I’M fair and blond, and one of my first memories as a toddler was the joy of peeling off my flaking skin in long strips after a sunburn. Growing up in the 1950s and ’60s, from spring to fall, we lived outdoors, and my face was often scorched a healthy red like the ruddy Marlboro Man on the TV commercials. Long after my body had turned brown, my face shone bright.
And though I was never one to waste a summer day lying outside baking in the sun, I’ve had several world-class sunburns, particularly in my teens and 20s. My last year of high school at senior class day, I ran around in just a pair of cutoff jeans, impressing girls, swimming in the lake, playing Frisbee all day, a phenomenal specimen. That night, I turned lobster red head to toe, and was so overcome by violent chills, I fainted.
I don’t recall using sunscreen until I was well into my 30s. Never even remember hearing about it. The main skin-care product I associate with the sun while I was growing up was Noxzema — that white, cool cream, applied at night, at home lovingly by my Mom to soothe sunburn pain after a long day outside.
As best I remember, the first time I used sunscreen was when my wife and I had our four children, in the late ’80s and early ’90s, and our pediatrician clued me in.
These last 10 to 15 years, I’ve been pretty vigilant. We live by the sea and keep a big selection of sunscreens, with SPF ratings of 30 to 45, near the front door, so it’s the last thing everyone sees before heading out. I wear a hat in the sun, cover up on the beach when not in the water, apply sunscreen year-round.
And I go to my dermatologist for regular checkups.
Most visits, she pulls out something that looks like a welder’s torch but instead of fixing the kitchen sink, she blasts me with liquid nitrogen chilled to 320 degrees below zero, which freezes and kills patches of dry, potentially cancerous cells. It takes a few days for the scabs to fall off, and until then if people ask I just say it’s a mild case of plague. The last few years, she has also sliced off pieces of me to be biopsied. Recently, she called to say two had come back cancerous — basal and squamous cells — and I needed to schedule a follow-up with her staff to have them removed. “Tell them you need a three-slot surgery,” she said.
Older white men like me are the worst when it comes to skin cancer rates. While the death rate from melanoma — the most severe skin cancer — has been declining for 20 years for people under 50, men over 50 have the highest increase in death rate, 3.2 percent a year since 2002. The highest annual increase in incidence of melanoma is among white men over 65, 8.8 percent a year since 2003. And while there’s also rapid growth among young white women ages 15 to 34 (40 percent of 18-year-old women have used a tanning bed in the last year, compared to 8 percent of men, according to the American Academy of Dermatology), nearly twice as many men as women die of skin cancer each year.
So here’s what I can’t figure: How could I have been so stupid? How was I so oblivious for 40 years, and could I blame my mother for any of this? Dr. Darrell S. Rigel, 59, a past president of the American Academy of Dermatology, and editor of “Cancer of the Skin,” a leading textbook in the field, advises against blaming mothers. “My own mother would spend hours tanning in the backyard, and developed a melanoma,” he said. “The public awareness on this is relatively new, 20 to 25 years.”
The progression from serious sun exposure to skin cancer can take decades to unspool in our DNA. “What we’re seeing now, in increased rates of melanoma, is what people did in the ’80s,” Dr. Rigel said. “Baby boomers out baking in the ’80s.”
Why didn’t baking boomers slather up? Turns out, the protective sunblock that we’ve doused our children with is relatively new. “In the ’60s and ’70s all we had was suntan lotion with an SPF of 2, to take a little edge off the sun,” Dr. Rigel said. “The first SPF 15 was introduced in 1986 and 30 SPF not until the early ’90s.”
Furthermore, dermatology was quite primitive when we were born. In the 1950s, Dr. Rigel said, doctors were still amputating limbs to stop the spread of melanoma. As late as the 1980s, he said, there were no good studies on how big a margin needed to be when removing a melanoma, and incisions would stretch 8 to 10 inches.
As to why we boomers were the first to metastasize in a big way, Dr. Rigel rounded up the usual suspects: increased wealth and leisure; the explosion in air travel, allowing more vacations in sunny Florida, California and Arizona and at ski resorts; a thinning ozone layer; and a longer life span that gives us the opportunity to die of more things.
The good news is that skin cancer is one of the most treatable of cancers when caught early. Since the American Academy of Dermatology undertook its first national public health campaign 25 years ago, there has been steady progress in reducing death rates. The five-year survival rate for melanomas has improved from 82 percent in the mid-’70s to 87 percent in the mid-’80s and to 92 percent by the mid-2000s.
For perspective: last year, 11,590 people died of skin cancer, more than the number of people who died of stomach cancer (10,620) but less than those who died from pancreatic cancer (35,240), breast cancer (40,610) and, the biggest of all, lung cancer (159,390).
Early detection is crucial. If a melanoma is removed while still confined to the skin, the five-year survival rate is 99 percent; if it has spread to the lymph system or blood, the survival rate drops to 65 percent; if it has reached the organs, 15 percent.
And if you need to be scared into a checkup, Dr. Rigel can do it: “For a melanoma the size of a dime, there’s a greater than 50 percent chance it’s already spread beyond the skin.”
And that, he said, helps explain why the mortality rate is increasing among men over 65. “They’re resistant to getting spots looked at,” Dr. Rigel said. “They tell me, ‘I’m only here because my wife made me.’ ”
At my recent checkup, I had suspected an asymmetrical red mark on my shin, nearly the size of a dime with irregular borders, that had lingered for months, no matter how hard I’d stared at it. My doctor cut out a piece for biopsy as well as two samples from my back.
Ten days later, I learned the mark on my shin was nothing, “a solar lentigo that became inflamed.” (Right.) But the two spots I didn’t know were there — to be honest, I can go years without looking at my back — were cancerous. One, midback, was basal cell, the most benign skin cancer. The other, near my right shoulder, was squamous cell, riskier but virtually always treatable when caught early.
Each year, one to two million cases of basal and squamous cell cancers are diagnosed.
The operation, done in the doctor’s office, was simple: gouging out the cancerous cells. For the record, I’ve written this entire column with 13 stitches in my right shoulder, a 1.5-inch incision.
To create his dermatology textbook, Dr. Rigel read many old textbooks, and he was struck by both the progress and primitiveness of treatment. “We’ve gone from burning out the cancer with a branding iron in the 1800s, to amputating limbs, then digits, then taking out big hunks and now smaller hunks,” he said. “I’m sure 100 years from now, they’ll pick up my textbook and say, ‘Can you believe in 2010 they used knives to cut out skin cancer?’ ”