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How Much Is Too Much Sun?

Audio

Aired 6/14/10

We'll discuss the benefits and the harms of sun exposure, how to protect your skin from the sun, and how to properly use sunscreen. We'll also talk about the ABCs of skin cancer, how to do a self-exam, reduce your risk and about advances in skin cancer treatments.

TOM FUDGE (Host): I’m Tom Fudge. You’re listening to These Days. Our relationship with the sun has had its ups and downs. Today, many people see sunburn as a thing to be avoided at all costs. It does age your skin and it gives you skin cancer. But the most deadly form of skin cancer, melanoma, may have little to do with sun exposure. And there are health consequences that come with getting too little sun. So as summer approaches we've decided to spend some time talking about the sun and what role it should play in our lives. We’ll be happy to take your questions or to hear your stories about the use of sunscreen and the like, so call us if you want to join the conversation. The number is 1-888-895-5727, that’s 888-895-KPBS. Joining me for the rest of this hour are two guests. In studio, Greg Daniels joins me. He’s an assistant professor at UCSD, and he’s with the Clinical Medicine Tumor Growth, Invasion & Metastasis Program at the UCSD Medical Center. And, Greg, thank you very much.

DR. GREG DANIELS (Assistant Professor, Clinical Medicine Tumor Growth, Invasion & Metastasis Program, University of California San Diego, Moores Cancer Center): Thanks, Tom, for inviting me.

FUDGE: And Edward Ross joins me by phone. He’s a dermatologist and laser specialist with Scripps Clinic. Edward, thanks.

DR. EDWARD ROSS (Dermatologist, Scripps Clinic): Yeah, thanks for having me here.

FUDGE: And, again, listeners, 888-895-KPBS. Well, Dr. Daniels, what are the different ways the sun affects our skin and our body. I think there are pros and cons.

DR. DANIELS: Absolutely. And thanks for having this topic. It’s a great discussion and appropriate time of the year. I was traveling last week and I got up in the morning and Good Morning America with a beautiful dermatologist who said, sun is killing America. And so I think we need a little balance here, and you’re right, the sun has both good and bad.

FUDGE: All right, and is it possible—I think I know the answer to this question—but is it possible to get too little sun? And do some people?

DR. DANIELS: Yep, a lot of people, particularly in the United States. One consequence of having too little sun or ultraviolet light exposure is vitamin D deficiency. We know that that is fairly prevalent in the United States as well as in more northern latitude countries. But, surprisingly, vitamin D deficiency is starting to show up in places like Australia and New Zealand as well.

FUDGE: One story I heard a long time ago, and I didn’t know this at the time, was that the character Tiny Tim in Charles Dickens’ “Christmas Carol” had rickets.

DR. DANIELS: Right.

FUDGE: And rickets is one of the things that’s caused by a vitamin D deficiency, right?

DR. DANIELS: Correct. And that Australian study is kind of interesting in that 30% of school age children were vitamin D deficient…

FUDGE: Huh.

DR. DANIELS: …and that’s where you think about rickets and bone development.

FUDGE: In Australia?

DR. DANIELS: In New Zealand.

FUDGE: I’m sorry. New Zealand.

DR. DANIELS: Yeah.

FUDGE: But that’s a pretty sunny country, isn’t it?

DR. DANIELS: Absolutely.

FUDGE: Okay. Well, let me put the question to you, Edward Ross, what are some of the pros and cons of sun exposure? How would you answer that question?

DR. ROSS: Well, definitely one of the pros is the euphoria most people feel being in the sun and certainly being in San Diego is one of the reasons we’re here. And I see the flip side of that. I see – Most of the people I see are either here for skin rejuvenation or restoration or trying to minimize some of the effects of skin cancer and that’s the downside. And the downside is the daily aging that the sun really has that sort of effect on the skin day by day. And living here versus living somewhere else, you really feel it. And we moved here several years ago from Boston and just being here for a year or two, you really see your skin age prematurely versus in a more northern climate.

