders are considered to have a high amount of sun exposure.

All cyclists are at risk for skin cancer, regardless of skin color, but fair skinned riders with light eyes and blonde or red hair are at the greatest risk. However, melanomas of the hands and feet are more common in patients with darker complexions. These can be neglected because of urban myths about pigment and cancer protection. Melanomas can and do occur on any skin surface as well as inside the mouth and eyes. The most common locations are the legs in women and the back in men.

One myth that needs to be dispelled is that melanoma only occurs on areas of skin that see a lot of sun. The fact is that while you may wear a jersey all the time, you can still develop melanoma on your ghostly white back or chest. The theory is that the immunosuppressive effect of the sun diminishes tumor suppression all over the body.  

Be "Sun Smart"

"Sun-smart" behavior includes minimizing or avoiding sun exposure at peak times (10 AM to 4 PM), using protective clothing and hats, sunglasses, and sunscreen with an SPF (sun protection factor) of 30 or higher. Remember to reapply sunscreen every 2 horus. And your best bet is to try riding early or late in the day with as much clothing as comfortable.

Reliable Internet resource about skin cancer: 

www.cancer.org (American Cancer Society)
Source: Carmichael Training Systems