ODE TO A MISSPENT YOUTH
(A poem written by a customer who has undergone numerous surgeries for skin cancer)

As I sit here slowly swelling,

Sadly now my story telling.

Latitude 42, some years ago,

Winters were grey and full of snow.

Not much sun shine, your skin got pale,

Not healthy looking, rather, frail.

Comes the spring, with it the sun,

To the beach we go, to have some fun.

To quickly tan, just add some oil,

For a “healthy” look, just lay and broil.

Some days to much, got brightly red,

First punishment that night in bed.

But now with 40 years of waiting,

Skin Cancer makes the sun worth hating.

So I tell the youth, sunscreen be wearing,

Or my fate you will be daring.

Sunburn today will fade tomorrow,

But years from now will follow sorrow.

They laugh and tell me “go away”,

A deep dark tan we’ll get today.

I shake my head and leave the shore,

A tan for me…………now NEVERMORE!
(With apologies to Edgar Allen Poe)


CANCER CAN BE COSTLY $$$$

• A letter from Warren Meanwell-
  
  My apologies for the lack of communication over the past months. Despite good intentions, some things just get in the way! For me, that's been getting control over my cancer. A battle in progress.
  
  As some of you may already know, rather ironically, I have been battling with Melanoma over the past 3 years. Its the horrid cancer that I've worked for so many years to bring to peoples attention, and developed products to help them avoid it. Its not just a bit of sunburn that disappears without a trace. Every time I got burnt as a youngster, I was doing irreparable damage and increasing my chances of developing melanoma.
  
  Early detection is paramount:
  Melanoma, if detected early, can be easily managed. I was not so lucky. Even though I diagnosed myself, (a mole on my right ankle only about 3-4mm diameter) it was a few weeks before I'd made it to a doctor. By then, the melanoma was 1.5mm deep. It changed color and hardened over the course of 2 to 3 weeks. That's deep enough to project through the epidermis. From there the malignant tumor was able to metasticise and cells penetrated the lymph system and lodged in lymph nodes in the groin. This condition is known as metastatic melanoma. The real danger here is that it can travel to vital organs like the liver, lungs or brain and in many cases can be fatal. Over 1200 Australians died from melanoma last year.
  
  I have Stage 3 cancer, with recurrent tumors developing in lymph nodes in the right side of my groin and lower abdomen. I've had surgery 5 times in the past 3 years, but leave one cell, and it all starts again. That's why I've got new tumors in me even weeks after my last surgery. So the lesson I've learned here is that surgery alone is not the answer, and it could possibly all have been avoided with closer monitoring and swifter action.
  
  Available treatments:
  It was recommended that I have radiation treatment following my last operation as a safeguard to stop the melanoma recurring. Despite limited evidence that this would be of any benefit at all, a radiation oncologist assured me that he could blast the complete area with minimal damage to the bowel, which I'd most likely require a bit of surgery on in the future to rectify! Are you serious? Yes, he was.
  
  Also importantly, once radiation has been used, you can no longer have surgery in that area.
  
  So after relentless searching and reading of forums online, I've found myself talking to a German physician near Frankfurt, with his own "klinik". I have just spent the past month there undergoing holistic complimentary and alternative medicine therapies (CAM). I spent 4 weeks there in my first visit, in which time I underwent 2 whole body hyperthermia treatments. This is where the body core temperature is raised to 41-42 degrees celcius over a 6 hour period and sometimes combined with low dose chemo which is extremely effective on metastasis.
  
  My Message to you:
  There are of course many more alternatives, some of which I'm doing, but I'll tell you more about those in future updates. The best advice I can give is check yourself regularly, don't procrastinate! If you suspect anything at all, get to a doctor or skin specialist - pronto! Book in for skin check-ups at least once a year.
  
  And above all else, make sure you protect what you've got. Your skin and your health is your biggest investment. Wear the right gear if you spend time under the sun, and enjoy. If you think the cost of a good sunprotection shirt is too much, try the cost of 5 operations, months off work and trips to Germany for treatment!!!
  
  Warren Meanwell
  Director
  SunProtection Australia
  
  
  
  1. What is Merkel cell carcinoma?
  
  Merkel cell carcinoma (MCC) is a rare, aggressive type of skin cancer that forms on or just under the skin. It is also called primary small cell carcinoma of the skin, trabecular carcinoma, APUDoma, neuroendocrine carcinoma, endocrine carcinoma, or primary undifferentiated tumor of the skin (1). MCC is believed to start in neuroendocrine cells called Merkel cells. These cells release hormones into the blood when stimulated by the nervous system. They migrate from part of the nervous system called the neural crest to the skin (2). Merkel cells are believed to play a role in making the skin sensitive to touch (3).
  2. How often does Merkel cell carcinoma occur?
  
  Approximately 1,200 new cases of MCC are diagnosed in the United States each year (4), compared with almost 60,000 new cases of melanoma and more than 1 million new cases of nonmelanoma skin cancer. The incidence of MCC has been rising, with a 3-fold increase between 1986 and 2001 (4). Most patients diagnosed with MCC are over age 50 at diagnosis (the average age is 69), with only 5 percent of cases diagnosed in those under age 50 (5). MCC is more common in white people than in other racial/ethnic groups. Some cases have been reported in Japanese people, but very few have been seen in black people (6).
  3. What are the possible causes of Merkel cell carcinoma?
  
  The exact cause of MCC is unknown, but it appears to be linked to sun exposure and immunosuppression (suppression of the body's immune system and its ability to fight infections or disease) (2). Sun exposure as a risk factor for MCC is supported by data that show a rise in incidence corresponding with the solar UVB index (scale indicating the intensity of solar ultraviolet-B (UVB) radiation at noon for a particular location) (6). MCC has been linked to conditions such as HIV infection, chronic lymphocytic leukemia, Hodgkin lymphoma (cancer of the lymph system), ectodermal dysplasia (a disease involving abnormal tissue development), and Cowden disease (a disease in which masses of abnormal but benign tissues grow in multiple sites in the body). Other possible causes include exposure to arsenic and treatment for psoriasis that uses psoralens (a medication that causes the skin to become sensitive to light) and ultraviolet-A light (PUVA) (2).
  4. What are the symptoms of Merkel cell carcinoma?
  
