Part 1 – Sun Damage
You’ve had your weight loss surgery in Dallas, lost weight and you’re looking and feeling great. For the first time in years you have the confidence to put on a swim suit and head outdoors to enjoy the Dallas sun. Well, take-care, the sun’s ultraviolet (UV) rays can wreak havoc on your skin and eyes if you don’t take appropriate precautions. Your skin (integumentary system) is the largest organ in your body. It accounts for 12-15% of the body’s total weight and in an average adult body it covers an area equivalent to 22 square feet. That’s a lot of skin to expose to potentially damaging UV rays. Everyone’s skin and eyes are at risk including those with dark skin and eyes; however, people with light skin, light eye color, and blond, red or light brown hair are even more susceptible and should take extra precautions. You also need to take extra precautions if you or a family member have a history of skin cancer, have many or large moles, have freckles before tanning, recently underwent bariatric surgery, work outdoors, live in a high altitude, vacation in subtropical climates, work inside but get intense sun exposure on other days, have any autoimmune or immune weakening disease, or take any medications that weaken the immune system or increase sensitivity to sun light.
First, a little more information about UV rays. The sun gives off UVA, UVB, and UVC rays year round including during hazy or cool days. UVA and UVB rays are both absorbed by the skin while UVC rays are primarily absorbed by the earth’s ozone. The intensity of UV rays depends on the time of year and area’s altitude. The higher the altitude or the closer the area is to the equator the more intense UV rays become. In Dallas, UV rays start increasing in intensity in the spring and are the most intense during the summer months. In the United States they are their most intense the months of April through October and between the hours of 10am through 4 pm. UV rays have increased radiation in areas with snow, sand, and water because of their reflective properties on the skin. UV rays can even reach below the water’s surface and cause skin to burn.
So, why should you care? For starters, UVB rays cause sunburns, cataracts and affects the immune system while UVA rays cause skin aging and wrinkling. After exposure to UVB radiation the skin may turn red (burn) in as little as 30 minutes but usually takes between 2-6 hours. Excessive UV radiation (both UVA and UVB) is the leading cause of non-malignant skin tumors and increases the risk of three types of skin cancer – melanoma, basal-cell carcinoma and squamous cell carcinoma. Tanning beds aren’t any safer. They can give off both UVA and UVB rays and should be used with caution if at all.
So, what can kind of precautions should you take? First, seek shade when the sun is at its highest overhead and therefore its’ strongest (usually 10 a.m. until 4 p.m. in the northern hemisphere). Use sunscreen but not just any sunscreen will do. Be sure and read the label on your sunscreen. It should state that it is a broad spectrum sunscreen. Only a broad spectrum sunscreen protects against both UVA and UVB rays; therefore, protecting your skin against skin cancer and early aging. Next, check the sunscreen protection (SPF) level. At minimum the SPF should be 15 but 30 or higher is better. A SPF of 30 gives you the equivalent of 1 minute of UVB ray exposure for each 30 minutes you spend in the sun. The higher the SPF the more protection it offers. A SPF of 15 filters out about 93% of UVB rays, while a SPF of 30 filters out about 97%, a SPF of 50 filters out about 98%, and a SPF of 100 about 99%. Regardless of the SPF, no sunscreen protects you completely. You should apply a generous amount of sunscreen, about 1 palm full to cover arms, legs, neck and face of an average adult, about 15 to 30 minutes before going outside. Don’t forget about lips, hands, ears, feet, shoulders, behind the neck, and underneath straps or areas of clothing that may move exposing the skin. Re-apply sunscreen at least every 2 hours to maintain protection or more often if you are sweating or swimming. Sunscreen only acts as a filter and does not block all UV rays. So, you should also wear dark colored clothing to protect as much skin as possible including long sleeves, long pants or skirts. Tightly woven fabrics protect more than loosely woven fabrics and dry clothing is more protective than wet. If you can see through a fabric then UV rays can get through too. Wear a hat with at least a 2-3 inch brim or baseball style cap with about 7 inches of fabric draping down the sides and back. A dark, non-reflective brim or underside will help reduce reflection onto the ears. Again, a loose weave straw hat doesn’t offer as much protection as a more tightly woven fabric.
Sun exposure can also damage the eyes leading to cornea burn or cataracts. The best way to protect the eyes is to wear UV blocking sunglasses that are labeled UV absorption p to 400 nm or Meets ANSI UV Requirements. These block at least 99% of UV rays. Those labeled cosmetic only block about 70% of UV rays. Darker lenses don’t provide better protection unless they have the ANSI label. Large-framed and wraparound sunglasses are more likely to protect your eyes from light coming in from different angles. Finally, double check medications a make sure there is no warning of increased skin sensitivity to UV rays. If there are warnings then stay out of that Dallas sun.
