ASK THE EXPERT: If I'm a senior citizen and have never been diagnosed with skin cancer, am I immune to it?

By Lindsay D. Sewell, MD

Lindsay D. Sewell, MD, is a dermatologist and graduate of The George Washington University School of Medicine in Washington, D.C.  After finishing his dermatology residency at Geisinger Medical Center in central Pennsylvania, he completed a combined fellowship there in Mohs Micrographic Surgery and Procedural Dermatology. In 2008, Dr. Sewell began private practice at High Valley Dermatology in Idaho Falls, Idaho. Dr. Sewell is a member of The Robins Fund for the Advancement of Mohs Surgery.

Q: I’ve spent a lifetime in the sun, and have never been extremely careful about sun protection, but though I have a number of growths on my skin (dark spots, dry patches, raised moles), I’ve never been diagnosed with skin cancer. If I’ve made it this far without skin cancer, doesn’t that mean I’m immune?  Do I really need to worry about sun protection or visit a dermatologist anymore?

A: A couple of years ago when I was giving a talk about skin cancer at a retirement home, one of the residents asked me something similar: “I’m over 80 — why do I need sun protection?’ 

It was a good question. Logic seems to dictate that in our older years, it’s pointless to try and prevent illnesses that experts say can take 20 years or more to develop. We may think we won’t live long enough for this preventive medicine to make any difference. While this may be true, the end of our lives is uncertain, so we need to keep taking care of ourselves to finish our lives as strong and healthy as possible. 

In answer to the older gentleman’s question, I started by asking a question back: “Do you enjoy being sunburned?”  Neither he nor anyone else in the room answered that they did. On the simplest level, we practice sun protection because sunburns hurt. But that’s not all they do. Both sunburns and suntans damage our skin’s DNA, breaking down its tissues so that it ages before its time, and producing genetic mutations that can lead to skin cancer. Suffering just five sunburns in the course of your life more than doubles your chances of developing melanoma, and each successive tan or sunburn raises the risks further. 

This is true at any age, but older people are at greatest risk because of all the damage they have already sustained. Furthermore, aging skin loses fat and water content and becomes thinner, allowing UV light to penetrate more deeply. At the same time, the body’s natural ability to repair damaged DNA diminishes (you may even see precancerous lesions grow bigger and more numerous), increasing the likelihood of abnormal cell growth that can lead to skin cancer. We never know exactly how much damage will trigger skin cancer, but studies show that one bad burn in older age may be the straw that broke the camel’s back, so the older you get, the more essential it is to practice comprehensive sun protection: seeking shade, especially between 10 AM and 4 PM; wearing sun-protective clothing, hats, and UV-blocking sunglasses; and using a sunscreen with an SPF of 30 or higher whenever you’re outside.

It’s just as essential to visit a dermatologist regularly. The dermatologist can partially repair some of your lifelong sun damage with lasers and photodynamic therapy, abrasion techniques, and topical medications such as retinoids, not just helping to rejuvenate your skin but also removing some precancerous lesions, thereby reducing your risk of skin cancer. Just as important, the dermatologist can discover cancers at an early stage before they become disfiguring and dangerous.

Published on March 4, 2015