  The most common symptom of any skin cancer, including MCC, is a change in the skin, especially a change in an existing mole or a new growth. MCC appears as a firm, painless lump within the skin that may resemble a cyst but is fixed; i.e., cannot be moved. The lump is usually less than 2 cm (about ¾ inch) in size and can be red, pink, or blue-violet. MCC is different from other skin cancers in that it grows rapidly over a few weeks or months (5).
  5. Where does Merkel cell carcinoma develop?
  
  MCC is usually found on sun-exposed areas of the body. Fifty percent of cases occur on the head and neck, especially around the eye and on the eyelid (1). Forty percent of cases occur on the arms and legs (2). MCC has also been found on the trunk and other areas of the skin that are not usually exposed to the sun (1).
  6. How is Merkel cell carcinoma diagnosed and staged?
  
  The doctor may use the following procedures and tests to diagnose MCC. Some of these tests are also used to help determine the stage of the disease. Stage is a description of the extent of cancer.
  * A biopsy is the removal of cells or tissue from a tumor for examination by a pathologist. The pathologist may study tissue samples under a microscope or perform other tests on the cells or tissue. Biopsies are used for both diagnosis and staging. The surgeon may also remove lymph nodes (small, round organs that trap cancer cells, bacteria, or other harmful substances) to help determine the stage of the disease.
  
  * Sentinel lymph node (SLN) biopsy is a procedure in which the sentinel lymph node is removed and examined under a microscope to determine whether cancer cells are present. The sentinel lymph node is the first lymph node to which cancer is likely to spread from the primary tumor. SLN biopsy is used to help determine the stage of the disease. SLN biopsy may cause fewer side effects than standard lymph node removal because fewer lymph nodes are taken out.
  
  * Immunohistochemistry (staining of cells with agents that react with antibodies on the surface of cancer cells) is a laboratory technique used to tell the difference between MCC and other types of cancer (2).
  
  * Computed tomography (CT), a procedure that uses special x-ray equipment to obtain cross-sectional pictures of the body, can distinguish MCC from small cell lung cancer and show whether the disease has metastasized (spread) to other parts of the body (5).
  
  * In an octreotide scan (sometimes called Somatostatin Receptor Scintigraphy or SRS), the doctor injects a small amount of a radioactive drug into a vein. The drug travels through the bloodstream and attaches to tumor cells. A machine called a scanner detects the radioactive material and creates scans (pictures) showing where the tumor cells are located in the body. For MCC, this test can be used for both diagnosis and staging (5).
  
  * A PET scan uses radioactive sugar, which is absorbed by cancer cells and appears as dark areas on the scan. It can be used for both diagnosis and staging of MCC.
  
  7. How is Merkel cell carcinoma treated?
  
  Surgery is the most common treatment for MCC. Surgery with wide margins (a large border of healthy tissue removed with the tumor) is the recommended treatment for MCC. Mohs micrographic surgery, a technique in which individual layers of tissue are removed and examined under a microscope until all cancerous tissue has been removed, may be used instead of traditional surgery with wide margins. Mohs micrographic surgery may be a good alternative for MCC tumors on highly visible areas such as the face, and in areas where the surgeon would not be able to obtain wide margins (5).
  
  The surgeon may remove lymph nodes to help stage the disease or to prevent recurrence (cancer coming back). The patient may also receive adjuvant radiation therapy (treatment given after the primary therapy) to decrease the chance of recurrence. Chemotherapy is the usual treatment if the disease has spread beyond the lymph nodes to areas that are not treatable by radiation therapy.
  
  Supportive care is treatment given to improve the quality of life of patients who have a serious or life-threatening disease, such as cancer. It prevents or treats as early as possible the symptoms of the disease, side effects caused by treatment of the disease, and psychological, social, and spiritual problems related to the disease or its treatment. For example, anticancer drugs such as carboplatin and etoposide may be given to relieve symptoms in some patients with MCC. Radiation may be used to relieve pain from MCC that has metastasized to the brain or bones, and to reduce discomfort from skin problems associated with MCC (2). Additionally, meeting with a social worker, counselor, or member of the clergy can be helpful to those who want to talk about their feelings or discuss their concerns. A social worker can often suggest resources for help with recovery, emotional support, financial aid, transportation, or home care.
  8. Are clinical trials (research studies) available? Where can people get more information about clinical trials?
  
  Yes. The National Cancer Institute (NCI), a component of the National Institutes of Health, is sponsoring clinical trials that are designed to find new treatments and better ways to use current treatments. Before any new treatment can be recommended for general use, doctors conduct clinical trials to find out whether the treatment is safe for patients and effective against the disease. Participation in clinical trials may be a treatment option for patients with MCC.
  
  People interested in taking part in a clinical trial should talk with their doctor. Information about clinical trials is available from the NCI's Cancer Information Service (CIS) (see below) at 1– 800– 4– CANCER and in the NCI booklet Taking Part in Cancer Treatment Research Studies , which can be found at http://www.cancer.gov/publications on the Internet. This booklet describes how research studies are carried out and explains their possible benefits and risks. Further information about clinical trials is available at http://www.cancer.gov/clinicaltrials on the NCI's Web site. The Web site offers detailed information about specific ongoing studies by linking to PDQ®, the NCI's comprehensive cancer information database. The CIS also provides information from PDQ.
  9. What is the prognosis for patients with Merkel cell carcinoma?
  
  Prognosis describes the likely course and outcome of a disease—that is, the chance that a patient will recover or have a recurrence. The prognosis for MCC patients depends greatly on the stage of the disease at the time of diagnosis. If the tumor is small (less than 2 cm or about ¾ inch) and cancer cells have not spread to the lymph nodes, the 5-year survival rate is more than 90 percent. Patients with MCC that has spread to the lymph nodes have a 5-year survival rate of about 50 percent. Overall 5-year survival for patients diagnosed with MCC is 64 percent (7), but half of patients with advanced MCC will live only 9 months (2). The disease recurs in about 50 percent of patients (7). It is important to keep in mind, however, that these statistics are averages based on large numbers of patients. Statistics cannot be used to predict what will happen to a particular patient because each person's situation is unique.
  
