I consider sailors at high risk for skin cancer and early skin aging due to extended exposure to sunlight and other elements such as wind and water.

Excessive and long-term exposure to ultraviolet light from the sun is the main cause of skin cancer. Over 90% of basal cell carcinomas and squamous cell carcinomas and the majority of melanomas are attributed to sun exposure. While the former two “keratinocyte cancers” (they are malignancies of skin cells in the upper layer of the skin called keratinocytes) are associated with long-term accumulated sun damage as well as sunburns and mainly develop on sun-exposed areas, not all melanomas are sun-induced and can appear anywhere in the body.

Because UV light is the most preventable risk factor for skin cancer, it is logical that protection from excessive sun exposure, sunburns, and avoidance of long-term accumulated sun exposure is the easiest way to reduce the risk of skin cancer. We have shown in another high-risk population, people who live with organ transplants, that consistent sun protection reduces the risk of new skin cancers even when started after skin cancers developed. For this reason, it is “never too late” to put on a hat, sun protective clothing and use sunscreen and start “sun-safe behavior”. The skin similarly to the lung and liver is capable of incredible repair once the harmful injury is eliminated.

But just as it is “never too late”, it is “never too early” to start sun protection. Experiencing five or more blistering sunburns between ages 15 and 20 increases one’s melanoma risk by 80% and nonmelanoma skin cancer risk by 68%. Women younger than 30 are six times more likely to develop melanoma if they tan indoors.

Unfortunately, sun damage does not show up for a very long time, it’s like filling up a glass of water drop by drop and the effects are not seen until the water is overflowing. Once the glass is full, skin cancer develops. And if we are smart, we don’t just keep wiping the water off but also close the tap and use sun protection.

So, when you wonder how full your glass is and when to see a dermatologist, here is my advice

If you are a sailor, consider yourself automatically at high risk for premature skin aging (wrinkles, sunspots, thickened lathery, and saggy skin) and skin cancer, so you should know your risk factors and the signs as well as symptoms for skin cancers.

**Risk factors for all types of skin cance**r include:
-             skin that burns easily, freckles and doesn’t tan
-             blonde or red hair
-             blue and hazel eyes
-             a history of excessive sun exposure
-             history of sunburns especially at a young age
-             tanning bed use
-             a weakened immune system
-             prior history of skin cancer
-             family history of skin cancer (due to similar genetics and also similar sun-seeking behavior within the family)

I would like to emphasize that although light-skinned individuals are at higher risk skin for skin cancer, dark-skinned people are not immune from skin cancer, especially from melanoma. Those of you who burn somewhat but still tan can be falsely secured and spend more time in the sun after developing a tan, increasing the risk for skin cancer.

Risk factors for melanoma in addition to the above:

- people with more than 50 moles, atypical moles or large moles

- people with a history of pancreatic cancer

- strong family history (two or more first-degree relatives affected)

- Parkinson disease

Signs and symptoms for

precancerous and cancerous skin lesions:

Melanomas are usually dark brown, black colored lesions (but don’t forget melanoma can be also pink in very light-colored people) that are characterized by the ABCDEs.

A= Asymmetry (color, border)

B= Border irregular

C= Color black and variable including pink, brown, and black

D= Diameter larger than a pencil eraser (about 6 mm) but a lot of moles that we are born with can be that size, so nowadays we use D =different (“ugly duckling”)

E= Evolving and changing.

Lately, EFG has been added.

E= Elevated

F= Firm

G= Growth to distinguish melanomas from moles.

I’d like to emphasize that most melanomas (nearly 70%) develop newly on normal skin and not from a previous mole, so if you see an irregular new more in adult age, it should be checked out.

What is the “Ugly Duckling Sign”?

Moles should look similar to each other on the individual body and if there is a mole that stands out and different from that of the other moles, it is the ugly duckling, the odd-mole-out or lone ranger. If you find an ugly duckling or a mole with any of the ABCDE+EFG, you should seek an exam by a dermatologist immediately.

There is a special kind of melanoma that develops on the face and is very much associated with sun exposure called lentigo maligna. It usually starts with a brown sunspot (lentigo), that with time becomes more irregularly colored, bordered, and grows in diameter.