Burned To A Crisp

You read that right. We'd love to be able to tell you that all the damage you've done to your skin while playing golf without wearing sunscreen can be reversed. Some of it can, but the jarring reality is that one out of every five Americans (one in three Caucasians) will develop some form of skin cancer in their lifetime. Every dermatologist we spoke with thinks the odds are even worse for golfers. Want to know why? Hint: It's not simply because we might be out in the sun more than most Americans.

"I don't think it's ignorance, and I don't think it's inherent in being exposed to the sun longer," says dermatologist Dr. Seth Kates. "People just don't care."

Adds Dr. Michael Kaminer: "Some golfers, it's like they're going out of their way to get skin cancer. They come up with every excuse you can think of for not wearing sunscreen."

Harsh statements, but ones based on experience. Kates and Kaminer are not only skin doctors, they're golfers. Kaminer has a 4.6 USGA Handicap Index. Kates is a 7.1. As golf buddies in the Boston area, they know what it's like to play 36 holes in the summer sun, and they know what it's like to see a golfer come into the clubhouse after a round looking like someone just dunked his head in a boiling lobster pot.

They, and many other experts in the skin-care field we consulted, would love to educate golfers on the dangers of long-term sun exposure. So would we. Please read on.

What is skin cancer?

Statistically, it's the most common form of cancer in the United States. Skin cancer is the mutation of cells on the outer layers of your skin caused by a number of factors, including excessive exposure to ultraviolet rays from the sun, heredity, genetics, skin type and a weak immune system. Of these, sun exposure is believed to cause 90 percent of all cases. The three leading types are basal-cell carcinoma, squamous-cell carcinoma and malignant melanoma. Actinic keratosis (abnormal skin growths) and dysplastic nevi (atypical moles) aren't cancerous but are often precursors to cancer. See our photo chart (below) to help identify various skin blemishes.

Is skin cancer fatal?

It can be. Malignant melanomas take the lives of more than 8,000 Americans a year, or about 13.5 percent of the people diagnosed with the disease, the Skin Cancer Foundation reports. Other forms of skin cancer are rarely fatal, although squamous-cell carcinoma can metastasize and result in death. But the situation isn't bleak. If detected early, 99 percent of all skin cancers are curable.

In the case of melanoma, once the cancer reaches the lymph nodes, the survival rate drops to 15 percent.

I play golf at least twice a month. How likely is it that I have skin cancer?

There are no statistics that specifically target golfers, so we asked some dermatologists who have lots of golfers as patients to assess the risk level. All said it's likely a higher percentage of golfers have skin cancer than the 20 percent reported for the general U.S. population, but it's hard to say how significant the increase would be because many other activities and lifestyles include the four to six hours of sun exposure from a round of golf.

I play most of my golf in Arizona. Am I at a greater risk in areas where the sun is more intense?

Surprisingly, Arizona didn't crack the top 10 among states with the highest number of melanoma cases. According to the American Cancer Society, 62,480 cases are projected this year. Three Sunbelt states topped the chart: California (7,620 cases), Florida (4,430) and Texas (3,940). But because the next seven spots were occupied by Northern states, experts struggle to reach a consensus about geography's role in skin cancer. "It's a tricky question," says Dr. Perry Robins, president of the Skin Cancer Foundation. "Obviously you're at greater risk in the Sunbelt states and at higher altitudes. But, then again, people who live in states that don't get a lot of sun might tend to overdo it when the sun is out."

Does the color of your skin make a difference?

Though skin cancer is less common in people with darker skin, it's often more deadly because it's harder to detect. "And melanoma can sometimes occur in non-sun-exposed areas, including the soles of the feet," says Dr. Bruce Brod, a dermatologist who also teaches at the University of Pennsylvania and is a weekend golfer. "Dark-skinned people still have to be concerned with skin cancer."

My skin is loaded with freckles and sunspots from too many years on the range. How can I check myself for skin cancer?

Every expert we spoke with said you should see a dermatologist once a year. In the meantime, you should inventory the moles, freckles and blemishes on your body -- make mental notes or take pictures. Then check monthly for changes. Don't forget those hard-to-see places like your scalp and backs of the legs and neck. Changes in color, size and texture are what you're looking for. Watch for spots or sores that continue to itch, bleed or don't heal. For more on melanomas, visit skincancer.org and click on "melanoma" and then "warning signs."

How is skin cancer removed?

For melanoma, the malignant skin cells and a wide margin of healthy tissue surrounding them are removed with a scalpel and sent to a lab for testing. This is typically an outpatient procedure. "If it's not melanoma, then it's crucial that your doctor is trained in Mohs micrographic surgery," says Dr. Kates, of Worcester (Mass.) Dermatology Associates. "Mohs is the gold standard. Essentially we remove a tiny piece of skin, test it for cancer, and then remove another tiny piece until we've removed all the cancer, while doing minimal, if any, damage to the healthy skin."

Are there any removal procedures that don't involve surgery?