So, you’re looking good and feeling great after your weight loss surgery, but forgot the sunscreen and you are now sunburned, what now? When you get burned there is usually pain and a sensation of heat that becomes more severe several hours after exposure. You may develop chills and your skin may become tight because the sun has dried it. After about a week your skin may peel leaving the skin beneath vulnerable to infection. Double check your bariatric surgery incision site. You can first take a cool (not cold) bath or apply cool compress to the burned area. Aloe Vera gel (can get with lidocaine) or other topical moisturizer applied to the burned area may ease discomfort. For seriously burned areas apply a thin layer of 1% hydrocortisone cream. Do not use petroleum based products because they prevent excess heat and sweat from escaping. Take an anti-inflammatory like ibuprofen to lessen pain and itching. Over the counter diphenhydramine (Benadryl) make help reduce itching and swelling. If the sunburn is severe and blisters develop don’t scratch or pop them. Stay in the shade until the sunburn is healed. If the pain persists or blisters become infected follow up with your weight loss surgery doctor, dermatologist and/or family practice physician.
Part 2 – Skin Cancer
As discussed previously, excessive UV radiation (both UVA and UVB) is the leading cause of non-malignant skin tumors and increases the risk of three types of skin cancer – melanoma, basal-cell carcinoma and squamous cell carcinoma. You should check your skin regularly at least once a month. When checking your skin, be sure to check under any skin folds and hard to see places. Use a hand held mirror to visualize those places that are hard to see, like your lap band surgery access port. Check your skin systematically starting with the head and working your way down to the toes. Pay special attention to any existing moles, blemishes, or birthmarks so you will know what’s normal for you and can identify any changes. A normal mole is usually an evenly colored brown, tan, or black spot on the skin. It can be either flat or raised, round or oval. Moles are generally less than 6 millimeters (about ¼ inch) across (about the width of a pencil eraser). A mole can be present at birth, or it can appear anytime during childhood or young adulthood.
When examining your skin you should compare any spots or moles using the ABCDE guidelines:
- A is for asymmetry Does one half of the spot or mole not match the other?
- B is for border Are the edges of the spot or mole irregular, ragged, notched, or blurred?
- C is for color Is the color of the spot or mole not the same all over (may have many shades of brown, black or with patches of pink, red, white, or blue)?
- D is for diameter Is the spot or mole larger than 6 mm across (about ¼ inch the size of a pencil eraser).
- E is for evolving Has the spot or mole is changed in size, shape or color.
If any of your spots or moles demonstrates any of these signs be sure and have your doctor check them out. Better safe than sorry.
Melanoma, the most dangerous form of skin cancer, is thought to be associated with severe UVB sunburns that occur before the age of 20; however, the risks are cumulative over time. Repeat blistering sunburn means increased risk of melanoma. Melanomas can occur anywhere on the body and commonly occur on the face and neck however, they are most likely to occur on the trunk and chest on men and legs on women. If left untreated melanomas is the most likely to spread to other parts of the body and is very hard to treat. Melanomas appear as a new spot on the skin or a spot that is changing in size, shape, or color. They are usually raised, have irregular borders and irregular coloration, and are larger than 4 cm.
Basal cell and squamous cell are the most common skin cancers but are less likely to spread to other parts of the body. However, if left untreated they can grow larger and invade nearby tissue organs. Basal and squamous cancers are most often found in areas that get exposed to a lot of sun, such as the head, neck, and arms, but they can occur anywhere on the body. You are looking for new spots, bumps, patches, or sores that don’t heal after several weeks. Basal cell carcinoma often look like a flat, firm, pale area or small raised pink or red translucent, shiny, pearly bumps that bleed after a minor injury. They may have one or more abnormal blood vessels, and blue, brown, or black areas. Large basal cell carcinomas may have oozing or crusted areas. Squamous cell carcinoma may look like growing lumps, often with rough, scaly, or crusted surface. They may also look like flat reddish patches in the skin that grows slowly.
Other UV-related skin disorders include actinic keratoses and premature aging of the skin. Actinic keratoses are skin growths that occur on body areas exposed to the sun especially the face, ears, backs of hands, forearms, and the V of the neck. They are premalignant risks for squamous cell carcinoma and are usually small (less than ¼ inch across), rough or scaly spots that may be pink, red, or flesh colored. People with one actinic keratosis usually develop more. Some can grow into squamous cell cancers, but others may stay the same or even go away on their own.
An ounce of prevention is worth a pound of cure when it comes to your health, especially since having weight loss surgery. Take precautions against UV rays, check your skin regularly, if you notice any new spots or changes in existing one like the ones listed above see your doctor. Now, grab that sunscreen, sunglasses, cover-up, and hat and enjoy the Dallas sun safely!