At one time, nothing came between Cheryl Hystad and the sun. She sought out a summer job that allowed her maximum exposure, baking -- without sunscreen -- in the lifeguard's chair.
Last August, a lifetime of sunbathing caught up with her. Ms. Hystad, then 33, was diagnosed with skin cancer.
"I thought I would never get it, especially this young," says the fair-skinned blond. "You always hear of people getting it in their -- 50s or 60s."
Not anymore. More and more young people are being diagnosed with skin cancer, say dermatologists. These young patients are among the 600,000 new cases expected this year, says Ruth Sikes, spokeswoman for the American Academy of Dermatology Chicago.
But not only are more people getting the disease; more are dying from it. Nearly 9,000 people are expected to die from skin cancer this year, 1,000 more than five years ago, Ms. Sikes says.
"It's almost approaching epidemic proportions," says Dr. Perry Robins, president of the Skin Cancer Foundation in New York. "When I first started my practice 26 years ago, the average age of my patients was late 60s. Now it's mid-50s."
The youngest patient he's ever treated had just turned 13.
Dermatologists believe that the sun and the depletion of the ozone layer are responsible for the increasing statistics. Public awareness also has caused many to be diagnosed earlier than before, they say.
Despite their efforts, however, doctors are still confounded by the prevailing notion that a golden hue equals good health. "Many of us spent many hours in the sun. It was Mom's general recommendation: The sun is good for you," says Dr. Kenneth P. Judd, the chief of dermatology at Greater Baltimore Medical Center.
Ninety-five percent of the skin cancer cases are caused by the sun, says Dr. Robins. (The remainder come mostly from chemicals, burns and injuries.) And with prime sun season nearly here, he winces when he considers the damage people will do during a week at the beach.
"The tan or sunburn will go away, but the underlying damage to the skin won't," says Dr. Robins, who is an associate professor of clinical dermatology at New York University Medical Center.
Most of the damage is done before people reach adulthood. The disease can enter an incubation period of 30 or 40 years, says Dr. Joseph Burnett, director of dermatology at the University of Maryland Medical Center. So avoiding the sun as an adult is no saving grace, he adds.
"It's common for a patient who's 50 or so to come in with skin cancer and say, 'But I haven't been out in the sun in 10 years,'" says Dr. Judd.
Bearing that in mind, dermatologists believe it's most important to spread the word to parents -- encouraging them to take extra precautions to protect their children from the harmful effects of sun exposure.
Ms. Hystad, who recalls receiving blistering sunburns as a child, is resolved to be more careful with her own 10-month-old daughter, Julia.
"I'm concerned whenever she's in the sun," says Ms. Hystad, who makes a point of putting suntan lotion and a sun hat on her daughter when she's outside.
The five-year survival rate for her type of cancer, basal cell carcinoma, is "literally 100 percent," says Dr. Judd. There are two other kinds: squamous cell carcinoma and malignant melanoma. The latter is considered the most dangerous; if left untreated, malignant melanoma may spread to other parts of the body, says Dr. Judd.
Skin cancer warning signs include any bump, red patch or mole that changes color or shape, bleeds, flakes, itches, burns or causes pain. Any of these should be cause for a visit to either a family practitioner, general internist or dermatologist.
Fair-haired, fair-skinned people who have had three or more severe sunburns face the greatest risk of developing skin cancer. The most common areas are the face, neck, shoulders arms, hands, lower legs and back. More men than women suffer from malignant melanoma, and doctors consider it an occupational hazard for fishermen, construction workers, farmers and other trades.
Depending on the type of skin cancer diagnosed, treatment can range from surgery to freezing to injections of interferon.
The best way to avoid being at risk: Stay out of the sun. If you must be in the sun, doctors recommend wearing protective clothing and using a sunscreen with a sun protection factor of at least 15.
"Tan slowly, avoid burning and use plenty of moisturizer," says Dr. Judd.
Dr. Robins also recommends people take advantage of the free screenings offered at local hospitals and conduct skin cancer self-exams at least four times a year.
Studies have shown that nearly 40 percent of the patients will develop a second skin cancer within five years. Follow-up treatment varies, but Dr. Judd recommends visiting a dermatologist a month after the skin cancer is removed. With malignant melanoma, he prefers to check patients every three months for the first year and then every six months for the next five years.
With proper precautions, the prognosis can be good.
"No one need die from skin cancer," says Dr. Robins. "Early detection makes all the difference. One eighth of an inch can mean the difference between life and death."
SKIN CANCER SELF EXAM
When conducting a self exam for skin cancer, look for:
* A skin growth that increases in size and appears pearly, translucent, tan, brown, black or multicolored.
* A mole, beauty mark or any brown spot that changes in size, thickness of texture; is irregular in outline; is bigger than a pencil eraser.
* A spot or sore that continues to itch, hurt, crust, erode or bleed.
D8 * An open sore that doesn't heal within three weeks.
1. Examine face, especially the nose, lips, mouth and ears -m front and back.
2. Thoroughly inspect scalp. Get a friend or family member to help, if you can.
3. Check hands carefully. Examine front and back of arms.
4. Scan all sides of upper arms.
5. Next focus on neck, chest and torso. Women should lift breasts to view underside.
6. With back to the full-length mirror, use hand mirror to inspect back of neck, shoulders, upper back.
7. Still using both mirrors, scan lower back, buttocks and backs of legs.
8. Sit; prop each leg in turn on another stool or chair. Use hand mirror to examine the genitals. Check front and sides of legs; ankles, tops of feet, between toes and under toenails. Examine soles of feet and heels. The following hospitals are offering free skin cancer screenings:
Howard County General Hospital's Outpatient Testing Center, 5755 Cedar Lane. Thursday, 9 a.m. to 6:30 p.m. No appointment necessary. Call (410) 740-7800.
University of Maryland Medical Center, University Health Center, S. Greene St., Friday, 8:30 a.m. to 11 a.m. Appointment necessary. Call (410) 328-4300.
Montgomery General Hospital's Physicians Office Building, 18111 Prince Philip Drive. June 3, 7:30 p.m. to 9 p.m. Advance registration required. Call (301) 598-9815 between 10 a.m. and 4 p.m.