If you were offered a do-over of your life, chances are sunburns and trips to the tanning salon would be on your avoid-at-all-costs list. While dermatologists can’t completely erase sun damage accumulated over the years, they now have many tools at the ready to help correct damage that starts showing in the 20s, 30s and beyond.
Sun damage, also called photodamage, occurs when the sun’s rays harm the skin’s DNA and also break down the collagen and elastin fibers that make skin smooth and taut. This DNA damage doesn’t just happen while you are outdoors and in the sun—it can continue for hours afterward, according to the American Academy of Dermatology (AAD).
“You might not realize that even when you have a tan, it’s not ‘healthy.’ It means your skin’s DNA was damaged,” says Sean Christensen, MD, PhD, director of Dermatologic Surgery at Yale Medicine Dermatology in Branford, located at 322 East Main St. The office’s opening this month coincides with the 30th anniversary of the Dermatologic Surgery Program. Now patients who need to see a dermatologist or have Mohs micrographic surgery to remove skin cancer can go to either Branford or 40 Temple St. in New Haven for care.
“By providing Mohs surgery in the Branford practice, we offer the broadest range of therapies to take care of the increasing number of skin cancers and melanomas we are seeing in our patients,” says Dr. Christensen, a dermatologic surgeon, which is a dermatologist with advanced training in removing skin cancers surgically.
The sun damages the deepest layers of the skin that often won’t be visible for years. “Many patients tell me they were unaware of the risks of sun exposure during their youth, until they start aging prematurely or learn they have skin cancer,” says Sarika Ramachandran, MD, medical director of the Branford office.
The more sun damage you’ve accumulated, the greater your risk for developing skin cancer and aging prematurely. But, it’s never too late to change your sun-worshiping ways. “We know from research that ongoing exposure to UV rays accelerates skin cancer formation,” says Dr. Christensen. Therefore, any decrease in sun exposure now will pay benefits in the future, even for patients who have already had one or more skin cancers.
Dermatologists can help undo severe and moderate damage caused by the sun’s rays using several treatments.
Severe sun damage: Skin cancer
Rates are on the rise. According to the AAD, one in five Americans will develop a form of skin cancer at some point in their lives. In the United States, about 9,500 cases of skin cancer are diagnosed every day.
If you have suspicious moles that are discolored or asymmetrical, bleed, or are evolving in size, elevation or shape, it’s a good idea to get them checked out by a dermatologist. “These can all be signs of skin cancer that needs to be removed before the cancerous cells have a chance to spread,” says Dr. Christensen.
The treatment: When a skin biopsy is taken and reveals skin cancer, a dermatologic surgeon can remove the spot using Mohs surgery. It’s a highly specialized and delicate procedure performed right in the doctor’s office under local anesthesia.
The surgeon removes only what’s necessary, layer by layer, to speed healing and minimize scarring. The dermatologist checks each section for residual skin cancer in an on-site laboratory while the patient waits in the office, explains Yale Medicine’s David J. Leffell, MD, founder and chief of the Dermatologic Surgery Program.
This procedure takes anywhere from one to a few hours (depending on how many layers need to be removed) and greatly increases the accuracy and success of skin cancer removal.
Moderate sun damage: Precancerous spots
It’s important to treat precancerous spots called actinic keratosis. That’s because a small percentage of these spots will turn into skin cancer over time. “Having actinic keratoses is a sign that your skin has been sun damaged, and you may be at increased risk to develop certain types of skin cancer, too,” says Jonathan Leventhal, MD, a Yale Medicine dermatologist who sees patients in the Branford office.
The treatment: There are several options available, including:
- Photodynamic therapy: This treatment can kill a few actinic keratoses or a broad area of abnormal cells during a procedure done right in the dermatologist’s office. The doctor puts a special medication on the skin and lets it soak in for one or several hours (depending on how much damage there is). Then, the dermatologic surgeon uses either blue or red fluorescent light (not ultraviolet) to activate the medication, which selectively kills abnormal, precancerous cells. Some patients need more than one treatment. “Photodynamic therapy is a nice way to treat a large area of precancerous lesions on the skin with relatively few treatments,” says Dr. Leventhal.
- Medications: Certain medications (such as topical fluorouracil and imiquimod creams) are also approved to treat actinic keratoses. Prescribed by a dermatologist, the creams are applied to the precancerous lesions, usually for a period of one to two weeks. The lesions will become inflamed and eventually slough off.
- Cryotherapy: For precancerous lesions, an experienced dermatologist use liquid nitrogen therapy to treat the area. A treatment that takes just a few seconds, the liquid nitrogen freezes the spot; over a few days, the spots may become crusty and slough off. It’s vital to have this procedure done by a highly experienced dermatologist since there is a risk of scarring. “It is also important that cryotherapy be performed by a provider who is able to distinguish actinic keratoses from other lesions that should be biopsied to check for skin cancer,” says Dr. Leventhal.
Whether your sun damage is severe or moderate, eliminating damaged cells can decrease the risk of future skin cancers. That’s good news for reformed sun lovers looking for a second chance at healthy, smooth skin.