Sun and Skin
Dr. Ralph Moss
Ackerman, MD, is an exceptionally distinguished dermatologist and
one of the world's foremost authorities on the subject of skin cancer.
In 1999, after a long career in academic medicine, he founded and
became director of the Ackerman Academy of Dermatopathology in New
because of his leadership and high standards, Dr. Ackerman's institution
quickly became the world's largest training center in the field of
dermatopathology. (Dermatopathology is the study of the disease processes
that affect the skin. It involves detailed knowledge of the microscopic
anatomy of the skin's structure in health and disease.) Dr. Ackerman
and his six associates examine more than 100,000 skin specimens and
do more than 4,000 consultations per year. Dr. Ackerman has published
625 research papers and his list of honors and awards includes this
year's Master Award, given to one person a year by the American Academy
makes this accomplished scientist particularly interesting is not
just his distinguished career in academic medicine but the fact that
he challenges some of the dermatology profession's most cherished
dogmas. According to an article in the New York Times (July 20, 2004),
at age 67, Dr. Ackerman "continues to teach and write, and also
to ask for data and question his field's conventional wisdom."
field is just replete with nonsense," he told the Times. For
Ackerman does not believe that the link between melanoma and sun
exposure (a central dogma of dermatology) has been proven. He himself
is deeply tanned and unafraid to expose his body to the sun.
does not believe that sunburns, even the painful or blistering kind
sustained early in life, necessarily lead to cancer. While some
studies do show a small association, he says, others show none.
Even those studies that show some such correlation "disagree
on when the danger period for sunburns is supposed to be,"
writes Gina Kolata, author of the New York Times article. Taken
as a whole, "the research is inconsistent and fails to make
doesn't buy the argument that sunscreens protect against melanoma.
He points to a recent editorial in an orthodox journal, Archives
of Dermatology, which also concludes that there is scant evidence
to support this crucial dogma (Bigby 2004).
while the incidence of basal cell and squamous cell carcinoma have
been shown to be closely linked to lifetime sun exposure, Dr. Ackerman
challenges the tenet that the more intense a person's exposure to
the sun, the greater their risk of melanoma. He believes that the
data for this also is not compelling. Although we are told that
the incidence of melanoma increases in populations that live nearer
the equator, the correlation is not that simple. Epidemiological
data on melanoma, says Dr. Ackerman, are imprecise and inaccurate.
The data simply "cannot demonstrate cause and effect."
a recent case-control study of 966 patients (Kennedy, 2003) studying
the effect of painful sunburns and lifetime sun exposure on the incidence
of several types of skin cancer concluded that lifetime sun exposure
is predominantly linked to an increased risk of squamous cell carcinoma
and to a lesser degree with two common types of basal cell carcinoma.
By contrast, this study found that lifetime sun exposure appeared
to be associated with a lower risk of malignant melanoma.
advises people to stay out of the sun in order to avoid premature
aging of their skin. He also says that if you are very fair, you can
prevent squamous cell carcinoma, a less dangerous cancer, by avoiding
sunlight. (Squamous cell carcinomas, although they can be disfiguring,
are rarely life-threatening.) But don't make the mistake of thinking
that by avoiding sunlight or using sunscreen you will be protected
against deadly melanoma. This, he says, is a myth.
knowledgeable researchers agree that sunscreens fail to protect against
melanoma. Dr. William B. Grant, for example, who heads the Sunlight,
Nutrition and Health Research Center (SUNARC) in San Francisco, points
out that sunscreens primarily block the shorter wavelength ultraviolet
(UV) radiation, whereas it is the longer wavelength UV that poses
the greater risk for melanoma.
feels that while there is some evidence pointing to a link between
sunlight and melanoma, it is not a simple cause and effect relationship.
There are many other factors that have to be taken into account. For
example, Dr. Grant points out that while it is true that melanoma
rates increase with increasing latitude, it is also true that even
as far north as Canada, Denmark and the Netherlands, occupational
exposure to solar UV radiation is associated with a reduced risk of
melanoma. Conversely, for those of northern European ancestry living
south of their latitude of origin, such as in Australia, New Zealand
and the US, melanoma rates are much higher than they are in their
countries of origin.
Dr. Grant points out that there is substantial evidence that dietary
factors, particularly vitamin D, can have a significant effect on
the risk of developing melanoma. He points to the work of Millen and
colleagues, of the National Institutes of Health, showing that diets
rich in vitamin D and carotenoids, and low in alcohol, may be associated
with a reduction in risk for melanoma (Millen, 2004). Therefore, Dr.
Grant feels that diverse factors including diet, skin type, the presence,
number and type of moles, and ethnic, ancestral and geographic origin
also have a major influence on melanoma risk. To say that sunlight
causes melanoma is at best an oversimplification and at worst a distortion
of the scientific evidence (Grant, 2004).
