Susan Tannura grew up soaking in the sun. She spent her summers working as a beach lifeguard, and recalls long days lying out in the sun.
"I was always the kind of person who had to have the best tan," she said. "You always look better with color."
Her quest for the constant tan continued into adulthood. A few years ago Tannura bought a convertible to get an extra dose of sun on her way to work. She loved spending all of her free time with her husband and two children at their backyard pool.
Then, in May 2007, at the age of 38, her dermatologist found multiple suspicious lesions on her face and referred her to Dr. Anthony Tufaro, a surgical oncologist and plastic surgeon at The Johns Hopkins Hospital in Baltimore.
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It was Tufaro who biopsied the lesions and diagnosed her with basal cell carcinoma, which is not only the most common type of skin cancer, it is the most common form of cancer overall. Basal cell carcinoma grows slowly but can spread if ignored for several years. Left untreated, it can do a lot of local damage, penetrating below the skin into the bone or nerves.
Tufaro told Tannura that he needed to operate on her.
"It's five separate malignancies on your face, so left unchecked, these will grow and become problematic," Tufaro told her.
On the day of her surgery, Tannura worried what she would look like after the lesions were removed from her face. After the operation Tufaro admitted that initially, she might taken aback by the scars.
"Now she's got a bunch of scars and incisions, so no matter how good it looks to us, it's going to be devastating to her," Tufaro told ABC News.
As a reconstructive surgeon, Tufaro's goal is to not only remove the cancerous lesions, but also to make her scars barely noticeable.
"No matter how you try to masquerade these things, she has a lot of incisions," Tufaro said of Tannura's face. "I can place the scar in the right position so it will animate well, meaning it will go with a natural crease. A thin white scar that is flat will not attract attention, but if it's raised or depressed or doesn't animate properly, it will get your attention and you'll keep looking at it."
Identifying Skin Cancer
According to the American Academy of Dermatology, it is estimated that more than one million Americans develop skin cancer ever year. Tannura was diagnosed with basal cell carcinoma, but doctors warn that over-exposure to the sun can lead to other more dangerous forms of skin cancer, such as squamous cell carcinoma and malignant melanoma.
Squamous cell carcinoma, the second most common skin cancer, often appears as a bump or red, scaly patch on the face and can spread to other parts of the body. Squamous cell carcinoma is generally the result of sun exposure, but according to the American Academy of Dermatology it can sometimes occur as a result of chronic wounds or damage to the skin.
Malignant melanoma, the rarest but most dangerous type of skin cancer, accounts for the overwhelming majority of skin cancer deaths. Melanoma often begins in or near a mole and early detection is essential for removal in a curable stage.
According to the American Melanoma Foundation, one American dies from melanoma almost every hour. Sunscreen as well as limiting time spent in the sun can help prevent melanoma.
Protecting Yourself From Harmful Rays
In addition to sun exposure, tanning booths can also increase your risk for skin cancer. Customers searching for the perfect tan may instead wind up with harmful UVA exposure and more wrinkles.
"Unlike statements made by some tanning booth salons, tanning booths will cause aging and wrinkling and significantly increase your risk of all skin cancers, including melanoma," said Dr. Philip Hellreich, associate clinical professor of medicine at the John A. Burns School of Medicine at the University of Hawaii.
Hellreich, a dermatologist, says that tanning booths mainly use UVA rays, which can cause wrinkling, and lesser amounts of UVB rays, which can cause sun burns.
While exposure to UVA rays can be damaging, you don't need to hide from the sun either. Hellreich advised that when you do go in the sun, use a sun screen with a Sun Protection Factor (SPF) of at least 30.
He recommends using a good quality sunblock. One of the best blocking agents currently available, according to Hellreich, is Anthelios which has a blocking ingredient called Mexoryl. It has been available in Europe for many years but was only approved by the FDA in 2006. Hellreich also recommends Neutrogena sun protection products with Helioplex.
Forgot your sunscreen? A company called Sunscreen Mist has developed booths that spray full body applications in only a few seconds. Users can choose the SPF level they desire. There are Sunscreen Mist booths at some beaches, water parks and resorts in Miami, Las Vegas, Myrtle Beach, S.C., and Chicago.
Tannura's Battle Continues
Tufaro operated on Tannura a second time to remove more basal cells in May, one year after her first surgery. Tufaro warned Tannura that this might only be the beginning of her battle against skin cancer and that she will need to regularly check herself and continue to see doctors.
"Cancers that develop early in life are forecasters of the future. She's going to have many more of these," Tufaro said.
But Tufaro says he makes no judgments on what could be called a self-inflicted disease.
"Many of the problems we deal with every day are because of things to which we have in some way contributed," Tufaro said. "I'm not here to make value judgments on what people do; I'm here to take care of patients and to tell them what they can do to improve their lives. But I'm not there to judge them and say God gave you this because you sat in the sun. I tell them how I can help them fix their problem and what they decide to do after they leave my office is their free will as adults."
For her part, Tannura has vowed to mend her habits in the sun that she so deeply loves.
"I think I'll still be going to the beach and going on vacations to sunny places," she said. "But I'll be sitting under the umbrella watching the kids swim."