FUDGE: And premature aging, would you say that that’s the most widespread concern people have about sun exposure?

DR. ROSS: I think on a daily basis until people are much older and they really face skin cancer in the mirror, that is their main concern between maybe age 30 and 50. Now some people have skin cancer as young as 15 or 16 but the great majority of Americans don’t face skin cancer until 45, 50, 60, and in that meantime between 35 and 50, I think it’s the aging that people finally recognize there’s a problem with the sun.

FUDGE: And going to get back to skin cancer in just a bit because that’s a very interesting subject and, listeners, if you have any questions, 888-895-KPBS. In terms of vitamin D deficiency and vitamin D is the sunshine vitamin, it’s what we get from the sun, Dr. Daniels, do people in San Diego get rickets? I mean, what is a serious – what’s a serious risk when it comes to vitamin D deficiency in our society?

DR. DANIELS: Well, rickets is uncommon these days for a couple reasons. One is that it’s recognized and the importance of vitamin D is recognized and we actually, as a society, decided a while ago to supplement our foods with vitamin D. So it’s unusual to get that amount of deficiency. But as Dr. Ross alluded to, there are other issues about the sun and vitamin D including, you know, your immune health so it turns out that infections are more common in patients that have low vitamin D, as well as low vitamin D is related to some other cancers relatively common such as breast and colon and possibly prostate cancer. So vitamin D deficiency is happening, the severe vitamin D that gives you rickets is uncommon but we are vitamin D deficient.

FUDGE: And what would you say you need to do – how much time do you need to spend in the sun to avoid a vitamin D deficiency? Dr. Daniels.

DR. DANIELS: Well, that will depend on where you are, what season it is. And so looking at vitamin D levels, you have to take that into account, as well as the pigmentation in your skin. As it turns out, the higher the pigmentation, the more paradoxically, one would think, you’re at risk for vitamin D deficiency. And that’s because the pigment helps protect us from the UVBs, which help synthesize vitamin D. So it depends on your skin color, it depends on the time that you’re out but, in general, the recommendation is 10 to 20 minutes of partial sun exposure during the 10 to 2 period to get your vitamin D levels per day.

FUDGE: Well, what do you mean by partial sun exposure?

DR. DANIELS: Face, upper extremities, that kind of exposure.

FUDGE: Well, let me go to you, Edward Ross. On the general subject of how much time we should spend in the sun, as we’re approaching summer, let’s talk about summer. What do you think is a good amount of time or a bad amount of time to spend in the sun?

DR. ROSS: Well, as Dr. Daniels said, it’s mainly darker skin patients who are having a problem, who stay indoors that have a problem with the vitamin D deficiency. For the average Caucasian in San Diego, just walking around even with a sunblock on, you’re probably going to receive enough ultraviolet light to have no problem with a vitamin D issue. But there are people, for instance if you’re a darker skinned young man who’s maybe 15 or 16 and you play video games all day, and this is a large number of people are doing this, I think that’s the group of people where we may have some trouble with vitamin D. And the second group of people that probably should receive almost no ultraviolet light except what they might be getting from walking to their car and back are patients who have preexisting skin cancers that have been treated because I don’t believe there’s probably any safe level of ultraviolet light for those patients. If you were to choose one, you might want to have the patient get a little bit of sun on an area that typically doesn’t get sun, like maybe their stomach, for five minutes and presumably that would be enough if you were going to do something at all. But I would say almost zero tolerance for certain subgroups of patients here in San Diego.

FUDGE: Zero tolerance, to stay out of the sun entirely?

DR. ROSS: Well, because you’re going to get some sun. I mean, unless you live like a vampire you’re going to get some sun in daily living in San Diego. In fact, if you look at the cumulative sun you might get in San Diego over the course of a year versus somebody in, let’s say, La Crosse, Wisconsin, you may get eight or ten times as much just doing normal activities. So I’d be more concerned in another climate compared to San Diego. I think here we have just our baseline sun exposure, even being careful, is probably excessive for most people in San Diego, particularly Caucasians with a history of skin cancer.

