
Should You Get a Scary UV Photo of Your Skin Damage? - bookofjoe
https://www.nytimes.com/2019/08/16/style/uv-photos.html
======
dcolkitt
The powerful dermatology lobby has consistently misled the public about the
so-called dangers of sun exposure. We've known for decades that sun exposure
has a strong _inverse_ relationship with all-cause mortality.

The fact of the matter is that the vast majority of Americans should be
getting a lot more sun exposure, not less. The intellectual sleight-of-hand
comes from an obsessive focus on skin cancer mortality to the exclusion of all
other causes of death. At the end of the day skin cancer is a relatively rare,
easily treatable disease, which only makes up 1.2% of all cancer deaths and
0.25% of all deaths.

Another way to think about this is even if sun exposure increased skin cancer
mortality by 250% (it doesn't), the documented 3%+ reduction in CVD is more
than enough to outweigh it.

[1]
[https://www.ncbi.nlm.nih.gov/pubmed/28074966](https://www.ncbi.nlm.nih.gov/pubmed/28074966)

[2]
[https://seer.cancer.gov/statfacts/html/melan.html](https://seer.cancer.gov/statfacts/html/melan.html)

~~~
gniv
> At the end of the day skin cancer is a relatively rare, easily treatable
> disease

Please don't say that. Most skin cancers are indeed treatable (basal cell and
squamous cell). But melanoma is not, unless caught early. Yes, there are some
better drugs now, but it's far from treatable. I have heard too many stories
of people who went to the dermatologist to have a mole checked, and 9 months
later they were dead. Melanoma is scary.

~~~
fragsworth
Melanomas are largely treatable because they _are_ caught early. People tend
to notice fast-growing tumors on their skin, unlike in other areas of their
bodies.

~~~
01100011
People often miss things, or mistake them for something else. My buddy thought
he had a mole on his ear until it turned out it was aggressive melanoma. They
reconstructed his ear and took out some lymph nodes, and 2 years later it came
back in his lung. Fortunately he enrolled in a clinical trial of immune based
chemo, so he only lost his thyroid and adrenal glands.

How likely is it that you'd notice melanoma on your scalp or back?

------
crazygringo
I've been Googling it and simply cannot find, anywhere, an explanation of why
areas of skin that reflect less UV (and are therefore darker) are "skin
damage".

Is this medically legitimate, or just a cool camera effect whose medical
causes/effects are unproven or uncorrelated with sun exposure or skin cancer?

To play devil's advocate, couldn't these just be spots that appear with
genetics or age regardless of sun exposure? And are there statistics showing
that skin cancer appears with significantly greater frequency on the dark
spots as opposed to lighter areas? Or heck, couldn't the dark spots function
as skin _protection_ (rather than "damage") since darker skin protects you
from the sun in general?

I _can_ believe it -- but the complete and total absence of any easily
verifiable facts here makes me skeptical about taking this at face value.

~~~
atombender
The thinking used to be that a tan (a complex process called melanogenesis)
was the skin protecting itself from DNA damage. However, research in recent
years suggests that DNA damage has already happened at the point when tanning
occurs.

For example, there's this oft-cited paper:
[https://www.ncbi.nlm.nih.gov/m/pubmed/15748643/](https://www.ncbi.nlm.nih.gov/m/pubmed/15748643/)
("Melanogenesis: a photoprotective response to DNA damage?"). Relevant quote:
"Growing evidence now suggests that UVR induced DNA photodamage, and its
repair is one of the signals that stimulates melanogenesis and studies suggest
that repeated exposure in skin type IV results in faster DNA repair in
comparison to skin type II. These findings suggest that tanning may be a
measure of inducible DNA repair capacity, and it is this rather than pigment
per se which results in the lower incidence skin cancer observed in darker
skinned individuals."

This does seem to be the current paradigm in dermatology, and it reflects what
I've been warned of by dermatologists. I've not been able to find any recent
research that challenges this theory.

~~~
Noumenon72
I never thought that a tan protected you from DNA damage _from the sunlight
that caused you to tan_. I thought that it protected you from _future_ DNA
damage to the now more type IV-like skin.

------
bhouston
Is this UV damage or just our reflecitivity to UV light?

~~~
iuvt7g67b
Melanin converts 99.9% of UV radiation into heat.

Even the synthetic form as noted here
[https://www.ncbi.nlm.nih.gov/pubmed/15068035](https://www.ncbi.nlm.nih.gov/pubmed/15068035)
The risk is poor nutrition, copper is needed for this skin pigment, which
means competing with the demands placed by other parts of the body like
collagen, (bones, skin, etc etc), blood cell production and more. Another
problem is the skin is washed often, daily in most cases and exposed to
chemicals which can become carcinogenic under the sun. Carcinogenic suncreams
exist. So its a complicated picture, poorly understood. The photo's are useful
for seeing the distribution of cells.

