Melanoma

An alarming increase in the occurrence of melanoma, a potentially fatal skin cancer, is causing a justified fear of excessive exposure to the sun. The rates in Scotland have doubled in the past decade, and the rates among fair-skinned people are increasing at a rate of 7 per- cent a year in many countries. Explanations for the increase range from the new cultural desire to be tan to the thinning of the ozone shield, which has always blocked much ultraviolet light. While both of these factors need to be considered, an evolutionary view suggests other explanations too. We do spend more time at beaches, but we spend far less walking in the sun without clothes on. The loss of ultra- violet blocking resulting from ozone depletion is more than counter- balanced in most areas by the local air pollution. What is new is not sun exposure or ozone inadequacy but our pattern of sun expo- sure. People now spend most of their time indoors and then go out- side on weekends for intense bouts of unaccustomed exposure. People who are outdoors for hours every day adapt to their amount

of usual exposure and are unlikely to get sunburnt. The risk of melanoma is related more closely to the number of sunburns than to the total amount of time spent in the sun.

Another novel environmental factor is the use of chemically com- plex sun lotions. Blocking ultraviolet radiation does curtail the devel- opment of cancerous lesions. A recent controlled study of 588 Australians found that those who used an active sunscreen developed significantly fewer precancerous skin lesions than those who used a cream that did not block much ultraviolet light. But might the chem- icals in sunscreens also cause problems? They don’t just sit on the surface of the skin but are absorbed into it. What effects do they have on skin cells, and how might they be transformed after binding to tis- sue proteins and being bombarded by strong light? The answers are very much in doubt. How ironic it would be if we were to discover that skin cancer can be caused, directly or indirectly, by suntan lotions! Attention should also be given to the products used to inhibit the inflammatory process of sunburn. Such inhibition might prevent cancer by preventing unnecessary damage from autoimmune reactions, but it might also protect damaged and potentially cancer- ous cells from being naturally destroyed by the immune system.

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