William Stebbins, MD, and C. William Hanke, MD, MPH, spoke to Jennifer Reinbold, a former pro tennis player who coaches in Indianapolis. Jennifer competed in nine grand slam tournaments, reaching the Wimbledon quarterfinals in 1983 before losing to the eventual winner, Martina Navratilova. After years of sun exposure, and some experience with skin cancer, Jennifer practices what she preaches: Respect the sun!
William Stebbins, MD, and C. William Hanke, MD, MPH
Q: What was your experience with sun exposure as a young tennis player?
A: I grew up in South Africa, two hours north of Johannesburg. I started tennis at eight, to spend more time with my older brother and his friends. We played outdoors year-round — there were no indoor facilities then. I had very light skin, so I was susceptible to sun damage. But little information was available about the long-term dangers of sun exposure.
|Figure 1: Jennifer (age 3) at a beach in South Africa with her older brother, Trevor Mundel, now Global Head of Research and Development at Novartis Pharmaceuticals.|
When I was a young child, my mother was vigilant about my sun exposure because she didn’t want me to get wrinkles. She was a pretty advanced thinker! She always had me wear a hat and sunscreen, which really stung when it got in my eyes. But I remember several blistering sunburns during summer beach vacations. While competing, I wore sunscreen on my face, but not always on my body — I was concerned that sunblock might trickle onto my hands, interfering with my grip. And in higher competition, I often skipped wearing a hat because I thought it might be a distraction.
Q: When did you start becoming aware of the harmful effects of the sun?
A: When I was a teenager on tour in England, my father had a melanoma, the most dangerous skin cancer, removed from his forearm. My parents didn’t like to give me bad news when I was away, so they told me about it only after the fact. Fortunately, the surgery was successful.
|Figure 2: Jennifer (seen at age 22) played on the women’s professional tennis tour for eight years.|
Q: How have you altered your sun protection behavior?
A: After retiring from the tour, I married and began teaching tennis in the Indianapolis area. In summers, I was often on courts eight hours straight. By then, I usually wore long-sleeved shirts; a bandana around my neck; and a wide-brimmed hat, along with sunscreen. But the effects of sun damage I sustained over the years started to appear. I’ve had several skin precancers removed at every visit to the dermatologist, which is at least twice a year. I had a basal cell carcinoma, the most common skin cancer, removed from my neck, and a squamous cell carcinoma, another common skin cancer, removed from my forearm. Once a person gets one skin cancer, they face about a 50 percent risk of developing another within five years.
Q: How do you reduce your risk of getting further cancers?
A: First, I do a careful head-to-toe skin check once a month. If I notice anything abnormal, I see my dermatologist. (This is in addition to my regular twice-yearly appointments). Also, I always use protective clothing and sunscreen, and avoid playing and teaching outdoors in the middle of the day, when UV exposure is most intense.
Q: Do you think the message about sun protection is getting through?
A: There is more sun awareness today. Most players I teach or play with wear sunscreen and have a hat in their tennis bags. However, they don’t usually reapply sunscreen when playing for extended periods. Also, just because they have a hat or visor doesn’t mean they use it! Many players don’t realize their scalps are as vulnerable as the rest of their bodies.
|Figure 3: (L to R) Jennifer with PA Nilhagen, renowned coach and Director of Tennis at 5 Seasons Sports Club in Indianapolis, along with her son Derek, 17, a member of the 2009 Indiana State High School Championship Tennis Team.|
Q: What information have you passed along to your children?
A: When my sons Derek and Graham were babies, I bought special UV-protective clothing for them to use at the beach. Now, one son carefully protects himself, wearing a hat and sunscreen when playing tennis outdoors, and a long-sleeved SPF 50 swimshirt when he swims. My other son is more resistant, and likes to tan. I have tried to educate him, providing sunscreen, hats, and protective clothing; the rest will be up to him! I know other teenage tennis players with his attitude — they know the dangers of sun exposure, but still like the look of a tan, and like most teenagers, believe they are invincible.
Q: Any last words of advice for tennis players?
A: Don’t forget to protect yourself. And keep your eye on the ball!
Dr. Stebbins is currently a Mohs micrographic surgery and procedural dermatology fellow under the direction of Dr. C. William Hanke at the Laser & Skin Surgery Center of Indiana and St. Vincent Hospital, Indianapolis, Indiana.
Dr. Hanke is the Director of the Laser & Skin Surgery Center of Indiana in Carmel, IN, and Senior Vice President of The Skin Cancer Foundation. He was the first physician in the United States to earn triple full professorships in Dermatology, Otolaryngology Head and Neck Surgery, and Pathology and Laboratory Medicine. He is past President of The American Academy of Dermatology, and has served as President of five surgical specialty societies: the American Society for Dermatologic Surgery, American College of Mohs Micrographic Surgery and Cutaneous Oncology, the International Society of Cosmetic Laser Surgeons, International Society for Dermatologic Surgery, and the Association of Academic Dermatologic Surgeons. He has written more than 350 publications including 91 book chapters and 20 books.