Sun and Skin
Dr. Ralph Moss
Bernard 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 York.
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 of Dermatology.
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
Dr. 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
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
Ackerman 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.
Grant 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.
addition, 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).
Ackerman 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).
noted, 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
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
my 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).
Skin Cancer Foundation has dozens of members of the sunscreen industry,
such as Pfizer, Johnson & Johnson and Procter & Gamble,
on its "Corporate
Council." In return, the SCF awards its Seal of Recommendation
to many of these same companies' products. It is a cozy relationship
restore 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
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
case-control study. Cancer Epidemiolo Biomarkers Prev. 2004
Nutrition and Health Research Center (SUNARC) www.sunarc.org
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