  
  Selected Reference
  
  1. Wood GS, Bagheri M, Gharia M, et al. Nonmelanoma skin cancers: Basal cell and squamous cell carcinomas. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKenna WG, editors. Clinical Oncology. 3rd ed. London: Churchill Livingstone, 2004.
  
  2. Poulsen M. Merkel-cell carcinoma of the skin. Lancet Oncology 2004; 5(10):593– 599.
  
  3. Camisa C, Weissmann A. Friedrich Sigmund Merkel. Part II. The cell. American Journal of Dermatopathology 1982; 4(6):527– 535.
  
  4. Hodgson NC. Merkel cell carcinoma: Changing incidence trends. Journal of Surgical Oncology 2005; 89(1):1– 4.
  
  5. Goessling W, McKee PH, Mayer RJ. Merkel cell carcinoma. Journal of Clinical Oncology 2002; 20(2):588– 598.
  
  6. Miller RW, Rabkin CS. Merkel cell carcinoma and melanoma: Etiological similarities and differences. Cancer Epidemiology, Biomarkers & Prevention 1999; 8(2):153– 158.
  
  7. Allen PJ, Bowne WB, Jaques DP, et al. Merkel cell carcinoma: Prognosis and treatment of patients from a single institution. Journal of Clinical Oncology 2005; 23(10): 2300– 2309.
  
  
  Getting Gorgeous (and Sun Safe) with Mineral Makeup
  
  Just what is mineral makeup? If you’ve opened a fashion magazine, you’ve seen an ad for these soft, shimmery cosmetics. Worn either as foundation or setting powder, mineral makeup gives the skin matte (no-shine) coverage and a natural-looking finish. And thanks to the sunscreen ingredients zinc oxide and/or titanium oxide in many formulations, mineral makeup can also supplement sun protection.
  
  What’s In It?
  
  Mineral makeup is loose or pressed powder consisting of naturally occurring inorganic materials such as bismuth oxychloride,
  For extended wear, mineral makeup should ideally be used in addition to rather than instead of a separate SPF 15+ sunscreen product.
  
  Boron nitride, mica, talc, titanium dioxide and zinc oxide — minerals. The makeup is popular due to its downy texture (which comes from boron nitride, corn starch or talc); shimmery colors (provided by iron oxides and mica); adhesive abilities (from bismuth oxychloride, boron nitride, and magnesium stearate), and absorbent qualities (properties of bismuth oxychloride and kaolin clay).
  
  Some mineral formulas also include silicones: stable and water-repellent compounds with high molecular weights. Silicones such as dimethicone, cetyl dimethicone and trimethylsiloxysilicate act as emollients and moisturizers, softening and adding hydration to the skin. Sometimes trace amounts of antioxidants or provitamins are added to the blend, too.
  
  Mineral Makeups as Sunscreen
  
  Titanium dioxide and/or zinc oxide are the keys to the sun protection offered by such makeups. These inorganic, insoluble minerals are considered “physical sunscreens,” and they work by reflecting the sun’s ultraviolet radiation (UVR) away from the skin, as opposed to chemical/organic sunscreens, which absorb rather than reflect UVR.
  
  “For incidental exposure — if you go out for a short while — mineral makeup used without a separate sunscreen is fine if the makeup’s SPF is at least 15,” says Diane S. Berson, MD, Associate Professor of Dermatology at Weill Medical College of Cornell University in New York City.
  
  When you’re planning to stay out in the sun for longer than 15 minutes, “Mineral makeup with SPF can enhance your protection if layered over a sunscreen product,” explains Leslie Baumann, MD, Director of the Cosmetic Dermatology division at Miller School of Medicine, University of Miami. The powder, applied on top of sunscreen, will probably catch any spots you may have missed.
  Application Issues
  
  One problem with mineral makeup — as with all sunscreens — is that consumers usually apply less than recommended for greatest efficacy. To evaluate a product’s SPF, testers apply two milligrams of sunscreen per square centimeter of skin, but this is extremely difficult for sunscreen users to replicate. As Warwick L. Morison, MD, Chairman of The Skin Cancer Foundation’s Photobiology Committee, observes, “I would guess that people use about a quarter as much” as the testing protocols. However, he notes, “People might actually use more mineral makeup” than they do sunscreen, possibly providing more protection.
  
  For extended wear, mineral makeup should ideally be used in addition to rather than instead of a separate SPF 15+ sunscreen product, says Arnold W. Klein, MD, UCLA Professor of Medicine and Dermatology.
  
  Application Tips
  When applied, mineral makeup’s finely ground particles cling to the skin’s surface. However, Dr. Berson observes, “The coverage can vary based on application method and consistency.” “Brushes tend to produce more scattered coverage,” Dr. Berson says. “If you apply more cohesive [pressed] powder with a finger or pad, it is more concentrated and hence more protective.” And Dr. Baumann reiterates, “Layer [mineral] powder over sunscreen — remember, sunscreen first!”
  
  How Far Does "Broad-Spectrum" Go?
  
  "Broad-spectrum" protection does not mean "full" or "complete" protection. No single strategy – except permanently staying inside – accomplishes perfect sun protection. Nonetheless, sunscreen has improved substantially over time. Decades ago, it protected only against UVB, the sun’s short-wave radiation. Research had clearly linked UVB to sunburn and skin cancer. However, exposure to UVA, long-wave radiation, was considered of little consequence. Then, UVA was shown to be the primary cause of premature skin aging (photoaging), and to exacerbate UVB's carcinogenic effects. "UVB was considered the primary offender in sun damage and skin cancer until we published studies showing that UVA and UVB combined were more damaging than UVB alone," says Isaac Willis, MD, professor of dermatology at Morehouse and Emory Universities, who served on The Skin Cancer Foundation’s first Photobiology Committee, a group of experts on the effects of solar UV. "UVA causes pigment darkening (tanning), and people used to think this offered protection, but tanning is really DNA damage."
  
