What's That Bump?
Human skin is a petri dish for lumps, spots, and bumps—a small city in itself with new denizens appearing with every birthday. While most nevi (moles) form within the first two decades of life, later years can give rise to red dots on the chest, skin tags on the neck or armpits, and keratosis, a thickening of the skin commonly found in the upper body. With such dermal biodiversity, it might be difficult to know which growths are harmless and which are not. "If you're over 40 or you have a lot of moles, it's not a bad idea to have a baseline skin check," says Uyttendaele, whose practice has recently put up new roadside billboards with an image of a leopard and the slogan "Have Your Spots Checked." While Uyttendaele cautions against self-diagnosis ("I can't train people to be dermatologists," he says), he does offer a few tips for those casual, after-the-shower self-exams that can sometimes prompt a call to the doctor's office.
"Any new growth, or a spot that bleeds spontaneously upon minimal pressure, a spot that is painful, or one that doesn't want to heal—those are some of the signs of basal cell cancers," says Uyttendaele. When looking for melanoma, he advises applying the educational acronym "ABCDE" to the brown spots we already have. "A" stands for asymmetrical ("If you have a mole that's the shape of Italy, and that's no good," says Uyttendaele). "B" is for borders, which are clear and sharp in healthy nevi, but might be jagged, fuzzy, or irregular in suspect moles. "C" is color, which you want to be uniform, not multi-hued. "D" is for diameter, which should be no larger than a pencil eraser, and "E" is evolving, as a change in shape and color can signal melanoma. While most melanoma in women form on the legs, the majority in men develop on the back, where they can evade discovery. "That may be why the prognosis for melanoma tends to be worse in men, because they're detected later," says Uyttendaele.
Sunny Good News
With the ravages of UV exposure laid out in vivid, medical-journal detail, it's no surprise that we're seeing more heliophobia (fear of the sun) in our culture—along with helicopter moms and dads who can't let their children walk two feet without slathering them in a whitewash of sunscreen. But there is danger, too, in avoiding the sun completely, and even dermatologists endorse some sun exposure to promote general health. It's common practice among psychiatrists to recommend that depressed individuals spend 30 minutes a day outdoors in the sunshine—and a protective coating of sunscreen won't offset the feel-good effects. Another boon to health is better sleep, since natural sunlight helps shut off the body's production of melatonin, the sleepy hormone. Going outside for 15 minutes at the same time each day, sans sunglasses (so sunlight reaches the pineal gland that produces melatonin), can help the sleep-challenged establish a normal circadian rhythm.
Perhaps most important, sunlight is crucial for the body's synthesis of vitamin D, which is vital not only for bone health but also as a protector against cancer, heart disease, stroke, depression, and an array of autoimmune diseases. Some studies show that as many as three out of four Americans are vitamin D deficient; for these individuals, a vitamin D supplement is recommended. For those who do not take a supplement, skin must be unprotected by sunscreen to do its important work of vitamin D production, which relies on the same UV rays that in excess cause damage. "Sunlight in moderation is not going to be harmful," says Uyttendaele. "People who go overboard with sun protection may do themselves a disservice." Still, his sunlight prescription is a modest one. For Caucasians, Uyttendaele recommends 10 minutes of unprotected sun exposure three times a week to the arms and legs only; for darker-skinned individuals, more time in the sun is necessary for adequate vitamin D. Most doctors agree that the face should be protected in all weather conditions with a broad spectrum SPF 30 to safeguard against wrinkles, sunspots, and other effects of photoaging.
Smarter Sunscreen
Not all sunscreens are created equal—and in fact many have come under fire from environmental and health groups for containing potentially harmful ingredients. Every year, the Environmental Working Group (EWG.com) releases its online list of safe sunscreens and its "hall of shame" of unsafe brands, which in the past has included trusted companies like Coppertone and Banana Boat. EWG's panel of scientists has named two chemical ingredients of particular concern—oxybenzone, which has been shown to have endocrine-disrupting properties, especially in children, and retinol palmitate (or vitamin A), which when exposed to UV light can actually hasten the growth of skin lesions and tumors. "Consumers need to know that ingredients in personal care products are very minimally regulated," says Leann Brown, a spokesperson for EWG. "The FDA does not require sunscreen companies to prove that their products are safe or even effective before coming to market."
