Always Use Suncream

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  • Published August 28, 2009
  • Updated August 28, 2009 at 3:23 pm

Triathletes are forced to spend several hours in the sun. Photo: John Segesta

We all know the dangers of spending too much time in the sun without protection. In this article, Dr. Jeffrey Sankoff, MD explains why it is especially important for triathletes to be aware of the old sol.

Written by: Jeffrey Sankoff, MD

When you’re a child, the leading authorities on all things related to your health are your parents. That is because they always have the right answers to keep you healthy and out of danger. Or at least I used to think so.

My mom—whom I will heretofore refer to as the Greatest Mom in the World, or GMW for short—actually dispensed all sorts of since-disproven axioms. Remember how reading in low light is bad because it will make you blind? Hogwash! Wait two hours after eating before swimming? Wrong again! Don’t run with scissors? OK, she did get that one right. However, GMW also unknowingly put me in harm’s way when she told me to turn off the TV, get off the couch and go outside for some sun and fresh air. Never mind that the air is dangerous enough in many places, but the sun, old Sol himself, has proven to be far more treacherous than GMW ever would have thought.

The harmful effects of the sun have become manifest as an ever-growing number of cancers of the skin. In fact, these have become the most common forms of cancer in the United States. Nearly all cases are one of the following three types, and all are caused by sun exposure:

Basal cell carcinoma (BCC): In the United States, BCC is the most common of the skin cancers. BCC arises from the cells that are at the deepest part of the skin. BCC is almost always found in sun-exposed areas, with the face, scalp and hands being the most common locations, and early detection is the norm. BCC is a very slow-growing cancer and almost never metastasizes. Treatment consists of surgical excision and is uniformly curative.

Squamous cell carcinoma (SCC): Constituting approximately 16 percent of skin cancers, SCC is found on the uppermost layer of the skin. Like BCC, SCC is most commonly found in sun-exposed areas. Unlike BCC, SCC can metastasize, and of the almost 200,000 people diagnosed in the U.S. each year, nearly 10 percent die from the disease.

Melanoma: Melanoma arises from melanocytes, which are cells that secrete the melanin that gives color to the skin. Darker-skinned people have more melanocytes and thus more melanin. Melanoma accounts for only 4 percent of skin cancers but for more than 80 percent of skin cancer deaths. Melanoma almost always begins in moles, which are areas of concentrated melanocytes. When detected early, melanoma has a 95 percent cure rate. However, once this form of cancer metastasizes, it is nearly impossible to treat.

The best measure of protection from skin cancer is to avoid unprotected sun exposure. This is particularly true in the summer months, at altitude, in areas closer to the equator and during midday, when the sun is strongest. If you must do your training at those times or in those locations, wear full-length clothing and sunscreen. I recommend a sunscreen with a protection factor (SPF) of 30 or more, and waterproof sunscreens are best during exercise.

Once skin cancer of any form develops, early detection and therapy are critical to ensure a cure. You should bring any new or suspicious lesion on the skin to the attention of your physician as soon as possible. Because melanoma often arises insidiously within pre-existing moles, it is important to check moles regularly. A mole that changes in size, shape or color, bleeds or itches is a potential melanoma. In addition, remember the ABCD rule: As opposed to moles, melanomas usually have asymmetrical shapes, irregular borders, uneven color and a diameter larger than that of a pencil eraser (about 5mm).

So, while GMW had the right idea, she may have wanted to insert some additional motherly advice about applying a thick coat of sunscreen in between getting off the couch and heading outside.

Jeffrey Sankoff, MD, is a two-time Ironman triathlete and ER physician at the University of Colorado Health Sciences Center in Denver, Colo. For more information, visit his website at

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