  The Advent of Broad Spectrum
  
  Because of such findings, broad-spectrum UV protection was born, as manufacturers added chemicals broadening sunscreen coverage into the UVA range. Currently 16 active ingredients are FDA-approved for sunscreens in the U.S., and several offer UVA protection. Ingredients such as avobenzone (ParsolR 1789), titanium dioxide and zinc oxide offer UVA protection. "With these newer additives, sunscreens offer protection across the entire UVA spectrum. Products providing such protection can properly be called ‘broad-spectrum’," says Warwick L. Morison, MD, professor of dermatology at Johns Hopkins Medical School and current Photobiology Committee chairman. "These ingredients combined with UVB-absorbing chemicals have greatly improved sunscreens." In the near future, he notes, European imports such as the UVA blocker mexoryl should extend protection even further.
  
  A Question of Measurement
  
  Unfortunately, no standard exists in the U.S. to measure UVA protection. It does abroad, but the FDA has never approved one. The standard we have, SPF (sun protection factor), is a holdover from when sunscreens shielded against UVB alone; it only measures UVB protection. Nonetheless, sunscreens with an SPF of at least 15 or higher do usually offer greater protection against UVA, especially when they contain one or more UVA-targeted chemicals. But remember, no matter how good a sunscreen is, some UV reaches the skin. The Foundation considers sunscreen one vital part of a comprehensive sun protection program that includes UV-blocking sunglasses, a wide-brimmed hat, and other sun-protective clothing, as well as shade, especially between 10 a.m. and 4 p.m.
  
  This article is excerpted from Sun & Skin News, Vol. 23, No. 2 .
  
  
  Not So Magic Numbers
  
  Dermatologists have long cited the sobering statistic that one blistering sunburn in childhood doubles a person’s lifetime chances of developing melanoma, the deadliest form of skin cancer. Now, Mayo Clinic researchers have given us a similarly scary new stat: Sustaining five or more sunburns by any age doubles your lifetime risk of developing any form of skin cancer
  
  Reporting on this research, the Mayo Clinic’s Health Letter noted other alarming new data as well, reflecting what they called “an unrecognized epidemic of skin cancer” in the U.S. All the trends are in the same direction – upwards: 1. The percentage of women under age 40 with the most common form of skin cancer, basal cell carcinoma (BCC), tripled between 1976 and 2003, while the rate for squamous cell carcinoma (SCC), the second most common skin cancer, quadrupled. In the past, these cancers were generally considered a major problem only for people over age 50. 2. Just 60 percent, rather than the usual 90 percent, of skin cancers identified in this research occurred on body sites that are typically sun-exposed, such as the head and neck. The remaining cancers were mainly found on the torso, a phenomenon that the researchers suspect may have resulted from widespread use of tanning beds. The important thing to remember about these statistics is that they’re only numbers. They needn’t apply to you personally if you routinely take the precautions recommended by The Skin Cancer Foundation to protect yourself against the sun’s (and tanning machines’) harmful ultraviolet rays.
  
  This article appeared in Sun & Skin News, Vol. 23, No. 2.
  
  
  Melanoma in kids increasing; doctors alarmed, puzzled
• The Seattle Times-
  
  By Lindsey Tanner
  
  The Associated Press
  
  CHICAGO — At age 10, freckle-faced Corey Halpin had bigger things to think about — like basketball and Boy Scouts — than the little black mole he noticed on his arm while camping.
  
  At first, he thought it might be a tick. "I pushed it, but it didn't move, but it bled," he recalled.
  
  It wasn't until a few months later, during a spring 2002 visit to his pediatrician, that Corey casually asked his dad if he should mention the odd mole. That led to a referral to a specialist and alarming test results that surprised even doctors.
  
  Melanoma, the most serious and potentially deadly form of skin cancer, was until recently almost unheard of in children, and it was a diagnosis for which his family wasn't prepared.
  
  "My husband and I were scared to death," and so was Corey, said his mother, Marge Halpin.
  
  Pediatric melanoma is uncommon, affecting seven children per million, or about 500 in the United States, according to 2002 statistics from the National Cancer Institute. But that number has risen from three per million in 1982.
  
  Dr. Charles Balch of the American Society of Clinical Oncology, who has specialized in melanoma for 30 years, saw his first pediatric case five years ago. Since then, Johns Hopkins Hospital, where he works, has treated about 20 youngsters, the youngest just 8.
  
  Dr. Anthony Mancini, dermatology chief at Children's Memorial Hospital in Chicago, diagnosed Corey Halpin's melanoma and said he and his colleagues have treated eight cases in the past nine years, about double the number seen in the previous 20 years.
  
  Recent studies also report increases in England, Sweden and Australia.
  
  "There's an appropriate level of alarm here," Mancini said. "Clearly it's happening, and it's deadly, and it's missed."
  
  Some pediatricians who see unusual moles in children "would ordinarily dismiss this as nothing, because melanoma is not supposed to happen in this age group," Balch said. "We all should be aware that this can occur and biopsy suspicious or changing moles in children."
  
  Balch said reasons for the increase are uncertain. Some doctors suggest that it might be from depletion of the ozone layer, which protects the Earth from some of the sun's damaging ultraviolet radiation. Others attribute it to excessive sun exposure and blistering sunburns in early childhood, although some experts had thought it took much longer for skin damage from repeated sun exposure to develop into cancer.
  
  Melanoma prevalence has risen in adults, too, more than doubling in the past 30 years, according to the cancer institute. The American Cancer Society estimates that this year 60,000 U.S. adults will be diagnosed with melanoma and that 7,700 will die from it.
  
  Melanoma develops in skin cells called melanocytes, which produce the pigment that colors the skin's surface and protects deeper layers from sun damage. It is much more invasive and likely to spread to other parts of the body than other skin cancers.
  
  Research from Italian doctors published in the March edition of Pediatrics found that melanoma lesions in children sometimes look different from those in adults and may be misdiagnosed.
  
  In adults, melanoma often looks like a black or very dark brown mole, or one with irregular borders. But half the Italian children studied had lighter lesions, and most had well-defined borders.
  
  Also unlike adults, most children with melanoma have no family history of the disease, and they may lack other risk factors, including moles present since birth, Balch said.
  
