By Ashley White, MD, MPH
“I’m a one, you’re a two and you’re a three,” I shared with two girlfriends as I doused every patch of my skin with SPF 70 sunscreen spray. The numbers refer to the Fitzpatrick skin scale, developed by Harvard dermatologist Thomas B. Fitzpatrick. The scale classifies how different people respond to ultraviolet light – specifically to one hour of sunlight on the first day of spring. So when my friends and I were in Las Vegas this weekend, the intense winter white I cultivated under scrubs and artificial lights all season was ready to burn.
I have light skin, dark hair and blue eyes. Normally, this would land me in the Fitzpatrick two camp. I take seconds to burn. But the ultimate dermatologic trump card? Freckles. And I’ve got’em good. Freckles are also known as ephelides and are non-malignant, non-mole hyperpigmentation lesions that get darker, bigger and more numerous with UV exposure. While freckles themselves aren’t malignant, the vast majority of people with freckles are Fitzpatrick one.
My friend Lena – a tall, blond, blue-eyed German – is Fitzpatrick two. She does tan but mostly burns. We went through two spray bottles of SPF 70 in less than 48 hours together. The last of our group was Kristen, a Fitzpatrick three. She kinda-sorta burns and has olive skin with dark features. Fitzpatrick four people have light brown skin, very minimally burn and tan easily. The Fitzpatrick five people have brown skin and almost never burn and the Fitzpatrick six people have very dark skin and tan very deeply. For dark brown and black people, the risk of certain types of skin cancer is low because they don’t burn so their skin cell DNA doesn’t take a beating like those of us see-through people. Even still, their risk is not zero.
Messing with the DNA of skin cells through UV light exposure can chart the course from normal skin cell to cancerous growth of mutant skin cells. I will say it again: UV light is a carcinogen. People who frequent tanning beds before the age of 35 have a 75% increased risk of melanoma – that’s the kind of skin cancer that can really kill you. In my humble opinion, none of this is worth the fashionable bronze look the Fitzpatrick one and two crowd seems to covet à la California girl. I would rather scare people with my blinding white skin than endure skin cancer, or even the risk thereof.
There are some lesions with malignant potential and there are a few different categories of skin malignancies that are of note. Many people have a genetic susceptibility but UV exposure is the biggest risk factor for all three categories. Very basically, basal cell carcinomas are pearly and sometimes have tiny blood vessels in them. They can invade the neighbouring skin and can even destroy cartilage on nose and ears. Most of these aren’t actually cancer but because they can invade, they need to be taken out.
Squamous cell carcinomas can look a lot of different ways, which is annoying. This is why a lot of doctors just perform in-office biopsies on lesions that look suspicious so that an exact diagnosis can be established. Both the squamous and basal types are overwhelmingly found on the face, ears, neck and arms. But in medicine, exceptions are the rule.
The third category of skin cancer is melanoma. It is the most serious. In the early stages, it sticks around the epidermis but it can invade anywhere. In the United States, nine thousand people die every year from melanoma. It comes in a variety of shades, sizes, shapes and colours. Again, this is why we take a sample of most things that don’t look completely smooth and uniform, like a mole.
So what do you do with all this information? If you live on Paudash Lake, or vacation there, I am going to go out on a limb and say statistically you’re likely Fitzpatrick one or two. Cover yourself up. Wear a ton of sunscreen, even between your toes and in your belly button. Then put it on again every hour. For the love of lake trout, do not use tanning beds. Then every month, look yourself up and down in all – and I do mean all – your nooks and crannies. See anything weird? Ask your doctor and ask them early. There is no stupid question that ever started with, “Can you look at this new thing I have on my skin?”
From my freckles to yours, enjoy your summer!