Skin cancer awareness month Episode 1: Sailors’ Skin

As early as 1894, Paul Gerson Unna, the famous German dermatologist, described prolonged exposure to sunlight a dermatosis (skin disease) of the exposed skin of sailors which he called “Seemanshaut” or “Sailor’s Skin” (1). A few years later, Hyde, in 1906, and Dubreuilh, in 1907, published the first extensive evidence in support of the theory that sunlight might be the cause of skin cancer. Dubreuilh observed that women workers in Bordeaux vineyards developed cancers on unprotected parts of their faces, while men had more skin cancer on the back on their necks (2). Harken Derm exists to help in protecting sailors skin.

In 1959, the pioneer cancer epidemiologist Eleanor MacDonald built a registry comparing people with skin cancer in the El Paso, Texas area to those in Hartford Connecticut. She describes that people, mainly farmers in Texas were referred to have “Farmer’s skin”, while the sea-fearing people in the Northeast referred to skin cancer as “Sailor’s Cancer” (3).

The August 11th, 1951 edition of the prestigious British Medical Journal published a “Refresher Course for General Practitioners” on “Cancer of the Skin”. As an example, it showed a picture of the farmer who was riddled with sun damage and pre-cancers but despite him being a farmer, the caption called it “Sailor’s Skin”4. Luckily, in the modern-day, we know far more about protecting sailors skin.


So, no wonder that when I met my husband who has spent his life in the sailing world, my dermatologist colleagues only had one question about him; Does he have “Sailor’s Skin”?

We all know by now that extensive sun exposure can cause skin cancer and in 2009 the WHO declared UV light both from the sun and from artificial lamps in tanning booths a complete carcinogen meaning that it can initiate and also promote cancer.

Dermatologists distinguish between intermittent high-dose UV radiation that most likely result in a sunburn and long-term, cumulative low-dose UV radiation that may condition the skin by a tan if achievable to more subsequent sun exposure. We believe that high dose, burning exposure is more responsible for melanoma formation while low and slow sunshine will cause basal and squamous cell carcinomas and early skin aging. Of course, nothing is so black and white in biology but a study examining nurses showed that early age blistering sunburns (more than 5 in between 15-20) increased their risk of melanoma by 80% (5).

What about sailors? Interestingly, despite extensive search, I was not able to find very good studies with exact statistics about protecting “Sailor’s Skin”. However, through my clinical experience with my sailor patients and my travels to regattas and encounters with sailors, I can testify that sailors, especially men with light skin definitely carry a lot of sun damage and have a higher skin cancer burden.

I believe the reasons are multifactorial. First of all, it is difficult for a sailor to “seek shade” or only sail during low-UV index hours of the day. Competitive and professional sailors cannot wear a wide brimmed hat most of the time. So, your face, ears and neck are definitely exposed to the sun. Most sailors start as a child or teenager, so they are more likely to have early even burning sun exposure and of course, if they continue sailing throughout their lives, the UV radiation all adds together. I often say it’s like filling a glass drop by drop with water. It takes a while and everything seems to be fine, but once it’s full, every drop will make it overflow. Once you exceed your sun allowance, you will start to develop skin cancers and each additional sun exposure will accelerate and cause more skin cancer. That is why you turn off the faucet and protect yourself extremely well from the sun once you have your first skin cancer instead of just mopping the floor and cutting the cancers out.

Lastly, UV rays are locally immunosuppressive to your skin. What does that mean? It means that they drive out those cells from your skin that would normally fight skin cancer. So, if you have a few cancerous cells that your skin immune cells may be able to suppress and control, if your skin is exposed to the sun, those cancer cells may escape your immune system and multiply, grow and even spread easier. For these reasons, protecting sailor’s skin requires both an understanding of the situation on the sea and the science of cancer.

I’d like to leave you with what I say to my friends, family and patients. It is never too early and never too late to use sun protection. Especially if you are high risk. Know your risk and know the signs of skin cancer. Protecting sailor’s skin means protecting you from the wind, sun and sea – the triple threat. Our Harken Derm formula is built to do just that. Shop the whole range here.

Bibliography:

  1. Unna, P. G.: Die Histopathologie der Hautkrankheiten, Berlin, A. Hirschwald, 1894.
  2. Arch Dermatol. 1960;82(6):865-869.
  3. J Invest Dermatol 1959 Feb;32(2, Part 2):379-82
  4. Br Med J. 1951 Aug 11;2(4727):348-51.
  5. Cancer Epidemiol Biomarkers Prev. 2014 Jun; 23(6): 1080–1089

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