FUDGE: Let’s take a call from Denny in San Diego. Denny, go ahead. You’re on the show.

DENNY (Caller, San Diego): Yes, hi, good morning. And I, too, happen to be in the skin business and one of the questions I have for the two lovely doctors that have called is maybe you can help me explain to my patients that an SPF 60 doesn’t mean they’re good for 60 minutes in the sun and they don’t have to apply it once. And, two, taking vitamin D should happen as early as possible, I think, at least 3,000 units. I – We, as practitioners, are seeing more and more influx like Botox is really not going to reverse sun damage and it’s – there’s nothing wrong with being very white. I don’t mind being very white. But SPF outfits, rash guards, I have a child, he balks out because mommy has him—always has had him—with a rash guard right down to his little fingertips, and while for a 10-year-old that’s no longer cool.

FUDGE: All right, so Denny, you’re white and proud.

DR. DANIELS: That’s right.

DENNY: White and for a snowflake face, that’s okay, but I’m also, Doctor, like you, I’m from back east also. And, yes, we do love the sun but none of us are that crazy.

FUDGE: All right, well, Denny, thank you very much. And who would like to – Edward, Greg, anyone want to take a shot at that? I guess she asked more than one question.

DR. ROSS: Well, I’ll address the Sun Protection Factor because that’s a term that comes up a lot. The Sun Protection Factor is a term that theoretically tells you how much longer you could stay in the sun without redness versus with a sunscreen versus without a sunscreen. So let’s say you wear an SPF of 60 and normally you would become red in five minutes, you should be able to stay out 60 times as long. Now, in reality those numbers are inflated and it’s largely because the amount of sunscreen people apply is only maybe one-third to one-fifth of that amount that are used in these tests. So in that sense, there is sort of an inflation of the Sun Protection Factor and also the Sun Protection Factor doesn’t tell you much about ultraviolet A protection, just ultraviolet B protection. So the caller is right in that the SPF can be a little bit deceptive and can be sort of your worst enemy if you really adhere to that number. So you still have to be safe, a little bit safer than that number. The number just tells you a relative amount of sunlight you could have versus without the sunscreen.

FUDGE: Greg.

DR. DANIELS: Yeah, I completely agree. But, you know, this is pretty controversial, too. And Dr. Ross mentioned that UVB is what we measure, which is what causes our skin to turn red and I think people recognize that Sun Protective Factor shouldn’t even be in the name because it’s not protecting, that’s for non-melanoma skin cancers, it clearly shows that it helps. But one thing that I worry about is that people put it on and feel like they’re prevented from getting melanomas and pretty much everything else and certainly a high number like 60, boy, that must really protect me. And I think it’s very misleading and it’s not quite as simple as we think it is. What she talked about in terms of clothing, clothing has a different rating and that’s a UV Protective Factor. That one actually does take into account both UVA and UVB in their rating system. And it probably is, in my choice of what to put on for the summer, sunscreen is near the bottom but above it is actually sun protective clothing, which I think is very good.

FUDGE: Let’s talk about skin cancer. Just very briefly, let me remind listeners I’m speaking with Greg Daniels in studio. He’s an assistant professor of Medicine at UCSD. Edward Ross is a dermatologist and laser specialist with Scripps Clinic. Greg, skin cancer does – Very simple question, does exposure to sun, too much exposure to sun, give you skin cancer?

DR. DANIELS: Not a simple answer, of course. So non-melanoma skin cancers, we know that, for example, if you live in a higher UV index kind of place, you get more non-melanoma skin cancers. That association hasn’t been shown for melanoma per se. There’s a large nurses’ health cooperative study that’s out there. Sun exposure and melanoma, which is, again, what usually comes in these discussions, the link there is complex and that’s because we probably don’t understand the initiating part for melanoma. And as we’ve already alluded to, sunblocks address UVB. The UVB causes DNA damage, there’s no doubt about that. But the DNA damage, the signature in melanoma is not the same signature that we see in UVB exposed cells. Also, the pattern of melanoma and the generic changes, we can actually divide melanoma into at least four different genetic subtypes and while there is a dose response in a subset of melanomas, these are the minority. This is probably about 5% of the melanomas out there that happen in the head and neck area. The relationship between sun exposure and melanoma in the rest of the 95% is more complex. I’m not saying that it doesn’t cause melanoma but that it’s not as simple as just blocking out UVB.

