Beware Of The Phony Melanoma Scare

From The Guardian (7/10) by Sam Shuster Don't Let The Phony Melanoma Scare Keep You Out Of The Sun

Skin cancer statistics are used to scare, not educate. Almost all of the 84,000 skin "cancers" that appear each year are in fact benign: they don't spread or kill; their cancerous name is a historical misnomer. Of course, sun exposure increases facial wrinkling, as does smoking, but the black ace in the fear game is melanoma, because the real thing is vicious.

Cancer Research UK say the incidence of malignant melanoma has "quadrupled in Britain in the last 30 years". But if this were so we would have seen coffin-loads of consequences by now. We haven't, and in a recently published large UK study (British Journal of Dermatology, 2009), I and my colleagues showed that the reason mortality has not increased with incidence is that the tumors reported are actually benign; they are not true malignant melanomas. Our explanation of the phony melanoma epidemic is "diagnostic drift which classifies benign lesions as … melanoma", a misdiagnosis "driven by defensive medicine, an unsurprising response to its commercialization".

The recategorisation by the International Agency for Research on Cancer, which gives sunbeds "the same high risk … as cigarettes and asbestos", is absurd. The field is an unreliable mess of conflicting conclusions, and the claim of a special risk for younger people, which the article repeats, is now denied. But critically, since we now know incidence is invalidated by classifying benign disease as malignant, until diagnosis is improved only studies of melanoma mortality are acceptable; and the few that have been done show that melanoma mortality actually decreases after UV exposure!

The poor relationship of melanoma to cumulative UV dose had solarphobics running for cover in the idea the article quotes, that a one-off sunburn "could develop into a melanoma". But that doesn't happen: unlike the benign tumors that really are caused by UV, melanomas do not predominate in sun-exposed skin. There are common sense reasons to avoid sunburn, and for use of sunscreens &endash; but not, to prevent melanoma, for which they have been shown to be ineffective.

Self-image is measurably increased by a tan, and we will learn much from understanding the mechanism of this well-being. UV initiates the synthesis of vitamin D, essential for our bones, and sunscreen promotion has led to problems. It also has a profound effect on our immune function. Strangely, the bastard science of descriptive epidemiology that masterminded the melanoma myth now claims that UV lowers the incidence of many internal cancers and melanoma, thereby outweighing any harmful effects.

Plants and animals owe their existence to the sun, and it is hardly surprising that we've learned to adapt and use it. That's why we can't give up our tan, and more importantly why we shouldn't try.

Sunscreen's Role In Preventing Melanoma Questioned

Dermatologist Dr. Bernard Ackerman devotes many hours of his time diagnosing cases of skin cancer. Yet, on a recent trip, he didn't seem worried about the potential risk of the disease while he sunbathed without the use of sunscreen or a hat. Ackerman, 68, is an expert in the field of dermatology and the emeritus director of the Ackerman Academy of Dermatopathology. He considers the connection between melanoma and the sun both inconclusive and inconsistent.

Dr. Ackerman disputes current assumptions connecting the sun and melanoma:

(1) If a person is badly sunburned, to the point of blistering at an early age in their life, they will develop skin cancer later on in life. Ackerman pointed out there were contradictions in the studies supporting this theory.

(2) Another common assumption is that sunscreen acts as a protection against melanoma. To counter this theory, Ackerman referred to a study completed in a dermatology journal on the subject that didn't provide any factual evidence to support this theory.

(3) The more intense the exposure to the sun, the greater the likelihood of developing melanoma. Ackerman claimed that much of the epidemiological research is inaccurate and doesn't evaluate cause and effect findings. Ackerman advised keeping out of the sun if you're concerned about premature aging or if you're very fair-skinned due to the increased risk of developing squamous cell carcinoma, a less dangerous form of cancer. Otherwise, Ackerman said it was not wise to hold onto the beliefs that included avoiding the sun and using sunscreen as ways to protect against melanoma.

Ackerman further challenges the "epidemic" of melanoma by questioning why African Americans and Asians developed melanoma on their skin mainly on areas that haven't been exposed to the sun such as the palms, soles, nails and mucous membranes. Another dermatologist, Darrell Rigel, disagreed with Ackerman's ideas stated that people who developed melanoma in areas that weren't exposed to sun were a result of the way sunlight suppressed immune cells in the surface of the skin that normally kept cancer at bay. Ackerman explained that this "immune-system argument" lacked evidence and acted as a hypothesis to the sun-exposure-causes-melanoma hypothesis.

The Food and Drug Administration (FDA) hosted a half-day symposium on tanning in July (2003) at the American Society of Photobiology's annual conference in Baltimore. Potential benefits and risks of UV exposure were discussed, along with presentations on how much UV you need to get a tan and how protective a tan is against sunburn.

"There is no real debate about a blistering sunburn,' FDA's Howard Cyr said in his opening remarks, "But there is considerable debate about tanning itself. Is it safe?" Cyr pointed out that there is no identifiable threshold for what level of exposure is "safe" and that few people have been taking into consideration that there are benefits to exposure as well.

Researchers have been using fish, mice and other marsupials to test different skin cancer models for years in trying to implicate UVA exposure as a risk factor for melanoma, the deadliest form of skin cancer. Data presented in Baltimore showed exactly the opposite.... mice exposed to pure UVA did not develop melanomas. Mice exposed to 100 percent UVB did develop melanomas.

With divergent conclusions with different mouse models, the mouse researchers are back to square one. Research still cannot explain how, why, or even if UV light is associated with melanoma at all.

As reported in the (from the New York Times article by Gina Kolata July,04),

Ray Allard (Tan Plus) Comment: We believe that it is always best to achieve a tan gradually, to prevent burning and with minimal or no use of sunscreen so as not to deprive the body of the suns' many health benefits. When you use sunscreen your body is absorbing synthetic chemicals, and with experts' recommendations to apply generous amounts of the product every few hours, you will likely be absorbing a fair amount. While the FDA classifies most active ingredients in sunscreen as GRASE (generally regarded as safe and effective), it is hard to believe that all of these chemicals will not have any effect on your system at some point. The truth is "what you put on your skin will eventually end up in your bloodstream".

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