In 2002, fresh out of college, Jake Gibb moved from the small town of Bountiful, Utah to Huntington Beach, California to pursue beach volleyball.
Months later he was diagnosed with melanoma, the most fatal type of skin cancer. He was 26 years old.
“I had this mole on my shoulder that was bothering me,” Gibb said. “I wasn’t worried about it and it didn’t look suspicious, but it kept rubbing against my seatbelt when I was driving so I had it looked at.”
The mole was removed and biopsied. When the sample came back positive for malignant melanoma, Gibb had surgery to remove a larger section around his shoulder. He has been under surveillance ever since.
“When I was a kid in the eighties and nineties, I’d lie out and sunbathe with baby oil on,” Gibb said. “We all did it. We’d call it our ‘base burn.’ We were clueless.”
Beach volleyball players can’t avoid the sun, but Gibb was able to return to the sport with a diligent sun protection regimen of long sleeves, hats and sunscreen. He represented the United States in the Olympics in 2008 and 2012, and he plans on competing in the next three Summer Olympics.
Gibb’s story shows the most important facts about skin cancer-it is on the rise in the United States and it is treatable if caught early.
“The doctors said my melanoma was most likely from burns or sun exposure when I was young,” said Gibb. “But my experience has made a lot of players around me more aware of skin cancer. They know what I went through and they are a lot more conscious of protection now.”
A RISING TREND
Skin cancer is by far the most common form of cancer in the United States. Over the past three decades, more people have had skin cancer than all other cancers combined. And one in five Americans will develop skin cancer in their lifetime.
Melanoma, the deadliest form of skin cancer, is also on the rise.
The American Cancer Society reported 76,690 new cases of melanoma in the United States in 2013. Eleven percent of those cases were in California, where melanoma is the fifth most common cancer in white residents. Los Angeles County sees about 1,300 new cases of melanoma each year.
The American Cancer Society estimates that almost 1,000 California residents will die of melanoma in 2014.
The most startling skin cancer data is the growing incidence of melanoma in young people. In the past 40 years, melanoma in people aged 18 to 39 has grown by 800 percent among women and 400 percent among men.
It is the leading cause of cancer death in women ages 25 to 30 and is second only to breast cancer in women ages 30 to 34.
There is little confusion about the cause of skin cancer. According to the American Cancer Society, almost all cases are attributed to ultraviolet (UV) light exposure, and just one blistering sunburn can double a person’s risk of developing melanoma. Just one indoor tanning session increases a person’s chances of developing melanoma by 20 percent, and each additional session during the same year raises that risk another two percent.
Yet, while the threat of lung cancer has helped steer people away from cigarettes, almost no progress has been shown in the risky behaviors that lead to skin cancer. Incidence of sunburn and indoor tanning have remained the same for over a decade.
“I don’t know that we’re making any headway,” said Dr. Len Lichtenfeld, the American Cancer Society’s deputy chief medical officer. “People are still using tanning beds and still letting themselves burn in the sun.”
Men are more likely than women to get skin cancer in their lifetime. However, according to a study conducted by the Mayo Clinic last year, incidence of melanoma has dramatically increased among young women.
The authors of the study believe that indoor UV tanning may explain this discrepancy, reporting that 71 percent of tanning salon patrons are women. Young people are at highest risk of developing cancer, and those who use tanning beds before the age of 30 increase their risk by 75 percent.
“It’s not a question of whether tanning beds cause cancer anymore,” said Dr. Jerry Brewer, Mayo Clinic dermatologist and researcher. “We’ve been able to prove that.”
The indoor tanning industry began about 40 years ago and became popular in the 1980s. It is now estimated that there are 22,000 tanning salons in the U.S. with a customer base of 28 million.
The International Agency for Research on Cancer, an affiliate of the World Health Organization, includes ultraviolet tanning devices in its Group 1, a list of the most dangerous cancer-causing substances that includes cigarettes and solar radiation.
In March 2013, the Food and Drug Administration issued a proposed order that, if finalized, would reclassify UV tanning devices as moderate to high risk devices (class II). Currently, tanning beds are considered class I medical devices, the same designation given to band-aids and tongue depressors.
