This is a plea to all children and teenagers, their parents and teachers, and the doctors who treat them: Please take sun exposure more seriously.

Many parents, if not most, are very conscientious about protecting babies from the sun — as long as the infants are still being carried or are confined to a stroller. But once children become ambulatory, sun protection too often takes a back seat to the myriad challenges of getting out of the house with toddlers or bundling children off to school on time.

Unless sun protection practices are established early in life as inviolable habits, akin to using seat belts in a vehicle, children become increasingly lax as they get older about preventing sunburns that can lead to life-threatening cancers decades later. In a study of 360 fifth graders over three years, Alan C. Geller, director of melanoma epidemiology at Massachusetts General Hospital, and his colleagues found that as the children moved into adolescencethe proportion who “often or always” used sunscreen declined to 25 percent from 50 percent.


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And once children reach their teens, sun protection succumbs to burgeoning feelings of independence and invulnerability, as well as the popular belief among teenagers that they look more attractive when sporting a tan. Few seem worried about the chances of developing wrinkled, leathery, blotchy skin decades later as a result. Fewer still seem to know that they are risking cancer.

Yet childhood is the most critical time for avoiding sun-induced harm later in life. As much as 80 percent of a person’s lifetime exposure to skin-damaging ultraviolet rays occurs by age 18. Multiple studies have shown that the more youngsters are exposed to the sun early in life, especially if they suffer serious sunburns, the greater the risk of later developing both superficial skin cancers and deadly melanomas.

The issue of sun protection is all the more important these days because the thinning of the ozone layer has rendered everyone more susceptible to skin-damaging solar radiation.

An Avoidable Risk

For all its marvelous life-giving properties, sunlight can also be damaging and sometimes lethal, even for those who “never” burn, tan easily or have naturally dark skin.

Most babies are born with blemish-free skin. But once exposed to ultraviolet radiation, those destined to become blonds or redheads often develop freckles, a sign of increased vulnerability to sun damage. Even more serious, in white populations, childhood sun exposure increases the risk of developing acquired nevi, or moles, those melanin-rich lesions that can become melanomas.

Unlike superficial forms of skin cancer, called basal cell and squamous cell carcinomas, melanomas are much more serious cancers that arise deeper in the skin and can spread and threaten life before they are detected. And it is not just the light-skinned who are at risk. Melanomas can also develop in people with very dark skin; while it may not burn as easily, darker skin is rich in the pigmented cells in which these cancers arise.

Canadian researchers showed more than a decade ago that routine use of sunscreen by school-age children diminishes their risk of developing moles. The study, directed by Richard Gallagher of the British Columbia Cancer Agency in Vancouver, followed 458 elementary school children over three years. All were initially examined to count and measure how many moles they had.

The children were then divided into two groups. The parents of both groups were asked to keep detailed diaries of their children’s sun exposure during the summer months. One group of parents was given educational materials and a supply of broad-spectrum sunscreen, SPF 30, and instructions to apply it whenever their children were likely to be in the sun for 30 minutes or longer. Each month, the amount of lotion remaining in the bottles was measured as a test of compliance.

The second group of parents received neither the educational materials nor the free sunscreen, though many parents in this group did apply sunscreen to their children on their own. At the end of the study, the number and size of moles on both groups of children was reassessed.

There was no difference in the amount of time the children spent in the sun or in how much clothing they wore. But the children whose parents got the educational information and sunscreen developed fewer moles than the children whose parents did not. And fewer moles, the researchers said, no doubt mean that these children will be less likely to develop melanomas when they grow up.

“This is a true prevention study,” Dr. Gallagher said. “Parents need to know that if they intervene early, they can probably significantly reduce their child’s risk of skin cancer in the future.”

In a 10-year study of 1,621 Australians ages 25 to 75, Adele C. Green of theQueensland Institute of Medical Research and colleagues found that those who used sunscreen daily on their head and arms developed half the number of melanomas as those who used it less often.

Helpful Programs

In an interview, Mr. Geller, a lecturer on health at the Harvard School of Public Health, cited several programs that could help change the sun protection practices of children. One is called SunWise, created for schools by the Environmental Protection Agency, which includes a “toolbox” of instructional materials that can help teachers incorporate sun protection messages into various subject areas, like math, social studies and physical education.

