Tanner’s Remorse: Message From Dermatologist With Skin Cancer
Wednesday, September 2nd, 2009
By Dr. Ellen Marmur
You were so careful all summer with the sunscreen. You applied it head to toe before you left the house to go to the beach, or pool, or club, or to lie out in the sun. And you even reapplied your sun protection every two hours! You have a hat, a surf shirt with UV protective fabric—you were committed!
But…you still got a tan. OK, it was cloudy one day and you didn’t realize so much sun (50 percent) gets through! Plus, you forgot your tube of sunscreen at home and you stayed out a little longer. And the last weekend of summer, you were just too relaxed to stress over anything.
And now you’re tan. And feeling maybe a little regret or guilt or even concerned. It’s time to go back to work looking rested and healthy and that too tanned look actually looks haggard. What can you do? How do you take away the tan and get back to healthy skin?
Here are a few tricks.
First—unexciting but simple—resume your sunscreen use. Drop the number from SPF 30 to SPF 15. Use the sunscreen stick or foam applicator when you reapply mid-day. Remember, the celebs wear sunscreen indoors too! (Especially inside airplanes.)
Second—start using a bleaching cream at night on your brown patches. Hydroquinone 4 percent is the key ingredient found in combination with glycolic acid, tretinoic acid, or hydrocortisone creams. Don’t go higher than 4 percent because too much can lead to blue-black permanent skin discoloration (called ochronosis.)
Third—use a creamy exfoliater daily. This removes the tough, tobacco colored dead skin faster and helps to restore your glow.
Fourth—invest in a medium strength chemical peel or even smarter—a Fraxel laser resurfacing treatment. This will help remove damaged cells as well as brown pigment. Remember, tan is trauma. It reflects cells that have been heated up and are in emergency defense mode. Melanin pigment makes us tan (which for some reason makes us feel young and beautiful again) but its sole purpose is to defend DNA from further UV attack. It literally covers the DNA like a shield. But if you’re tan, your DNA has already been hit and possibly mutated and this is where skin cancer starts. Resurfacing and peels remove the surface cells and may help eliminate early skin cancer cells.
Fifth—eat well. Food is the best way to optimize your immune system to heal thyself. Eat salmon and sunflower seeds and avocado and drink green tea. For a comprehensive guide to what to eat for good skin check out chapter three in “Simple Skin Beauty.”
Tanning was just recently upgraded from a possible to a known carcinogen by the World Health Organization. You’ve heard the sunscreen message a million times before but let it sink into your skin. Enjoy your active lifestyle but use protection—it will be one of the best investments you’ll ever make.
Dr. Ellen Marmur is an Associate Professor and the Chief of Dermatologic and Cosmetic Surgery at The Mount Sinai Medical Center in New York City. Dr. Marmur specializes in skin cancer, surgery, cosmetic surgery, and women’s health dermatology. Her first book, “Simple Skin Beauty” (Atria Publishing) will be available in October 2009.

Fellow volunteers, many of whom I now consider friends, use these photos for fundraising purposes. I use them to show friends and family why these trips are so important to me. You always ask someone if it’s ok to take his or her photo beforehand. It’s a common courtesy. I can count on one hand the occasions someone said no. Kids smile and giggle and with the invention of digital cameras, their faces illuminate when they see their own picture – probably for the very first time. My first two visits I shot on 35mm and could not do this.
Before my first trip with Hearts in Motion, I searched for information on what the country is like. I knew it was riddled with poverty and I knew not to drink the water (or brush your teeth with it or be caught singing in the shower) for fear of “traveler’s revenge.”
What surprised me more than any book or article could say is just how friendly the people are. I’m not saying that if I walk down the street in Guatemala City that people say hello. They don’t do that where I live in New York City. Yet in small villages or even larger towns, people welcome me.
I don’t go out alone at night. I just go out each day to help someone get medical care, a clean shirt, a new toy. In return, I bring home souvenirs in the form of photographs and the occasional stomach bug. A small price.