Despite the risks, every day more than a million Americans use tanning devices. And many of them are young girls.The Center for Disease Control conducted a study that showed 29 percent of white high school girls went to an indoor tanning parlor at least once a year, and 17 percent went “frequently,” at least ten times in a 12-month period.
“There is this thought that, ‘It won’t happen to me because I’m young,’ but that’s not true anymore,” said Dr. Brewer.
Dr. Jerod Stapleton, a behavior scientist at Rutgers University in New Jersey, is devoting a five-year study to understanding why young women are still drawn to indoor tanning. The $700,000 study is funded by the National Cancer Institute.
“Studies suggest that such frequent use causes a greatly increased risk of melanoma,” Stapleton said. “To this point, many studies on the topic haven’t specifically focused on understanding the particular behavioral aspects in play among this group of tanning bed users.”
The study began this year and will continue until 2019. Stapleton hopes to shed light on the attitudes that drive young women to tan.
“We want to better understand how they view tanning and how they think about the associated risks,” he said. “The research will also test a tailored online ‘behavioral intervention’ designed…to encourage users to adjust their tanning behavior or at least start thinking about indoor tanning a little differently.”
DIARY OF A TANNER
Sarah Tiefenthaler of Venice was one of those frequent indoor tanners.
When she started going indoor tanning as a high school student in Tehachapi, California, it was just for special events like prom. Her mom signed a permission slip to allow her to tan before she was 18. By the time she moved to Los Angeles for college, she was hooked.
“In college it got out of hand,” Tiefenthaler said. “I got those unlimited monthly packages and kept going to get my money’s worth. I would go every other day. It was very relaxing and I liked the way my skin looked.”
Tiefenthaler was stepping out of a tanning bed when she first noticed something odd on her skin right below her bust. She saw a dermatologist who biopsied the lesion and determined that it was basal cell carcinoma, a lesser form of skin cancer. She was able to treat the area with an ointment.
A year later, when Tiefenthaler was 26, she had a spot on her thigh biopsied. This time it was melanoma.
“I never thought I would be diagnosed at 26 with something life threatening,” she said. “I really believe that both sites came from my tanning bed usage. I went so frequently, and both were in spots where you wouldn’t normally get sun exposure, even in a bathing suit.”
Luckily, the melanoma was still in its early stages and doctors were able to remove it through surgery. She now has a five-inch scar along her upper thigh.
Tiefenthaler was in the process of starting her own business when the cancer diagnosis came in. She developed a love for yoga in her early twenties and began practicing yoga on a paddleboard in the ocean. Five years ago she founded YOGAqua, a mobile yoga studio that teaches students yoga on stand-up paddleboards on the water in Marina Del Rey.
“With YOGAqua I am out in the sun four days per week, more when I am training teachers,” she said. “I use sunblock and alternate short sleeves and long sleeves. I get a skin check at the doctor every six months. I have to be very careful.”
Tiefenthaler hasn’t had any skin cancer scares since 2010. She also hasn’t set foot in a tanning salon since then.
“I immediately stopped tanning and I will never go again,” she said. “And I am always really insistent on my loved ones about staying out of tanning beds.”
FIGHTING THE TANNING INDUSTRY
While Tiefenthaler was fighting a private battle with skin cancer in 2009 and 2010, Ted Lieu, then Assemblyman from Torrance and now State Senator, fought a public battle with the tanning industry. He wanted to stop young people like Sarah Tiefenthaler from having access to tanning beds as minors.
As a member of the State Assembly, Lieu attempted to pass legislation banning minors from the use of tanning facilities. At that time in California, and in all other states, those 14 to 18 could go to a tanning salon with a permission slip signed by their parents. His bill passed in the assembly but died in the senate.
“When I became a State Senator I tried again,” said Lieu. “This time we were able to take on the tanning industry and get it passed.”
The bill, SB-746, was passed in 2011 and eliminates the consent option regarding minors between 14 and 18 years of age, thereby prohibiting anyone under the age of 18 from using an ultraviolet tanning device in California.
