Chapter 9
Risks Of Overexposure

· Non-melanoma
· Melanoma
· Actinic elastosis
· Actinic karatosis
· Polymorphous light eruption (PLE)
· Sunburn
· Photoaging

Salon owner/operator and client education is the number one factor that can and will diminish the chances of risk during the tanning process. As with any process involving UVR exposure, it is vital to stress moderate, sensible and responsible tanning and consistent use of approved eye protection.

Risks Of Overexposure
Overexposure, which is defined as a UVR dose sufficient to cause erythema, should be avoided. Repeated overexposure is believed to cause eye and skin injury and allergic reactions and increase the risks of developing photoaging of the skin, dryness, wrinkling, and (sometimes fatal) skin cancer.

Skin cancers can be divided into two main categories (melanoma and non-melanoma) and three main types (Basal Cell Carcinoma, Squamous Cell Carcinoma, and Cutaneous Malignant Melanoma). Non-melanoma skin cancers are the most common skin cancers. Basal Cell /carcinoma and Squamous Cell Carcinoma are the two most common forms of non-melanoma skin cancers. Melanomas are cancers that develop from melanocytes.

1. Non-melanoma Skin Cancer
More than 1 million cases of Basal Cell or Squamous Cell cancer will be diagnosed annually. Men are twice as likely to develop non-melanoma cancers than women. Death is uncommon in these cancers. It is estimated that 1,000 to 2,000 people die each year from nonmelanoma skin cancer.

Basal Cell Carcinoma (BCC) occurs in the deepest layer of the epidermis and it is named for the skin cell in which it arises. Affecting 800,000 Americans each year, Basal Cell Carcinoma is the most common form of skin cancer. About 70 to 80 percent of all skin cancers in men and 80 percent to 90 percent in women are Basal Cell Carcinomas. They occur most frequently on exposed parts of the body�the face, ears, neck, scalp, shoulders and back.

Basal Cell Carcinoma is slow growing. It is rare for Basal Cell Carcinoma to spread to the lymph nodes or to distant parts of the body. If the cancer is not treated, however, it can grow into and invade the bone and tissue nearby.

After treatment, Basal Cell Carcinoma can recur. Thirty-five percent to 50 percent of people diagnosed with one Basal Cell cancer develop a new skin cancer within five years of the first diagnosis.

Signs�Basal Cell Carcinoma usually appears as a smooth, waxy or pearly bump that grows slowly and rarely spreads.

Squamous Cell Carcinoma (SCC) occurs in the upper layers of the epidermis. Afflicting more than 200,000 Americans each year, Squamous Cell Carcinoma is the second most common form of skin cancer. Squamous Cell Carcinomas account for about 10 percent to 30 percent of all skin cancers. Squamous Cell Carcinomas most commonly appear on exposed areas of the body (the face, ear, neck, lip, and back of the hands) but can occur on mucous membranes and all other areas of the body.

Squamous cell cancers tend to be more aggressive than basal cell cancers. Although it is uncommon, they are more likely to invade surrounding tissues, and slightly more likely to spread to lymph nodes or distant parts of the body

Signs�Squamous Cell Carcinoma causes a firm, nodular or flat growth with a crusted, ulcerated or scaly surface on the face, ears, neck hands or arms.

2. Melanoma
Cutaneous Malignant Melanoma (CMM) is more rare but is aggressive and can be fatal. It is estimated that in 2005 there will be 59,580 cases diagnosed and 7,770 deaths reported. Since 1981, the incidence of melanoma has increased a little less than 3 percent per year. The percentage of people who develop melanoma has more than doubled in the past 30 years. Malignant melanoma causes more than 75 percent of all deaths from skin cancer. Melanoma is the most common cancer among people 25 to 29 years old.

This disease can spread to other organs, most commonly the lungs and liver.

Malignant melanoma diagnosed at an early stage usually can be cured, but melanoma diagnosed at a late stage is more likely to spread and cause death.

Signs�Melanoma often appears asymmetrical, irregularly bordered and with a diameter larger than the head of a pencil (about � of an inch).

Susceptibility
The following factors increase an individual�s susceptibility to skin cancer: a family history of skin cancer, Skin Type 1, multiple sunburns, photosensitivity, and certain types and large numbers of moles. Skin Type 1 individuals should never be allowed in a tanning unit, they are biologically incapable of acquiring a tan. Individuals who have a past history of skin cancer should also not tan.

It is the operators responsibility to follow moderate, sensible, and responsible tanning practices (properly skin typing, following manufacturers recommended exposure schedules, checking medical information for photosensitizing medications and conditions, not allowing a client to tan more than once in a 24-hour period) to ensure that overexposure does not occur.

Medical Help Regarding Skin Cancer
If you notice a new growth, change in skin or sore that doesn�t heal in 2 weeks, see your physician. Don�t wait for pain; skin cancers are usually not painful. The cure rate for skin cancer is high if you receive treatment early. If a client questions you regarding a growth, change in their skin or a sore, refer them to their physician or dermatologist for evaluation.

There are several other skin conditions that have been associated with overexposure to sunlight (ultraviolet radiation). They are:

Actinic (solar) keratosis (AK). A horny growth or callosity associated with middle-aged or elderly individuals with fair complexion. AK is a premalignant condition that may give rise to squamous cell carcinoma and is linked to repeated overexposure to sunlight.

Polymorphous light eruption (PLE). A common disorder that is characterized by a delayed abnormal response to sunlight, usually a rash or eruption, that is found on UVR-exposed areas of the skin. Women are four times more likely to experience PLE symptoms than are men. Additionally, about 5% of the public is prone to an outbreak of PLE. The typical onset is 1 to 24 hours after exposure and the condition usually resolves itself within seven to ten days.

Sunburn (Erythema)
This condition is an acute reaction in the skin following overexposure to UV radiation. UVB accounts for most sunburn reactions. Symptoms of sunburn usually appear within a few hours after exposure, bringing pain, redness, swelling and occasional blistering. Because a large area of the body is often effected after overexposure, a sunburn can cause headache, fever and fatigue.

Sunburn may not slow you down too much, but a lifetime of overexposure to UV radiation can damage your skin and increase your risk for skin cancer. If you have severe sunburn or immediate complications (rash, itching or fever), contact your physician.

Photoaging
The term photoaging is a relatively new one. Utilized to describe skin changes that result from chronic UVR overexposure that mimic the physiologic aging process, photoaged skin is typically thickened and has increased numbers and activity of skin cells. There is a degeneration of collagen fibers and an increase in elastin of the skin.

Photaged skin appears rough and thickened, with wrinkling and furrowing. It is dry to the touch and may have a yellowish color associated with brown hyperpigmentation.

Photoaging has been linked mainly to UVA radiation. Although UVA carries less energy than UVB rays, it penetrates more deeply into the skin and tissues beneath. Prolonged, intense exposure to UV can damage tissues in the dermis and cause premature aging. It is believed that 90 percent of the visual characteristics associated with aging (less elasticity, hyperpigmented spots, fine lines, wrinkles) are increased by exposure to UV.