FUDGE: Now melanoma is the skin cancer we really need to worry about because that’s the one that’ll kill you.

DR. DANIELS: Right.

FUDGE: But the other skin cancers, non-melanoma skin cancers, I’ve spoken with you about this before. You don’t consider them terribly dangerous.

DR. DANIELS: Well, they’re very common, and left unattended and neglected, they can spread. That’s pretty unusual. And as an oncologist, we worry about things spreading and killing people. So it’s unusual to spread and kill somebody with a non-melanoma skin cancer. It can happen if you totally neglect it. Whereas melanoma, if you have something as thin as .5 millimeters, can come back 10 years later and kill you.

FUDGE: And the non-melanoma skin cancers, I’m sorry, did you say, Greg, that they are caused by skin exposure? They are pretty common on the areas of the face, the neck.

DR. DANIELS: Exactly. So you can see a clear dose response. The more UV light exposure you have, the more non-melanoma skin cancers, and that’s – that exposure pattern’s lacking for melanoma.

FUDGE: And with that, we do have to take a break. And my guests are Edward Ross, Greg Daniels. We’re talking about exposure to the sun and how much sun is too much sun. If you want to give us a call, we’ll be back in a minute. The number is 6-1 – I’m sorry, is 888-895-KPBS.

FUDGE: Coming up in the next hour of These Days, we’ll talk about the cost of building affordable housing. San Diego’s Housing Trust Fund was created as a way to help pay that cost 20 years ago. Also, we’ll talk about the problem of early Alzheimer’s disease. Right now, we’re talking about the problem of too much or too little sun exposure. My guest by phone is Edward Ross. Dr. Ross is a dermatologist and laser specialist with Scripps Clinic. Joining me in studio is Greg Daniels, an assistant professor at UCSD. He’s in the Clinical Medicine Tumor Growth, Invasion & Metastasis Program at UCSD Medical Center. Give us a call at 888-895-KPBS if you want to talk about sun exposure. Before we get to our callers, let me go to you, Edward Ross. I don’t know if cancer is your specialty but what would you like to say in response to what you heard from Greg Daniels and what kind of advice, vis-a-vis cancer risk, do you give to your patients?

DR. ROSS: Well, I agree with basically what Dr. Daniels said and there is not a clear correlation, for example, between melanoma and sun exposure but there is between particularly squamous cell carcinoma and latitude. For example, the further you go north and south from the equator, the lower the skin cancer risk is. But my take home message is that really seeing most of the sun damage that we see here as far as cosmetic concerns and skin cancer, that the less sun you get, the better. And it’s mainly because we do live here in San Diego. We don’t need extra sun. I mean, the idea of, for example, of going to a tanning bed here in San Diego just seems crazy. There is so much sun just walking back and forth from your car to wherever you work that that’s sufficient for everybody here, I think.

FUDGE: Do you agree with that, Greg Daniels?

DR. DANIELS: Well, again, it’s – I wish we knew the answer to this. The caller mentioned that there’s nothing wrong with being very white. You know, we’re doing this great experiment in society where a country like Australia, we took a bunch of northern European white people and moved them down to Australia and exposed them to this new environment and…

FUDGE: Now most of them did move down there voluntarily.

DR. DANIELS: Some did, yes.

FUDGE: I want to point that out, just in case people get the wrong impression.

DR. DANIELS: Right. No, this isn’t a clinical experiment.

FUDGE: I mean, some prisoners went down there…

DR. ROSS: Actually…

FUDGE: …but most people went there voluntarily.