  Corey Halpin, of Hanover Park, a Chicago suburb, has no relatives with melanoma or any other kind of cancer. But he does have other risk factors: fair skin, red hair and green eyes. Mancini, his doctor, said the traditional A-B-C-D signs of melanoma — asymmetry, border irregularities, colors of mixed black and brown, and diameters larger than a pencil eraser — sometimes occur in children. But a child's lesion also can be smaller and pinkish. Mancini instead recommends the "ugly-duckling" detection method: watching for a mole that looks completely different from the child's other moles.
  
  In Corey's case, the mole was tiny but much darker than his other freckles, and it bled, another warning sign. Three years since his surgery, he is cancer-free. He has tests every few months, but doctors said his long-term survival chances are excellent.
  
  News Flash:
  
  The World Health Organization recommends that no person under 18 should use a sunbed
  
  
  Corbis/RDB
  Stricter controls are needed on sunbed use
  
  
  17 MARCH 2005 | GENEVA -- Today, the World Health Organization (WHO) is highlighting that sunbed use poses a risk of skin cancer, and that no person under 18 years of age should use a sunbed. It is known that young people who get burnt from exposure to UV will have a greater risk of developing melanoma later in life, and recent studies demonstrate the direct link between the use of sunbeds and cancer.
  
  WHO highlights its recommendations as many people, especially young women in developed countries, prepare to get a tan in anticipation of summer.
  
  Worldwide, WHO says, there are an estimated 132 000 cases of malignant melanoma (the most dangerous form of skin cancer) annually, and an estimated 66 000 deaths from malignant melanoma and other skin cancers. These figures continue to rise: in Norway and Sweden, the annual incidence rate for melanoma is estimated to have more than tripled in the last 45 years, while, in the United States, the rate has doubled in the last 30 years. Growth in the use of sunbeds, combined with the desire and fashion to have a tan, are considered to be the prime reasons behind this fast growth in skin cancers.
  
  Worldwide, the incidence of melanoma varies more than 150-fold. The highest rates are found mainly in those nations where people are fairest-skinned and where the sun tanning culture is strongest: Australia, New Zealand, North America and northern Europe. One in three cancers worldwide is skin-related; in the United States, that figure is one in two. There are an estimated 1.1 million annual cases of skin cancer in the United States.
  
  "There has been mounting concern over the past several years that people and in particular, teenagers are using sunbeds excessively to acquire tans which are seen as socially desirable. However, the consequence of this sunbed usage has been a precipitous rise in the number of skin cancer cases," said Dr Kerstin Leitner, WHO Assistant Director-General responsible for environmental health. "We are therefore calling attention to this fact and we would hope that this recommendation will inspire regulatory authorities to adopt stricter controls on the usage of sunbeds."
  
  Some sunbeds have the capacity to emit levels of ultraviolet (UV) radiation many times stronger than the mid-day summer sun in most countries. At present, however, only a few countries have effective regulations on sunbeds or their use. Belgium, France and Sweden have legislation, limiting the maximum proportion of UV-B (the most dangerous component of UV radiation) in the UV output to 1.5% (a similar level of the carcinogenic UV that is emitted by the sun). In France the regulations require all UV radiation-emitting appliances to be declared to the health authority, minors under the age of 18 are banned from their use, trained personnel must supervise all commercial establishments and any claim of health benefit is forbidden. The State of California in the United States prohibits anyone under 18 from using sunbeds/tanning salons. Often, however, effective implementation of regulations remains a challenging issue. WHO encourages countries to formulate and reinforce laws in order to better control the use of sunbeds such as the ban of all unsupervised sunbeds operations.
  
  Some of the main consequences of excess UV exposure include skin cancers, eye damage and premature skin ageing. A study in Norway and Sweden, for example, found a significant increase in the risk of malignant melanoma among women who had regularly used sunbeds. Furthermore, excessive UV exposure can reduce the effectiveness of the immune system, possibly leading to a greater risk of infectious diseases.
  
  Acute effects of UV radiation on the eye include cataracts, pterygium (a white coloured growth over the cornea) and inflammations of the eye such as photokeratitis and photoconjunctivitis. This is why protective goggles are recommended when using a sunbed.
  
  Only in very rare and specific cases, WHO counsels, should medically-supervised sunbed use be considered. Medical UV devices successfully treat certain skin conditions such as dermatitis and psoriasis. These treatments should only be conducted under qualified medical supervision in an approved medical clinic and not unsupervised either in commercial tanning premises or at home using a domestic sunbed.
  
  WHO's recommendation on sunbed usage is part of its overall efforts to protect the health of those people who could be overexposed to UV radiation. WHO, along with its partners, the International Commission on Non-Ionizing Radiation Protection, the United Nations Environment Programme and the World Meteorological Organization, have elaborated the Global Solar UV Index, which is now used in many countries including Argentina, Australia, Czech Republic, Finland, France, Germany, Greece, Israel, Mexico, Norway, Poland, Portugal, Spain, Sweden and Switzerland, and has recently been adopted for general usage in the United States and Canada.
  
  "In all of our actions, we are clear: avoid excess exposure to UV and, when you have to be in the sun, protect your skin. Malignant melanomas, other cancers and conditions are the consequence of not taking the proper precautions," added Dr Leitner.
  
  
  News Flash #1:
  
  APPROVED BY THE AUSTRALIAN AND NEW ZEALAND BONE AND MINERAL SOCIETY, OSTEOPOROSIS AUSTRALIA, AUSTRALISIAN COLLEGE OF DERMATOLOGISTS AND THE CANCER COUNCIL AUSTRALIA RISKS AND BENEFITS OF SUN EXPOSURE POSITION STATEMENT
  