A Melanoma Epidemic'
is a questioning sort of person. He even debates whether the much-vaunted
"epidemic" of melanoma actually exists. The definition of
melanoma, he points out, has changed over the past few decades, leading
doctors to diagnose, remove and cure lesions that until recently would
not have been called melanoma at all.
criteria today, clinically and histopathologically, are diametrically
different from those 30 years ago," he said. In medical school,
he told the Times, "we were taught that melanoma is a big, black,
fungating tumor that kills. Who would have believed then that you
can recognize melanoma for what it is when it is small and flat and
the size of the fingernail on your pinky? You would have said they
were insane" (Kolata 2004).
a central dogma of the dermatology profession is that sun exposure
promotes melanoma. The American Academy of Dermatology's website states
that it is clear that excessive sun exposure can promote the development
of melanoma. But if this is correct why do African-Americans and Asians
develop melanoma precisely on those parts of the skin that are not
exposed to sunlight - the palms, soles, nails and mucous membranes?
Even among whites, the most common melanoma sites are the leg (in
women) and the trunk (in men). These are hardly the most sun-exposed
body parts. Why not on the face and arms, which are much more frequently
exposed to Old Sol?
arguments (and he is by no means alone in feeling this way) leave
conventional dermatologists sputtering with frustration. One leader
in the field told the New York Times that "it was perverse of
Dr. Ackerman to pick the data apart." But is it perverse to question
dogmatic beliefs? This official further claimed that melanoma can
occur in unexposed places because "sunlight suppresses immune
cells in the skin's surface that ordinarily hold cancer at bay."
While many would undoubtedly disagree with him, Dr. Ackerman does
not accept this immune surveillance' argument. He sees it as
a tenuous theory manufactured in order to support a dubious hypothesis.
insightful interview with Dr. Ackerman comes at a crucial moment in
the history of dermatology. In my opinion, the dermatologists have
painted themselves into a corner on the issue of sun exposure, sunscreens
and melanoma. The best that can be said is that they are trying to
stem what they perceive to be a rising tide of preventable melanoma
cases with a public health campaign. But the science behind this campaign
is shaky, at best.
leaders of the field, such as Dr. Ackerman, are now trying to help
their profession find its way back into the light. Although it is
not mentioned in this interview, the recent forced resignation of
Michael Holick, MD, PhD, from his dermatology professorship at Boston
University has overshadowed this debate and moved it from the back
rooms of Academe squarely into the medico-political realm. As readers
of this newsletter may remember, Holick was asked to resign after
he expressed opinions that were essentially identical to those of
Dr. Ackerman. But Dr. Holick took his arguments directly to the laypeople
in a popular book (The UV Advantage) andunlike the retired Dr.
Ackermanwas in a position that was vulnerable to retaliation.
previous articles on Dr. Holick click or go to any of the following:
the dermatology profession should reconsider its dogmatic positions
on the relationship of sunlight to melanoma. It should also reexamine
its embrace of the sunscreen industry, whose sales have grown from
$18 million in 1972 to almost a half billion dollars today. The supposedly
protective effect of sunscreen against the development of melanoma
is a major reason for that boom. According to medical writer Michael
Castleman, writing in Mother Jones magazine:
get much of their information from the SCF [Skin Cancer Foundation,
ed.], and the SCF, in turn, is heavily supported by the sunscreen
industry. (A sunscreen manufacturer even funded SCF's quarterly
consumer publication, "Sun and Skin News.") No wonder the
foundation doesn't give much credence to the growing number of studies
showing that even so-called broad-spectrum sunscreen doesn't prevent
melanoma. Like the road-destroying trucks that guaranteed work for
the concrete company, rising melanoma rates scare people into using
more sunscreen" (Castleman 1998).
Cancer Foundation has dozens of members of the sunscreen industry,
such as Pfizer, Johnson & Johnson and Procter & Gamble, on
Council." In return, the SCF awards its Seal of Recommendation
to many of these same companies' products. It is a cozy relationship
their collective good name, dermatologists need to come clean with
the public about what is scientifically proven and what is merely
speculative about the relationship between cancer and sunlight. In
particular, truth-seekers in the field need to band together and demand
that B.U. reinstate Dr. Holick. Nothing less will convince the public
of the dermatology profession's intellectual honesty.
W. Moss, PhD
is directed by Ralph W. Moss, Ph.D. Dr. Moss is the author of eleven
acclaimed books including Antioxidants Against Cancer, Herbs Against
Cancer, Questioning Chemotherapy, and Cancer Therapy. He consults
for thousands of clients through his Moss Reports service. The
Moss Reports specializes in educating cancer patients about the
most promising alternative treatments for their condition.
from Chet: Be sure to sign up for Dr. Moss's excellent newsletter
at his website.
ME. The end of the sunscreen and melanoma controversy? Arch Dermatol.
2004 Jun;140(6):745-6. Review.
William B, PhD, personal communication July 28, 2004. Dr. Grant's
Sunlight, Nutrition and Health Research Center (SUNARC) www.sunarc.org
C, Bajdik C , Rein W, et al., The influence of painful sunburns and
lifetime sun exposure on the risk of actinic keratoses, seborrheic
warts, melanocytic nevi, atypical nevi and skin cancer. J Investig
Gina. A Dermatologist Who's Not Afraid to Sit on the Beach. New York
Times, July 20, 2004. Accessed July 24, 2004 from:
Michael. Sunscam:Think sunscreen protects against cancer? Think again.
Mother Jones May/June 1998. Retrieved on July 24, 2004 from:
AE, Tucker, MA, Hartge P, Halpern A, et al. Diet and melanoma in a
case-control study. Cancer Epidemiolo Biomarkers Prev. 2004
Nutrition and Health Research Center (SUNARC) www.sunarc.org
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