By Steve Hanf

Like millions of dads around the world, Andrew enjoys spending time on the beach with his family. And just like many others, he’s got his preferred beach routine down pat.

Shade canopy and umbrellas? Check. A variety of sunscreens and creams chilling in the cooler? Check. Timers set for when it’s time to reapply. Check.

After all, come Monday morning, Andrew – make that Doctor Andrew Villanueva – has a reputation to uphold when he walks into his Forefront Dermatology office.

“It wouldn’t look good if I came in to work with a tan or a burn,” he says with a laugh. “We still do get out in the water. We still enjoy it. Getting a little sun isn’t going to hurt you. You do it in moderation, you’ll be totally fine.”

Sage advice, of course, but the words “Outer Banks” and “moderation” don’t often happen together. When you live at the beach, sun worship can become a way of life. When you work at the beach – lifeguarding, fishing, doing pools and landscaping, roofing – so many of those long, punishing hours take place under cloudless skies. Vacationers flock here to eat too much, drink too much and sunbathe too much, making locals wince in sympathy (and sometimes empathy) at the sight of that glowing red skin.

All too often, the consequences of those long-forgotten sunburns materialize decades after you’ve finished peeling. According to the American Academy of Dermatology, one in five Americans will develop skin cancer in their lifetime, making it the most common form of cancer in the U.S. While the vast majority of the nearly 10,000 people a day who are diagnosed with skin cancer have highly treatable cases, nearly 20 a day die from melanoma.

Outer Banks Coastal Life caught up with three local healthcare providers to get their thoughts on this juxtaposition of staying safe while also enjoying this sun-soaked place we call home.

An ounce of prevention…
Villanueva, who splits his time between Forefront’s offices in Kitty Hawk, Virginia Beach and Chesapeake, says most people understand the best ways to stay safe in the sun.

Concentrate on lower-intensity morning and later afternoon hours rather than being out from noon to 3, and definitely take care to not nap on the beach.

Wear sunscreen and sun-protective clothing, including sunglasses and a wide-brimmed hat: “Ball hats are great and all for the front of your face, but I unfortunately do too much surgery on ears,” he says. “Your ears stick out like little satellites from your ball caps.”

As for chasing that bronze complexion inside, plenty of discussion on the dangers of tanning beds has taken center stage in recent years, with 44 states now restricting access in some way. In North Carolina, for instance, no one under the age of 18 is allowed to use a tanning booth.
“Oh my God, those are coffins with lights,” Villanueva says. “Skin cancer usually affects people 50, 55 and above, but unfortunately I’m treating a lot more younger patients than expected, from late 20s to early 30s. Nine out of 10 times it’s usually the tanning booths.”

We all know about sunscreen… right?
Dr. Jeff Pokorny, a plastic surgery specialist with Carolina Coastal Plastic Surgery, did a deep dive on all things sunscreen a decade ago while coming up with a product that many locals will remember: BANXblock. While the specialty brand proved too much to juggle with everything else Pokorny and his wife had going on and is no longer on the market, the experience of developing a new sunscreen proved highly educational.

Pokorny says sunscreens didn’t really become popular until the 1970s, with the goal of applying some kind of suntan lotion being to prevent a painful sunburn. But…

“Preventing sunburn and preventing skin cancer are potentially two different issues,” Pokorny explains. “Evidence indicates that getting intermittent severe sunburns is probably your biggest risk factor for skin cancer. If you tend to kind of hold a tan throughout the year, that’s not nearly as dangerous as somebody who gets badly burned two or three times a season repeatedly over the years.”

Americans may have taken sun safety more seriously 100 years ago, as is displayed by this early 20th century photo of Nags Head beachgoers. The first intended use of parasols and umbrellas was not for protection against rain, but to shield from the sun. The history of beach umbrellas links to Ancient Egypt. Photo from the David Stick Papers, Courtesy of the Outer Banks History Center.

That being said, Pokorny also points to efforts in the 1990s to make sure everyone spending time outside used sunscreen as a great example of showing how the math of “more sunscreen = less skin cancer” doesn’t add up.

“Despite the fact that people were using more sunscreens, the skin cancer rates continued to increase. So, we kind of thought this was an opportunity to come out with a sunscreen product that was specifically designed to not necessarily just stop you from getting sunburned, but the idea of finding active ingredients that may help prevent skin cancer,” he says.

At the heart of that idea is using a sunscreen that blocks and reflects the sun’s rays so that solar radiation never reaches the skin and therefore cannot do its damage at the cellular level. And that’s what BANXblock offered: All-natural ingredients like zinc that block both UVA and UVB radiation from the sun’s rays.

“The chemical-based sunscreens may have some value, but I think they’re more of a product that allows that solar radiation to penetrate your skin and then either absorbs the radiation inside your skin or, worst-case scenario, allows the damage to occur and then just blocks your body from responding to it,” Pokorny says. “So, the take-home is that if your goal is to prevent skin cancer, you should maybe disregard the SPF on the bottle and look at zinc and titanium. Water resistance is an important point, too.”

