Killer Tan

Melanoma is the fastest rising cancer in Minnesota and local experts are pioneering cutting edge research and treatments

skin cancer awareness, health and wellness
Illustration by Mercedes deBellard

It’s not hard to spot the outliers during Minnesota winters. They’re the lucky ones who have jetted off to a tropical destination, returning with a golden souvenir. Tan skin is a signal for friends and coworkers to ask about their trip, or for the skeptics to wonder if their bronzed colleague got a deal on a month-long tanning bed package. 

If not a status symbol, many desire a tan to mask imperfections (or to look better in that pale yellow bridesmaid dress). Despite our obsession with our skin’s appearance—a typical woman will spend $15,000 in her lifetime on makeup products—many overlook skin’s most important concern. One out of five Americans will have skin cancer at some point in their life, and in Minnesota, melanoma rates are increasing faster than any other cancer. For white women ages 18–49, the rate has doubled since 1995. Fortunately, experts in Minnesota have contributed findings on the cause, and are also researching new melanoma treatment methods.

In 2014, Minnesota was the eighth state to ban indoor tanning for people under the age of 18. Today, only eight states have no indoor tanning restrictions. Following the legislation, the University of Minnesota released a study that was the first to examine whether risks for melanoma differ by both age and sex. The takeaway? Tanning beds are more dangerous than we think and can pose a serious health hazard. 

Indoor tanning is strongly linked with an increased risk of melanoma, especially in women younger than 30. “We can see that 97 percent of the women who developed melanoma had a history of using tanning beds,” says Dr. Rehana Ahmed, a Twin Cities-based dermatologist and one of the study’s researchers. According to the study, even if you only use a tanning bed 10 times in your life, it’s enough to increase your risk of melanoma three-fold. UV radiation in tanning beds is so concentrated that one session is equivalent to standing at the equator for hours.

Many vacationers head to the tanning salon to get a “base” tan, hoping to avoid burning their skin at their sun-filled destination. Ahmed advises against this practice, because while sunburns contribute to a higher risk of melanoma, indoor tanning significantly increases melanoma risk even in those who never experienced burns.

Most people have moles, but some are more susceptible to cancers than others (see below). Melanoma begins in the melanocytes cells, responsible for forming moles and the color (called melanin) in your skin, and can be caught early by spotting abnormality—discoloration, asymmetry, change in diameter, border, or color. In its early stages, an abnormal, new, or changing mole is typically the only symptom. Melanoma can be removed surgically, and depending how deep it is, lymph nodes can be removed and further tested. When the cancer has spread, there are chemotherapies to treat it, but they’re still not effective for treating all melanoma cases. A few new treatments are on the horizon and may offer help in the future.

“Now we can find how to combine new treatments and interventions with these ‘first base’ hits to get a ‘home run’ cure.”

Ahmed and her team are continuing research on a nanocapsule therapy that was studied to treat prostate cancer, but is proving effective for all all cancers, including melanoma. The medication shuts down a protein that causes cancer cells to grow—a groundbreaking therapy because it will only affect cancer cells, eliminating the debilitating side effects of treatments such as chemotherapy. Despite favorable results, the research is still in the beginning stages, so it could be years before humans can reap the benefits of nanocapsule therapy.

Currently, several immunology therapies also offer hope in treating skin cancers. Anti-PD-1 drugs target a protein that is involved in a complex process that prevents the immune system’s T-cells from attacking cancer. More than a third of advanced-melanoma patients who received one of the new immunotherapy drugs in an early trial were alive five years after starting treatment—double the survival rate typical of the disease, according to a study released this year. 

Dr. Svetomir Markovic of the Mayo Clinic in Rochester was part of a team that studied a protein marker whose frequency may predict patient response to PD-1 immunotherapy for melanoma, resulting in better recommendations for treatment. Markovic is extremely encouraged by these recent breakthroughs. “Now we can find how to combine new treatments and interventions with these ‘first base’ hits to get a ‘home run’ cure. The whole field is reignited. It’s at the front and center of everybody’s mind.”

New discoveries have also been made in the realm of prevention. Dr. Mohiba Tareen of Tareen Dermatology in Roseville cites a recent Australian study in which patients who consumed 500mg of vitamin B3 twice daily experienced a 23 percent reduction in the number of pre-cancer and cancerous lesions. 

Getting your skin checked is the best first step to avoid skin cancer. Your dermatologist will help you identify what moles are normal on your body and will point out anything unusual. Then, make self-skin checks part of your annual self-breast examinations (for women) and self-testicular exams (for men). The more you become familiar with the moles on your body, the more likely you will be able to spot irregular growths or changes.

In addition to annual skin checks, create a daily skincare routine. Exposure to UV light also speeds up the aging process (photoaging is prolonged exposure to UV radiation over a lifetime), so using a facial sunscreen plays double duty in keeping your skin as healthy as it looks, especially when the product includes anti-aging ingredients such as retinoid and antioxidants including vitamin E, beta-carotene, and vitamin C. Many facial products with tinted sunscreens can be used in place of foundation.

Keep hats, sunglasses, and sunblock readily accessible, whether by the bathroom sink, at the front door, or in the office. Still can’t do without bronze skin? Spray tan technology is advancing and self-tanning lotions have improved to give you a more consistent, natural look—without UV hazards.

Sunscreen 101

SPF, or Sun Protection Factor, is the number on a bottle of sunscreen that determines how well a sunscreen protects against UV radiation. (An SPF of 30 protects against about 97 percent of rays). Look for a sunscreen that is labeled “broad spectrum” meaning it protects the skin from both UVA and UVB rays. Minerals such as zinc oxide and titanium dioxide, which are the safest and most effective active ingredients, act as a physical sunblock, reflecting UV rays. 

For day-to-day use, a sunscreen with SPF 30 is recommended—a number high enough to reduce the risk of melanoma by 80 percent. For prolonged time in the sun (on vacation or at the beach), the higher the SPF the better, and make sure to apply a thick layer.

It’s important not to keep your sunblock in your car or anywhere it could get hot—those temperature changes quickly inactivate the sunblock. Also check the expiration date. While the lotion may appear to be normal, the active ingredients may not block the sun as effectively.

If you prefer to use sunscreen with limited or no chemicals, brands including Elta and Revision can be purchased at the doctor’s office or online. Or look for over-the-counter sunscreens marketed for babies or for sensitive skin because they will have fewer additives, such as Vanicream (developed in Rochester, MN), Babyganics, and the Honest Company.

Are You at Risk?

Even people with naturally dark skin are at risk of melanoma and skin diseases, but some people should exercise greater caution if possessing any of the traits below

  • Fair skin (anyone can get skin cancer, no matter your skin color, but having less melanin, or less pigment, in your skin provides less protection from UV radiation)
  • Blond or red hair, light-colored eyes, and you freckle or sunburn easily
  • A history of sunburns, especially in youth
  • A person’s risk for melanoma can double if they have had more than five sunburns at any age
  • Increasing intermittent sun exposure and artificial UV light in childhood and during one’s lifetime
  • A family history of skin cancer
  • If you have more than 50 moles, abnormal, or large moles
  • Time in sunny or high-altitude climates where the sun is strongest

Visit the Academy of Dermatology and Minnesota Dermatologic Society to find clinics that provide skin checks.