  Summary statement: A balance is required between avoiding an increase in the risk of skin cancer and achieving enough ultraviolet radiation exposure to maintain adequate vitamin D levels. Sun exposure is the cause of around 99% of non-melanoma skin cancers and 95% of melanoma in Australia, however, ultraviolet radiation B (UVB) exposure in small amounts is essential to good health. In Australia, where ultraviolet radiation levels are in the high to extreme range for most of the year, sun protective measures to reduce the incidence of skin cancer must continue as a high public health priority. The majority of Australians generally have sufficient ultraviolet radiation exposure to enable adequate vitamin D production – serum 25-hydroxy vitamin D levels >50 nanomole/Litre (nmol/L) – to form and maintain healthy, strong bones. It is well established that Vitamin D forms in the skin as a result of UVB exposure. However, there are few studies currently available that have investigated the amount of UVB that people require to synthesise adequate vitamin D 2. There is evidence to suggest that prolonged or excessive sun exposure has no benefit in health outcomes related to Vitamin D 3. Therefore, people should continue to protect themselves from overexposure, especially during peak ultraviolet radiation periods (10 am to 3 pm). Further scientific investigation of the amount of ultraviolet radiation exposure required to ensure adequate vitamin D levels in Australia is warranted. People are at risk of vitamin D deficiency and may need vitamin D supplementation if their exposure to ultraviolet radiation is not adequate. People living in the southern parts of Australia have a higher risk of vitamin D deficiency, particularly during the winter months. Recommendations 1. In most situations, sun protection to prevent skin cancer is required during times when the UV index is moderate or above (>3). At such times when the UV index is higher than or equal to 3, sensible sun protection behaviour is warranted and is unlikely to put people at risk of Vitamin D deficiency. 2. Most people achieve adequate vitamin D levels through the UVB exposure they receive during typical day-to-day outdoor activities. As an example, it has been estimated that adequate vitamin D levels (>50 nmol/l) can be achieved in summer by the face, arms and hands or the equivalent surface area being exposed to as little as an average of 5 minutes of sunlight either side of the peak UV periods on most days of the week. In winter, in the southern states of Australia where UV radiation levels are less intense, Vitamin D levels may be maintained by approximately 2-3 hours of sunlight exposure accumulated over a week to the face, arms and hands or equivalent surface area.
  
  
  News Flash #2:
  
  SUNSCREEN USE: From The Cancer Council Victoria
  
  Why sunscreen is important
  
  Sunscreen protects areas of the body that cannot be covered with clothing or hats. For best protection, use sun protection factor (SPF) 30+ broad spectrum, water resistant sunscreen.
  
  It is important not to rely on sunscreen as the only form of sun protection. No sunscreen offers 100% protection from ultraviolet (UV) radiation.
  
  UV radiation is divided into UVA, UVB and UVC. UVC has the shortest wavelength and cannot get through the ozone layer to reach us. But UVA and UVB reach the earth's surface. They have both been linked to skin cancer.
  
  SPF 30+ broad spectrum sunscreen filters out about 97% of UVB rays and 90% of UVA.
  
  
  How it works
  
  Sunscreen prevents most ultraviolet (UV) radiation from reaching the skin. The sun protection factor (SPF) rating indicates the amount of UVB radiation that can be blocked by the product.
  
  The 'SPF' of a sunscreen does not really mean the 'strength' of a product. How long it takes skin to burn depends on the time of day, the time of the year, the amount of reflected UV radiation, how cloudy it is and a person's skin type.
  
  Broad spectrum sunscreen is recommended as it screens out both UV radiation types.
  
  Because sunscreen cannot completely shield the skin from UV radiation it should not be considered the first choice for skin protection. Nor should it be used as a means of staying out longer in the sun.
  
  
  When buying sunscreen
  • Choose broad spectrum sun protection factor (SPF) 30+ water resistant sunscreen.
  • Price does not indicate quality of sunscreen. All sunscreen in Australia must comply with the Australian/New Zealand Standard.
  • Check the use by date on sunscreen labels. Do not use if past the use by date.
  • If you have sensitive skin, try a fragrance free product.
  • Test sunscreen on a small part of the body first to check for any irritations.
  • Sunscreen comes in creams, lotions or gels. All work equally well.
  
  
  Tips for applying sunscreen
  • Apply sunscreen to clean, dry skin.
  • Use a teaspoon of sunscreen for each limb. Most people do not apply enough sunscreen.
  • Apply sunscreen twenty minutes before going outdoors to give it time to bond to your skin.
  • Reapply sunscreen every two hours or more often if you are swimming or sweating a lot.
  • Never use sunscreen to spend more time in the sun.
  
  TINTED WINDOWS: From The Cancer Council Victoria
  
  Car window tinting
  
  Most car and truck window tints absorb a significant amount of ultraviolet (UV) radiation and provide excellent protection.
  ? Ordinary car and truck windows block about 94% of the UVB.
  ? Laminated windscreens block all of the UVB radiation and about 80% of the UVA radiation.
  ? Clear window films can block as much as 97% of the UVA radiation.
  
  Consumers must weigh up the costs against the benefits.
  
  Consumers can also reduce the effects of UV radiation while in their vehicle by wearing a long-sleeved shirt, sunglasses and sun protection factor (SPF) 30+ sunscreen applied to exposed skin.
  
  
  Building window tinting
  
  In general, ultraviolet (UV) radiation through the windows of buildings poses little risk to people unless they are spending extended periods of time close to a window that receives the direct sun.
  
  News Flash #3:
  
  UV Index Guidlines:
  
  EPA and NOAA's National Weather Service Adopt New Global Ultraviolet Index Guidelines - Guidance helps reduce overexposure to dangerous UV rays
  
  U.S. Environmental Protection Agency (EPA)
  National Oceanic and Atmospheric Administration (NOAA)
  
  Contact: John Millett, 202-564-7842 / millett.john@epa.gov
  Carmeyia Gillis, 301-763-8000 ext. 7163 / carmeyia.gillis@noaa.gov
  
  (Washington, D.C. - May 26, 2004) The EPA and the National Oceanic and Atmospheric Administration's (NOAA's) National Weather Service today announced the new Global Ultraviolet (UV) Index, which replaces the existing UV reporting methods in the United States.
  
  Developed by the World Health Organization, the United Nations Environment Programme, and other international organizations, the Global UV Index is a set of guidelines designed to better help people understand which precautions to take to protect themselves from different levels of UV radiation. These guidelines will standardize reporting of surface UV radiation levels in the United States with reporting in other nations. The Government of Canada also is adopting the guidelines today.
  