------
sharkweek
Hey! You! Schedule a visit with a dermatologist today.

The appointment takes about 20 minutes, and they do a great thorough check of
all your moles and other skin irregularities. If you go once a year or so,
they'll almost certainly catch anything that needs to be removed before it
gets deadly.

Two stories:

First, a close friend of mine ignored a skin irregularity for years and years
until he had to have his entire thumb amputated. Unfortunately, the melanoma
had already spread, and now he's a terminal patient (although a few clinical
trials have helped extend his life beyond the initially predicted timeline!).

Second, my business partner goes in to get his skin checked every year. The
dermatologist caught an irregular mole, confirmed it was cancerous, but
because of how soon it was caught, the doctor removed it, and he hasn't had
any other signs of cancer since.

~~~
dcolkitt
There's no evidence that population-wide skin cancer screening has any impact
on overall mortality. And in fact dermatologists have an enormously high rate
of misdiagnoses leading to a lot of unnecessary painful and stressful
biopsies.

> The second ecological study compared the melanoma mortality experience in
> Germany with the melanoma mortality experience of subregions of 22 European
> countries for the years 2000 to 2013, none of which had organized screening
> programs. After adjustment for potential confounders, Germany and the 22
> European regions had similar malignant mortality rates, suggesting no
> benefit of screening.[30]... One case of melanoma was detected per 28
> excisions overall (for both men and women), while 52 skin excisions were
> required to detect one melanoma in men aged 20 to 34 years.[31]

[https://www.cancer.gov/types/skin/hp/skin-screening-
pdq#_24_...](https://www.cancer.gov/types/skin/hp/skin-screening-pdq#_24_toc)

My advice would be just the opposite. Unless you're an at-risk individual or
have a family history of melanoma, skip the dermatologist appointment.

~~~
CalRobert
Very valid points, but for what it's worth some people will worry until
they've got a negative from someone who knows what they're doing. False
positives are stressful, but I like having someone who actually understands
dermatology take a look, especially since I grew up getting way too much sun,
and since I started balding have had a couple bad head burns (I now understand
why hats are a good thing).

Also, if you don't have a partner who sees you naked on a regular basis, there
are parts of your body you probably don't see too often. I have a birth mark
my wife sees more than I do.

~~~
kaybe
> Visual examination of the skin in asymptomatic individuals may lead to
> cosmetic or functional complications of diagnostic or treatment
> interventions and the psychological effects of being labeled with a
> potentially fatal disease, although robust data on the frequency of such
> events are lacking. Other harmful consequences are overdiagnosis, leading to
> the detection of biologically benign disease that would otherwise go
> undetected,[7,8,32] and the possibility of misdiagnosis of a benign lesion
> as malignant.

The potential harm does not sound too horrible, especially since anomaly
detection normally results in removal of a small piece of your skin that heals
easily and that's it.

> One case of melanoma was detected per 28 excisions overall (for both men and
> women), while 52 skin excisions were required to detect one melanoma in men
> aged 20 to 34 years.

On the other hand, the detection rate is actually quite high in my opinion,
since they tend to cut out anything small that is suspicious and only do a
thorough check afterwards.

It might be different from an economic point of view for the system paying for
these checks, but as an individual I'd say there is little to lose and a lot
to gain. (The options usually are: Nope, no cancer and you have a small
wound/scar. / Yes, it was cancer, but we already took it out so you're fine
now.)

~~~
ofibrvev
Melanoma biopsies are not typically “small pieces of skin”.

Any other kind of biopsy will be unreliable and is more likely to be a waste.

How are you basing detection rate on that information? Hint: you can’t. Or if
you are implying that detecting 1 case in 52 cases of melanoma is good (a
sensitivity of 2%) then you’re nuts.

All medical students and dermatologists train on the basic guidelines for skin
cancer screening. Please leave this to the professionals.

------
danepowell
I read the whole article expecting the question posed by the title to be
answered. It never was, nor was there any appeal to science, data, or
statistics on UV skin photography. Pretty disappointing.

Specifically, I wonder how good of an indicator of sun damage or cancer risk a
photo like this really is, or if it's just an advertising gimmick.

~~~
gniv
It kind of is answered, at the end:

"Doctors don’t need UV photography for diagnostic purposes. “We are trained to
pick up on subtle changes,” said Dr. Rachel Nazarian, a dermatologist with
offices in Murray Hill. The pictures, she said, are “meant for dramatic
effect."