DR. DANIELS: Yeah, and, you know, Australia has the highest rates of skin cancer and melanomas out there. And so the pigmentation in our skin does afford us some protection. Again, there’s nothing wrong with being white but when we expose ourselves to environments that we’re not necessarily adapted to, depending on your beliefs, either from God or from Dawin, and we’re out there in the sun, we don’t quite understand what we’re doing to ourselves sometimes. And here we try to fix it by blocking UVB and I don’t think that it’s fixing it. It clearly hasn’t fixed it in Australia where they’ve been trying this for 30 years with a very strong national campaign of sunscreen and the incidence of melanoma continues to go up almost unabated. So, I’m not saying that there’s anything wrong with being white because I’m a middle-aged white guy, but I have some concerns about our lack of pigmentation.

FUDGE: Is it a fact, Greg, that the risk of melanoma has gone up as society has changed to a society where more people are working indoors?

DR. DANIELS: Right, so melanoma 100 years ago was really a 1-in-5000 kind of lifetime experience. And now in the U.S. for somebody like myself, it’s a 1-in-40 lifetime experience. So something dramatic has changed and is it an ozone hole? Or other – like maybe it’s tanning beds or things like that. I don’t think so. I think what’s happened is that we’ve taken ourselves out of our chronic exposure kind of nature and we see – We know this for melanoma, that a low level of chronic exposure—and we can measure this with collagen cross-linking in the skin and stuff—actually leads to both a lower incidence of melanoma and lower mortality from melanoma. So, again, if we’re just talking about melanoma, the sun and chronic low level exposure seem to have some protection. So we keep focusing on let’s lather on the sunscreen, let’s stay out of the sun for melanoma, and it just – I’m not sure that’s correct.

FUDGE: And…

DR. DANIELS: But we’re trying it as an experiment.

FUDGE: Let’s go to Christine, who’s in her car, I think still in her car. Go ahead.

CHRISTINE (Caller): Me?

FUDGE: Hi, Christine. Are you there?

CHRISTINE: Yeah, can you hear me?

FUDGE: We can.

CHRISTINE: Great. Yeah, so I had melanoma. You know, I went in to get my usual check and they wouldn’t even let me leave the office. I got 24 stitches, and that was a, you know, the first. I’d had some basal cells, that was the first melanoma. Now I’m confused about if I can go to the beach this summer.

DR. DANIELS: Right.

DR. ROSS: Well…

DR. DANIELS: Yeah, and I’ll just try first. And, you know, my patients commonly come in with this. They’re fearful, they have sunglasses on, they have hats on, and these are typically – they drive themselves to the vitamin D deficient kind of state even here in San Diego because of this fear. And certainly I agree with the general party line, don’t go out and get burned. Don’t spend long times in the sun just baking yourself. You’ve already shown that your skin is susceptible to both non-melanomas and melanoma skin cancers. However, it needs to be tempered with you need some moderate sun exposure for your general health and other things that come with this type of vitamin D exposure.

FUDGE: And Edward Ross.

DR. ROSS: Well, I would say clothing is definitely the best sunscreen, as Dr. Daniels said. So clothing would be number one. The one concern with using sunscreen and wearing a lot of protective clothing is if you do stop and make a mistake, in other words you’ve sort of lost your immunity from the sun. If you go out every day, it’s true, one of the ways nature protects you is you become darker each day you’re in the sun and that’s the way we were protected each spring. But if you do wear sunblock and you stop, then you’re not as protected as you would otherwise be. So the one concern I have is somebody who would go to the beach who wouldn’t protect themself even more than usual if they had been using sunblock because when you’re younger, you tend to tan and you go out, as you’re older you’re out in the sun less and you’re more likely to get burned simply because you’re more likely to get a lot of sun without good protection. So the one thing you have to do is you have to use it regularly. But if you use it regularly, sunblock and good protective clothing, you’re going to be better off in the long haul than the person who is out there in the sun daily getting more sun than they need because you are going to come in with damaged skin both from a skin cancer perspective and from a cosmetic perspective.