  "With summer around the corner and sun-drenched beaches beckoning, it's easy to forget that the sunlight that feels so good can be harmful," said EPA Administrator Mike Leavitt. "Our new UV index is a quick and easy way for people to know when it's important to use sunscreen and to avoid too much sun."
  
  Retired Air Force Brig. General David L. Johnson, Director of NOAA's National Weather Service, agreed, adding, "Each year more than one million people are diagnosed with skin cancer in the United States, making it the most common form of cancer in the country. Clearly, there is a need for more guidance with UV index information, which we are providing today."
  
  The UV Index is a measure of the amount of skin-damaging UV radiation reaching the earth's surface. Currently, UV Index forecasts issued by the National Weather Service provide information about UV intensity during the solar noon hour (1:00 p.m. daylight saving time) of the following day. The UV Index informs people when rays will be strongest so that they can take action to protect themselves. Overexposure to UV radiation from the sun is a preventable contributor to serious health effects, particularly skin cancer. Incidence of malignant melanoma, the deadliest form of skin cancer, has more than doubled in the United States in the last thirty years.
  
  "We are excited that the US is adopting the Global UV Index," said Dr. James Spencer, Co-Chair of the National Council on Skin Cancer Prevention and Professor of Dermatology at the Mt. Sinai School of Medicine. "If people use the Index to protect themselves from the sun during peak UV intensity hours, their chances of UV-related health problems – like skin cancer – will decrease greatly."
  
  The National Weather Service and EPA will provide daily UV forecasts for 58 major metropolitan areas, as well as forecasts by zip code. Information about the Global UV Index, including downloadable files and links to sites about UV radiation, is available on EPA's Web site at: http://www.epa.gov/sunwise/uvilaunch.html .
  
  
  
  
  NEWS FLASH #4:
  
  Calif. to Ban Teens From Tanning Booths
  California Assembly Votes to Ban Teenagers From Artificial Tanning Booths
  
  The Associated Press
  
  
  
  
  SACRAMENTO, Calif. May 20, 2004 — A state famous for tanned bodies and year-round sunshine would be the nation's first to ban teenagers from artificial tanning booths if a bill passed Thursday by the state Assembly becomes law.
  
  Lawmakers, citing a rise in skin cancer cases in California and across the nation, voted 42-26 to add artificial tanning to teenage no no's that already include smoking, drinking and buying lottery tickets.
  
  Teens often visit tanning salons before proms, vacations and weddings, say owners of an industry that claims 160,000 employees nationally and $5 billion in annual revenue. California is estimated to have 1,500 tanning salons.
  
  Backers of the bill, including the California Society of Dermatology and Dermatologic Surgery, blame tanning salons for part of 1 million new cases of skin cancer diagnosed every year in the United States. The group cited 7,400 deaths annually from melanoma, the deadliest form of skin cancer.
  
  "There is a big difference between going to the beach and a tanning salon," said the bill's author, Assemblyman Joe Nation, a Democrat. "When kids go to the beach they put on sun screen."
  
  The bill passed despite opposition from tanning salons and Republican lawmakers opposed to "meddling" in personal choices.
  
  "If this bill passes it proves there's no part of somebody's life this Legislature won't stick its nose into," said GOP Assemblyman Ray Haynes.
  
  Heidi Blank, manager of San Diego's Hollywood Tans, said she thought the bill could "hurt my business somewhat. But what are you going to do? There's people bigger than me making those decisions."
  
  She said teenagers account for about 5 percent of her store's clients.
  
  The bill, which now goes to the Senate for consideration, requires teenagers to have a doctor or surgeon's prescription before being allowed to tan indoors.
  
  Along with 26 other states, California already requires permission from parents or a legal guardian for teens 15-18 to use artificial tanning salons. Children 14 and under must be accompanied by a parent or guardian.
  
  
  NEWS FLASH #5:
  
  The World Health Organization issued the following media release today (26th
  April 2004);
  
  
  Sunbed Users Run Greater Risk of Developing Skin Cancer, WHO warns
  
  The desire to acquire a tan for fashion or cosmetic purposes is only going
  to add to the 132,000 melanomas that are already occurring globally each
  year, World Health Organization (WHO) Director-General Lee Jong-wook warned
  today as the evidence mounts on the adverse health effects associated with
  artificial tanning sunbeds and the number of sunbed outlets throughout the
  world continue to grow
  
  Speaking from Melbourne, Australia, at the launch of WHO's Risk and Guidance
  brochure for Artificial Tanning Sunbeds, Dr Lee said, "Given what we know
  about the risks of sunbed use, we must educate the general public and advise
  government authorities about the risks associated with their use and
  particularly reduce their use by children and adolescents."
  
  "One in every three cancers worldwide is a skin cancer, we do not need to
  have this risk increased by a large percentage of the population receiving
  excessive amounts of UV radiation for cosmetic purposes through sunbeds."
  
  Studies completed in Australia showed that from 2000 - 2004 the number of
  sunbed operators had more than doubled.
  
  "These statistics coming from Melbourne are alarming. This Sunbeds Risk and
  Guidance brochure will help inform governments and hopefully encourage
  sunbed operators to improve their practice." Dr Lee said.
  
  The guidance recommends the banning of unsupervised sunbeds, and
  restrictions on under age use and customers who have fair skin.
  
  Craig Sinclair, author of the publication, explained: "Sunbeds can emit
  levels of ultraviolet radiation that are five times the strength of
  Australia's summer midday sun. For this reason, unregulated exposure to UV
  radiation from artificial sources is a considerable health concern."
  
  "This sunbed brochure provides recommendations for governments - not only
  Australia's - to consider so that adverse health effects and consequent
  health care cost can be minimized. Governments the world over should be
  considering comprehensive regulation governing the operation of sunbeds,"
  added Dr Lee.
  
  The Artificial Tanning Sunbeds Risks and Guidance can be found on the World
  Health Organisations website: http://www.who.int/uv/en/
  
  
  
  NEWS FLASH #6:
  Provided by the EPA
  
  Many sunscreens don't block a type of ultraviolet light that new research
  has shown leads to potentially cancer-causing mutations.
  
  Australian and U.S. researchers say that ultraviolet-A (UVA), which is
  responsible for the sun's ageing effects, plays a bigger role in causing
  skin cancer than previously thought.
  