While BANXblock is gone, there are countless zinc-oxide and other mineral-based sunscreens currently on the market. Caroline Conkwright, who has worked at Forefront for the past 10 years as a Certified Physician Assistant, points out that new sunscreens coming onto the market are actually helping reverse some of the past damage that’s been done.

One of her favorite products to recommend is ISDIN, developed in Spain for sun worshippers on the Mediterranean coast. Conkwright got her mother and father-in-law using ISDIN and says, “their skin looks like it literally has been reverse-aging because of that sunscreen.”

No stranger to sun damage, Outer Banks Coastal Life’s editor, Jeff Donohue, underwent photodynamic therapy – better known as “blue light treatment” a few years back. While closely resembling a mean sunburn, the procedure helps to eliminate pre-cancer cells, with the red glow typically subsiding in less than a week.

What if the damage has been done?
There are other ways to try to lessen the consequences of old sun damage, Conkwright says. Some people are familiar with photodynamic therapy – better known as “blue light treatments” – that can help kill abnormal, potentially cancerous cells in specific spots of the skin. Pre-cancer creams can do the same thing.

The important thing, especially as people age, is to make sure regular skincare checks are done at both primary care visits as well as dermatology appointments. After all, the damage has been done. For most, it’s a matter of “when” rather than “if” when it comes to skin cancer.
“When I was growing up, I was actually one of those people that did the baby oil when I was a teenager and I went to tanning beds when I was in college,” Conkwright says. “Just thinking back on all the horrible things that I’ve done to my skin and now seeing what it can do years down the line, it’s just such a wakeup call, and I just wish that people could really see what they’re doing to their skin.”

Conkwright rotates between the Forefront offices in Kitty Hawk, Elizabeth City and Virginia Beach. A typical day at the Kitty Hawk location will see 30 to 40 patients come in, most of them for routine skin checks and then smaller numbers who need treatments for skin issues such as acne or eczema, and those seeking aesthetic treatments.

A regular number of skin cancer excisions and atypical mole removals also take place every day, and Conkwright says the Kitty Hawk office tends to see the most skin cancers when those trouble spots are detected and analyzed.

Villanueva is Forefront’s Mohs surgeon, the surgical procedure that removes a lesion from the skin in thin layers until no other cancer cells are found. In a typical week, he spends the vast majority of his time with small basal cell carcinomas, which are the most common skin cancers in the world.

“I kiddingly say, ‘If you’re gonna grow skin cancer, this is the one I recommend,’ only because it doesn’t really spread to any parts of the body, but it does continue to grow,” Villanueva explains. “We just get the roots out, keep it as small as possible.”

But throughout the spring months, Villanueva also saw what he called an “astronomical” number of melanoma cases among his OBX patients.
“Those are the dangerous ones. I don’t like hearing the M word around my clinic,” Villanueva says. “Melanomas are the ones that can rapidly spread or have a higher rate of mortality, and ones that we want to try to catch as early as possible.”

Once the cancerous spot has been removed, Villanueva continues his crusade on continuing education. He tells the grandparents he treats to wear their bandages proudly: Tell the kids and grandkids about this sun damage from 20, 30, 40 years ago that got you. That you got it checked out and taken care of. And that it didn’t have to be this way…

“At the end of the day, that bandage over their nose or ear or cheek is going to be a reminder to someone they’re personally close to and remind people this isn’t something they need to be taking lightly,” he says.

If an especially large chunk of skin needs to be cut out to remove a cancerous spot, or if it’s in a tricky area like an eyelid or the nose, plastic surgery might be necessary. That’s where Pokorny and other plastic surgeons come in.

“We cut out a lot of skin cancer and we also do reconstructions after they’ve been cut out,” he says of Carolina Coastal Plastic Surgery. “When you identify cancers when they’re small, our job is very easy. It’s when things get out of control that it becomes more of an issue and could be a disfiguring or deforming event for them.”

The key comes in stopping skin cancers before they have a chance to take hold. No sunburns. Tanning in moderation. Constant vigilance. All those things people know yet struggle to put into practice.

“I think it’s a hard sell,” Villanueva says. “Some longtime patients, I see them come in for surgery and I’ll give them a little hell, ‘Why do you look so tan, you’re coming in to get your cancer removed?’ and we’ll banter back and forth in a good way. It’s hard to teach an old dog new tricks, but I think it’s possible. There’s a lot of educational information and our current culture now knows about it.”

Steve Hanf lives in Southern Shores with a sun-conscious redhead. Reporting this article did, however, evoke memories of a painful sunburn during a snorkeling outing in the Bahamas 25 years ago.

Author: Steve Hanf

Steve Hanf is a former professional sportswriter who teaches the journalism classes at First Flight High School. The dormant Nike Running Club app on his phone offers a reminder of the seven half-marathons and one full marathon he completed … several years ago.