Yes, removal is sometimes done with creams and scraping, but most nonsurgical procedures are used only on precancerous blemishes and only the smallest and shallowest basal- and squamous-cell carcinomas. Liquid nitrogen is often used to burn off spots. Other techniques, says Dr. Kaminer, are laser-based.

What are UVA and UVB rays, and what's the difference between SPF and UPF?

The sun emits three types of ultraviolet radiation, and each one has a different wavelength. UVC rays usually do not reach the Earth's surface, but UVA and UVB rays do. Of the two, UVB rays give you a sunburn. UVA is a deeper-penetrating ray that is responsible for long-term damage to skin. SPF (Sun Protection Factor) is a rating system approved by the Food and Drug Administration to determine how effective a sunscreen is against stopping only UVB rays. UPF (Ultraviolet Protection Factor), is a similar rating system to SPF but is used for clothing. The number represents the product's ability to block UVB and UVA rays. The higher the number, the better the blocking power.

Gray day? Eighty percent of harmful UV rays penetrate clouds.

As a kid, I spent every summer at the beach or playing golf. We didn't use sunscreen. Is it too late for me to reverse the damage done to my body?

It's never too late. If you start protecting yourself now, the skin can begin to repair itself, much like the lungs do when someone quits smoking. Contrary to popular belief, 80 percent of your lifetime sun exposure is not acquired by age 18, says the Skin Cancer Foundation. You've actually acquired 23 percent. After that, it jumps to 47 percent by age 40, and 74 percent by age 59.

Is there such a thing as a healthy tan?

Some experts recommend 15 to 20 minutes of unprotected sunlight a day so the body gets an ample supply of vitamin D. A tan is the body trying to protect the skin against further damage from the sun. So no tan is healthy. The Skin Cancer Foundation is "strongly against" 15 to 20 minutes of unprotected sunlight exposure, but the American Cancer Society says "most people need only 15 minutes a day, three times a week of sun exposure to make enough vitamin D. And you need only exposure to your hands, arms and face." The answer we liked best came from Dr. Kates: "Even if you're wearing sunscreen, you aren't blocking out the sun entirely," he says. "So just by putting on some sunscreen and going out to play a round of golf, you will get more than enough vitamin D."

What is sunburn, and does it lead to skin cancer?

The burn is a result of ultraviolet rays damaging the skin's DNA. If you've had five or more sunburns in your life, you've doubled your chances of getting melanoma.

What's the best way to treat sunburn?

Drink water to replace fluids, take some acetaminophen (Tylenol), and soothe the skin in cool water or, even better, milk, which creates a protein film that helps ease the discomfort, says the Skin Cancer Foundation. "When your skin begins to peel -- a natural part of the healing process -- use a non-greasy moisturizer to reduce itching," Dr. Robins says. Adds Dr. Andrew Jaffe, a dermatologist in southwest Florida: "A topical steroid can be prescribed by a doctor for a really bad burn."

What about hair and lips?

Lips are a prime breeding ground for skin cancer, says Dr. Jaffe, because golfers forget to apply a lip balm with SPF protection. "It's skin, too," he says. If you forgot a hat, shame on you. But you can spray an alcohol-based sunscreen into the scalp to keep from scorching the top of your head. It's perfectly safe for hair. And don't forget the skin behind the ears. Dr. Jaffe says those areas get pummeled by the sun.

What should I be looking for in hats and clothes?

Nearly all golf-clothing manufacturers offer merchandise that has UPF protection. "In the early years, I wasn't aware that normal clothing didn't protect me from the sun," says Greg Norman, whose apparel company offers sunscreen materials in its clothes. "I distinctly remember playing the Australian Skins in the '80s in North Queensland and suffering intense sunburn through my shirt."

I'm on medication, and the label says to avoid the sun. Is it still OK to play golf?

Generally, it's still OK to play, says Dr. Brod, but you should consult with the prescribing physician to be sure. If you're in the sun while taking these medications, be sure to wear protective clothing.

What should I do to protect my skin when I'm not playing golf? After the round? Rainy days?

Retinoid creams (Avage, Renova) can reverse some sun damage when applied regularly, says Dr. Brod. "Topical antioxidants also might reverse some of the damage. I also recommend applying sunscreen no matter what you're doing. Driving in the car, for example, is a prime way of getting too much sun exposure."

__YOU WANT A PIECE OF ME?

By Hank Haney__

Take my advice: If you're a golfer, you should go to the dermatologist every six months to a year. Why so frequently? One time I noticed a spot on my face that looked like a zit. Six months later, it was a white spot that wouldn't go away. They tested it, and it turned out to be skin cancer.

So my doctor performed Mohs surgery (see "How is skin cancer removed?") and dug out the spot, which left a hole the size of a dime on the right side of my face. After that he cut a triangular patch on the top and bottom of that circle, then closed it all together. The guy worked it right into a wrinkle in my face, and you can hardly notice it now.

I have the biggest problems on the right side of my face, most likely because it got more sun than the other side. When you stand on the range for as long as I have, and the sun comes up a certain way and you face the same direction for a lot of years, you're bound to have trouble.