  But some sunscreens don't block UVA, just ultraviolet-B (UVB).
  
  The research team, led by Dr Nita Agar from the Melanoma and Skin Cancer
  Research Institute at Sydney's Royal Prince Alfred Hospital
  , published its work in the latest issue of
  the Proceedings of the National Academy of Sciences .
  
  Scientists have thought that the UV light responsible for sunburn, UVB, was
  the main type of UV light that caused skin cancer.
  
  But this latest research says the effect of UVA has been underestimated.
  
  "It may be that widespread use of UVB-blocking sunscreens in Australia...has
  led to an increase in human exposure to UVA and allowed us to detect these
  changes now," the researchers said.
  
  Scientists knew that UVA penetrated the skin more deeply than UVB. But they
  thought that UVA photons were less likely to be absorbed by the DNA and
  cause critical mutations. So, UVA was thought to be less carcinogenic.
  
  But when the researchers looked at the effects of UVA and UVB on the DNA
  from two types of skin cancer cells, they found that UVA caused more
  mutations in a critical part of the skin than previously thought.
  
  Most of the UVA mutations were in cancerous cells found in the same part of
  the skin where stem cells occur, the basal keratinocytic layer. By contrast,
  most UVB mutations were found in cells from a more superficial layer of
  skin.
  
  The researchers said their work would have profound implications on public
  health worldwide as researchers had so-far stressed UVB as the
  cancer-causing part of the spectrum.
  
  Growing evidence
  Professor Alan Coates, chief executive officer of The Cancer Council
  Australia said the research added to concerns
  that other parts of the UV spectrum could damage human skin.
  
  Coates said that although there have been mice studies showing that UVA
  damaged skin cells, this "careful piece" of research showed that skin
  cancers really started in the deepest layers of the skin, where the longer
  wavelengths of UVA light penetrated.
  
  But the research didn't alter The Cancer Council's recommendations, he said,
  adding that it reinforced the message that sunscreen was only part of the
  answer in preventing skin cancer.
  
  "It's pretty much the message we've been putting out anyway," Coates told
  ABC Science Online.
  
  "Wear a shirt, not a see-through one, because if you can see through it the
  sun can; wear a hat; and stay in the shade between 11am and 3pm."
  
  Old-fashioned sunscreens could lull people into a false sense of security,
  he said, particularly if they are using a sunscreen with poor protection
  against UVA. People might stay in the sun for longer, thinking they were
  protected.
  
  "Broad-spectrum sunscreens do protect against UVA but to varying degrees,"
  he said.
  
  Coates said The Cancer Council was looking at adopting a method developed in
  the UK of rating sunscreens' UVA protection using a system of stars. This
  would be similar to how sunscreens provide a rating system for UVB
  protection.
  
  
  NEWS FLASH #7:
  BBC News
  Last Updated: Tuesday, 30 March, 2004, 09:27 GMT 10:27 UK
  
  
  
  Young face skin cancer 'timebomb'
  
  Many young people face the prospect of developing skin cancer if they continue to ignore warnings to protect themselves from the sun, say experts.
  
  A survey by Cancer Research UK found nearly three-quarters of young Britons aged 16-24 who responded want a tan despite the risk of cancer.
  
  Case of life-threatening malignant melanoma have risen 24% in five years.
  
  The charity has joined forces with ministers to launch a new public education campaign.
  
  
  Unless young people change their habits and learn to protect themselves properly in the sun we could be heading for a skin cancer time bomb
  
  
  
  Dr Charlotte Proby, Cancer Research UK
  
  It says, while young people are constantly warned about the dangers of binge drinking and unprotected sex, not enough is being done to warn them about the dangers of too much exposure to the sun.
  
  Experts are concerned that the growth in foreign holidays, and soaring temperatures in the UK will put more and more at risk.
  
  In 1995 there were 5,626 new cases of melanoma in Britain but by 2000 this figure had risen to 6,967.
  
  Sunbeds
  
  The CRUK survey of more than 1,800 adults found 70.6% of those aged 16 to 24 liked or aimed to get a tan on holiday, with only 7.7% saying they avoided getting a tan.
  
  Sun safety
  
  Stay out of sun 1100-1500 BST
  Cover up
  Wear sunglasses with UV protection
  Never burn
  Use factor 15+ sunscreen
  Take extra care of children
  Do not use sunbeds
  
  
  
  Medical notes: Skin cancers
  
  Young women were the most likely to seek a suntan and more prone to using sunscreen with low SPF levels.
  
  Earlier this month CRUK and the Sunbed Association called for children under the age of 16 to be banned from using sunbeds because the cancer risk was so high.
  
  Scientists believe spending endless hours on a sunbed damages skin cells in the same way as lying unprotected in the sun for too long.
  
  Campaigners called for coin-operated salons to be shut down and urged the introduction of Europe-wide guidelines for all other tanning businesses.
  
  Each year about 1,700 people die from melanoma - the third most common cancer among people aged 15 to 39.
  
  More than 62,500 cases of non-melanoma skin cancer are also recorded in Britain each year.
  
  Dr Charlotte Proby, a leading dermatologist for Cancer Research UK, says: "Many teenagers have grown up with an obsession about getting a tan on holiday. But young skin is very vulnerable to UV radiation.
  
  "Unless young people change their habits and learn to protect themselves properly in the sun we could be heading for a skin cancer time bomb.
  
  "The message is getting through slowly but, as the survey indicates, there is still widespread ignorance about the potential danger of sunburn."
  
  Cancer Research UK and the Department of Health is this year focussing their joint SunSmart campaign on telling young people and mothers of young children how to stay safe in the sun.
  
  Public health minister Melanie Johnson announced the Department of Health was investing £400,000 into the campaign over the next three years.
  
  "When you consider that sunburn in childhood increases the risk of skin cancer in later life, the importance of this SunSmart campaign really hits home."
  
  
  NEW FLASH #8:
  
  To view the latest advertising from the Australian Cancer Council which is targeted at teenagers go to the link provided:
  
  http://www.sunsmart.com.au/s/media/advertising/tv_ads.htm