The cervical cancer screenings and basic exams for women require a special team of practitioners from the states. It’s like many of the other clinics Hearts in Motion does in Guatemala throughout the year and this is often the only chance these women have to get this examination. Each February, a group of old and new volunteers spend 4-5 days visiting different villages while the general medical clinic operates adjacent. Many of these same volunteers travel to Roatan, Honduras each September as well.
The highlights of my five trips to Guatemala often come from our general medical clinics. You see how people live in mud-and-stick fabricated homes to how they pass the time without television, Internet, school or even unfortunately a job. Sometimes it’s a 3-hour road trip through mudslide-ravaged villages. Other times, it’s 25 minutes off the main transcontinental road. There are clinics where we see 75-100 patients and then those that easily reach in to the hundreds. Parasites are a common problem, as is malnutrition. For many, this is their one chance to be seen by a health care professional even if they might not have an ear infection or exhibit symptoms of disease. Vitamins, a little ibuprofen for an aching back or antacid for recurring heartburn often does the trick. Sometimes parents of children born with cleft palates come seeking assistance and we arrange for them to be evaluated by our plastic surgery team that visits each March.
This February, I translated for a pediatrician who himself has adopted four children from Guatemala and wanted to “give back” to the country that has given him so much. A man in his 40s recovering from a stroke came in with his family. (It’s not often we see men at these clinics except on Sundays.) After a brief examination, we referred him to a local neurologist in addition to regular physical therapy at the clinic Hearts In Motion built in the nearby city of Zacapa.
On average, clinics see about 200 general medical patients each day. There are also clinics specifically for dental care (extractions, cleanings), eye care and ob/gyn care (more on that next week.) And while it’s not a clinic, the most-eye opening experience for many volunteers is visiting the local garbage dump where many people live. We make sandwiches of bean puree and cheese and fill plastic bags with horchata — a rice milk drink. The residents come running when our yellow school bus makes it way in and line up waiting for a meal and the clothes and shoes we bring. It’s probably the one hour of the trip that most reminds you — even on a bad day, life is good.
A prosthetist came down to make artificial limbs — a new project spurred by a desperate need. I first saw him making casts for a little girl — she couldn’t have been much more than 18 months old — who burned both hands in a pot of masa.
It was a long and complicated surgery and both could not be done in the same trip. Two doctors, a nurse anesthetist and an OR surgical tech operated on Carla, the older of the two. From a lay perspective, it was hammers, drills and chisels. I wasn’t sure how I’d react having never witnessed surgery, let alone something so noisy to the untrained ear. It was fascinating. The surgeons knew there was a possibility that future corrective surgery might be necessary, but the following year she was thriving. She came to thank us that next October when her brother underwent the same procedure.
Clubfoot is another common ailment often correctible with surgery. But I met one special family that trip that we couldn’t help. A mother and child both have dwarfism and the child’s surgery was too complicated for our team to perform in Guatemala as it involved her knee and leg. In cases like this, the director Karen Scheeringa-Parra and the in-country H.I.M. volunteers work with doctors in Guatemala and the states to try and find a solution.
Sushi bars are the fastest-growing restaurant segment of the ethnic food industry. That’s good news for Americans, because if you’re in search of a healthy meal, Japanese food fits the bill. Traditional Japanese food is one of the healthiest fares, most often prepared with little oil and features ingredients like tofu, rice, seaweed, noodles, vegetables, and small quantities of fish, chicken, and lean meat. Most sauces are low-fat, and made with a base of broth, soy sauce, or sake. But beware! As sushi becomes more and more mainstream, many rolls are being created to suit the high-fat palette of American diners. Nowadays, cream cheese, tempura flakes, mayonnaise, and deep-fried fish, are popular ingredients in sushi rolls.
I’ve been concerned for a long time about the tendency that my patients have to mix their medications with over-the-counter treatments and herbs. This is not a safe or wise approach, though most of the time, no major side effects occur.