FUDGE: Let’s go to Julianne in Oceanside. Julianne, you’re on the show.

JULIANNE (Caller, Oceanside): Hi. I actually – Well, you kind of answered the question but I have a friend who’s a dermatologist. She says do not leave the house without wearing SPF 60 so – and – but I’ve also heard like from Kevin Trudeau and these alternative medicines, do not wear any sunscreen, it’s awful for you. So I tend to just wear the clothing but now I’m worried about vitamin deficiency and people say that there’s not a great vitamin D supplement you can easily buy at the store. So I don’t know what the best option is, and I’ll take my answer off the air. Thank you.

DR. ROSS: Well, I think there are good vitamin D supplements, number one. But, number two is that I do think using sunblock is helpful. There are – there have been recent reports. This Environmental Working Group came out with some reports and they kind of gave sunscreens ratings and there were hazards associated with some of these so-called organic sunscreens that they have cited but overall you’re better off with sunscreen than not wearing sunscreen. So I think the – There certainly is no compelling evidence, at least outside of very small rodent studies, that there are any harmful effects from any of the commercial available sunscreens. So I wouldn’t be concerned about that.

FUDGE: That Environmental Working Group paper, they talked about photocarcinogenic properties of vitamin A, which is in sunscreen. Is that – I don’t know…

DR. ROSS: That was retinyl palmitate. Well, there is, you know, vitamin A is one of these sort of ‘no better friend, no worst enemy’ types of things, that if you use vitamin A properly and isotretinoin is sort of a synthetic form of that, we use that for skin cancer prevention, particularly in patients with multiple squamous cell carcinomas and transplant patients. So, certainly, vitamin A has been used on the other side. When used topically in small animals, and I’ve done some research in the lab with small animals and skin cancer, certainly you can induce skin cancer easily in these animals, and maybe more easily with the application of this type of retinyl palmitate but it’s with very large exposures and animals with very large surface dividing ratios. And it really is not, I think, something you can extrapolate to humans wearing sunscreen on a daily basis.

FUDGE: Anything from you, Greg?

DR. DANIELS: Yeah, we’re not sure. It is always hard to extrapolate from animals studies but we have a human study where in lung cancer patients we gave them higher doses of vitamin A compared to not supplementing patients, and they died quicker. So there are issues we don’t quite understand. The notion that, again, is pretty common but I just want to put out as cautious that sunblock is okay for you. We don’t know what’s causing melanoma in there, and if it’s the UVA light that’s getting through and we, as a society, are lowering our melanin and pigment down, we’re not blocking UVA with most of the sunscreens out there.

FUDGE: Well, when you talked about this animal study, though, you say we gave them vitamin A. Was it topically on the skin or was it a way…

DR. DANIELS: No, it was a non-animal study. It was actually a clinical study in patients with lung cancer.

FUDGE: Oh. Oh, patients with lung cancer.

DR. DANIELS: And those patients – Yeah, those patients died quicker.

DR. ROSS: But there was an animal study where they did apply it topically and that was, I think, what the caller was maybe referring to…

DR. DANIELS: Umm-hmm. Right.

DR. ROSS: …is that you can induce skin cancer more easily in some patients with sun plus topical vitamin A.

FUDGE: Well, let’s go to Samantha in San Diego. Samantha, you’re on the show.

SAMANTHA (Caller, San Diego): Thanks so much. This is a fascinating conversation. I have a question about the application of all this to small children. I have three small girls and the advice that I’ve been given in the last few years from pediatricians is that you want to keep the babies out of the sun. If they’re under six months, no sunscreen, over six months, you know, use safe sunscreen. And then the most concerning thing to me is that if they’re breast fed, the pediatricians are now recommending that we give vitamin D supplements. And I just have a hard time believing that this is a proper balance, you know, of risks and benefits. We’re having supplementation of, you know, this vitamin and using sunscreen whether it be safer or not and keeping babies completely out of the sun and at the same time, you know, it – Is that actually better? Is that a better balance than just taking a baby in the sun every now and then? Or, you know, getting them some early morning sunlight? And so I just was hoping to get your comment on that, and I’ll go ahead and take them off the air.