Another is Pool Cool, developed by Karen Glanz, professor of epidemiology and nursing at the University of Pennsylvania, and designed for children ages 5 to 10. Lifeguards and parents at swimming pools are taught about the use of sunscreen, shirts and hats to reduce sun exposure.

“A T-shirt has an SPF of 7 or 8,” Mr. Geller said. “A shot-glass amount of sunscreen should be applied to all exposed skin, including the ears, back of the neck and top of the feet, which are often forgotten.”

In Australia, where skin cancer has long been epidemic, a “no hat, no play” policy as part of a broad-based emphasis on sun protection has made the country one of the first in the world in which skin cancer incidence is declining, Mr. Geller said.

He also urged pediatricians “to take sun exposure more seriously” and to emphasize the importance of sunburn prevention at every visit with children. And, he said, sunscreen should be made readily available at pools and beaches.

“We should be applying the lessons learned from tobacco, using clever public service ads and more emphasis in schools of the downsides of sunburn,” he said. “Kids need to hear messages about the impact of sun protection multiple times from multiple sources.”


Everyone is familiar with the SPF system which rates the level of UVB or sunburn protection; however, people remain unfamiliar with the dangers posed by UVA rays.  They are responsible for solar aging and the majority of sun induced melanomas.

The process of solar aging involves chronic long-term exposure to micro-doses of UVA light. UVA exposure produces damage over years, by inducing a multitude of tiny “scars”; in which one, etched over another, over time cause the visible wrinkle.

Ninety percent of the skin in composed of the thick, tough collagen which lies directly beneath the surface epidermis. It is the interaction of UVA rays on the collagen that leads to aged skin. One would expect tough collagen to be unaffected directly by the low energy UVA rays. However, studies conducted by dermatologist Dr. John Voorhees, discovered that UVA rays alter the way new collagen is laid down and old collagen is broken down. Specifically Voorhees determined that exposure to UVA rays turns on genes resulting in the production of enzymes that promote collagen breakdown, while at the same time turning on different genes that inhibit new collagen formation. The result is that one damages collagen each and every time one is exposed to UVA rays. One can see the cumulative effect of this damage in U.S. truckers versus English truckers. The U.S. truckers have more pronounced solar aging on the left side of the face versus the right side for the English who drive on the other side of the road.

Even more worrisome than solar aging it the fact that UVA exposure is now strongly linked to sun induced melanoma. Long wavelength UVA rays interact with melanin containing melanocytes producing oxidative byproducts which lead to melanoma induction.  It is possible to wear a sunscreen that has great UVB or sunburn protection, but little in the way of long wavelength (greater than 350nm) UVA protection.

This will allow someone to stay out in the sun for hours without getting burned, but all the time “cooking” themselves with melanoma inducing UVA rays. Perhaps it is no coincident that the incidence of melanoma has exploded at the same time there has been ever more pervasive sunscreen use.

The key is to know a product’s Critical Wavelength® value. This value tells a consumer how far out a sunscreen’s protective umbrella extends across the UVB/UVA spectrum.  This rating system has recently been adopted by the U.S. FDA as the standard for making any broad spectrum, anti-aging, or skin cancer prevention claim. It is important to know this value.

So what does all this mean to golfers, or anyone spending long hours enjoying the outdoors? Well if you don’t want your face to look like a worn out saddle, get proactive:

1. Use not just a high SPF sunscreen (SPF 15 or higher), but one with a known level of UVA protection. Critical Wavelength® is the gold standard rating the level of UVA protection. This Critical Wavelength® value needs to be over 370nm. All LUCA Sunscreen products display a Critical Wavelength® value.

2. Apply sunscreen to dry skin before going outside. Application to wet or sweaty skin markedly reduces effectiveness.

3. Use sun protective clothing, broad brimmed hats and shirts.

4. Reapply sunscreen every two hours to dry skin. Most people apply less than half of that is recommended.

5. Use common sense and avoid direct sun exposure when practical. UVB rays or sunburning rays are most intense in the midday, during the summertime, but UVA rays remain constant all day and all year long. The incidence of skin cancers including deadly melanoma is increasing at epidemic proportions but being proactive, particularly at a young age might just save your life, and keep you looking younger longer.

- Karl Gruber M.D.