FUDGE: All right, well, it gets complicated. Greg, do you want to…

DR. DANIELS: Yeah…

FUDGE: …answer that?

DR. DANIELS: …complicated and very heated. I have five children, by the way, and my wife and I debate this all the time. Currently, I’m winning so that they go outside without sunscreen but they don’t get burned. They wear hats. That’s our compromise. But I agree, we’re managing a lot of stuff that we used to not really manage and are we doing a good job by it? I heard somebody this morning saying we shouldn’t send our kids to camp this summer because of the risk of swine flu. And it’s like, no, these kids are at risk if they stay home with my wife all summer long without going to camp. That’s the real risk.

FUDGE: So…

DR. DANIELS: So what are we doing? I’m not sure.

FUDGE: Edward Ross.

DR. ROSS: Well, I mean, I think we’re managing but on the other hand you could argue I’m managing these patients coming in as early as 32 or 28 or even 36 with severe sun damage, not just in the form of skin cancer but broken blood vessels, multiple brown spots almost like leopards. So, yes, you certainly could go back and everybody always comes in and tells me the story, well, we didn’t have sunscreens when I was growing up, and we didn’t have sunscreens back then, and I think that is one of the things we’re going to see. I think we’re going to see a generation, I hope, if people are more careful in the sun, not getting zero sun but just small amounts of sun, where patients will come in 30 years from now and just be less damaged than they are today. And I think if we don’t change that behavior, we’re going to see the same types of sun damage and skin cancer rates even worse than not wearing sunscreen. So…

FUDGE: Yeah, you know, I wanted to say, and we’re almost out of time, but I sense – I don’t know if I sense a disagreement between the two of you but, Greg, you seem to be a little bit more pro-sun and, Edward, you seem to be a little bit more anti-sun in terms of, you know, what advice you would give to patients. Edward, would you agree with that?

DR. ROSS: Yeah, I’d sort of agree with that, I guess because every patient I see, the first thing I see is their skin and most of the patients I’m seeing, their concern is that they’re damaged and that’s why they’re coming for fixing the skin. They’re kind of coming for a car repair, and I guess if you saw the car be damaged over speed bumps every day, you would say get rid of the speed bump, and I look at the sun as sort of the speed bump wrecking the shocks every day. And so I think you really need sunblock to protect that as part of the whole program. The other program is minimize your daytime activities and protective clothing. I do agree, protective clothing is the best weapon, and just altering your behavior.

FUDGE: And Greg Daniels.

DR. DANIELS: I am pretty pro-sun. I’m not ‘go out and lay by the pool burn’ kind of pro-sun. But when I see my patients, I worry that we’ve gotten into this intermittent pattern of exposure based on how we’re all moving indoors with fluorescent lights and things like that and I just see the incidence of melanoma continuing to increase, vitamin D deficiency paradoxically increasing, too, which is a risk factor for melanoma. Something’s not making sense and we keep trying to battle it by staying out of the sun more and more and I’m just not sure that’s correct.

FUDGE: Well, I’m afraid we’re out of time. My apologies to those callers who called in and we weren’t able to get to them. If you go to KPBS.org/thesedays you can comment on this segment if you would like. So thanks very much for calling. Thanks very much to our two guests. Edward Ross is a dermatologist and laser specialist with Scripps Clinic. And, Edward, thank you very much.

DR. ROSS: Oh, thank you. Thanks for having me on.

FUDGE: Greg Daniels is an assistant professor of Medicine at UCSD. He’s in the Clinical Medicine Tumor Growth, Invasion & Metastasis Program at UCSD Medical Center. Greg, thank you.

DR. DANIELS: Thank you very much, Tom.

FUDGE: And if you’d like to hear this segment again or hear any other segment, These Days segment that has aired, or make a comment about something you’ve heard on the show, go to KPBS.org/thesedays. I’m Tom Fudge. Stay with us as These Days continues.

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