“We know that cancer risk is cumulative; that the more exposure you have at early age, the worse it is later,” said Lieu. “These kids go tanning as teens and then see the effects manifest much later. There was a correlation between tanning devices and skin cancer before but now we know there is actual causation.”
The tanning industry, questioning the science linking melanoma to UV devices, aggressively battled against the bill. The Indoor Tanning Association dispersed brochures asserting the health benefits of tanning beds. They claimed that the new ban would cost the industry thousands of jobs and issued a press release stating that “the decision regarding whether or not a teen is allowed to suntan is a decision for parents, not government.”
“They fought it hard,” Lieu said. “But we had overwhelming scientific evidence this time. We had doctors and patients testify. In the end, there was very strong support for the bill.”
Senator Lieu’s bill was the first of its kind in the nation. It has been used since as a model for similar legislation passed in Texas, Nevada, Illinois and Vermont.
“Brazil has banned indoor tanning altogether,” said Lieu. “We need to start thinking about the risks more seriously. These machines are not well-regulated. You have no idea what dose of UV light you are getting.”
When the Beach is Your Office
While staying out of tanning beds is a simple lifestyle choice, preventing skin cancer gets a little trickier when you make your living outdoors.
Jeff Nygaard started playing volleyball at his Wisconsin high school in 1986. In 1990, after reaching six-foot seven in height and amassing great skill on the court, he was recruited by the University of California at Los Angeles to play volleyball for the Bruins.
“I didn’t really stop playing volleyball for the next 20 years,” he said. Nygaard spent about half that time playing beach volleyball. He enjoyed great success indoors and out: In 1996 and 2000 he was a member of the Men’s Olympic National Indoor Team and competed in the 2004 Summer Olympics in Athens, Greece.
“During the seven years on the beach, I was pretty bronze because I chose to play in only a hat and board shorts, common for male beach athletes,” he said. “There is a persistent undercurrent to beach volleyball with skin cancer, but bridging the gap and thinking about actually getting cancer was a much bigger leap than you might expect.”
In 2007, after seven years of strictly playing beach volleyball, Nygaard took a professional contract to play for an indoor team in Istanbul, Turkey. Shortly after his arrival, Nygaard began experiencing skin problems.
“I had this constant itching and soreness from a red spot on my back that would bleed when I scratched it,” he said. With prodding from his wife, Nygaard made an appointment with a dermatologist when he returned stateside.
“The exam itself was not very daunting or scary,” he recalled. “I had no understanding or appreciation for the depth of what he was looking for.”
The doctor biopsied not only the spot on Nygaard’s back but also an area on his left arm.
“I got a call the next Monday that the spot on my back was skin cancer, basal cell carcinoma,” he said. “And then, two days later, I got the call that the spot on my arm was melanoma.”
Nygaard was shocked. He immediately researched the disease and was panicked to learn its deadliness. And though the treatment of his melanoma was swift and effective, the impact of the diagnosis continues to linger for Nygaard.
“I was ready to never play beach volleyball again,” he said. “I never wanted to be in the sun for fear of more sun damage.”
With time, Nygaard reconciled the idea of returning to beach volleyball by committing to safe practices. He wore heavy sunscreen of at least SPF 50, covered his torso and arms in long sleeve shirts and tried to limit his time in the sun.
“I was only in the sun as long as I needed to compete and then I would run to shelter,” he said. “I had the mental hurdle of wanting to compete to win but hating being in the sun. The more success I had during a tournament meant more sun exposure, which made me hate being out there.”
The spectators weren’t always happy with post-cancer Nygaard being out there, either.
“There is that commercialized package of the beach volleyball player being sexy, tanned, sweaty and nearly naked,” he said. “When I started wearing long sleeve shirts, I had many people turn their heads and give me looks ranging from dismissal to downright disgust. But I didn’t care. I choose my path to deal with what I was dealing with.”
Nygaard is now assistant coach for the men’s volleyball team at the University of Southern California and spends most of his time indoors. He shares his story when the opportunity arises, but he tries not to preach.
“Let’s be honest, if you hit the beach yesterday and got lobster pink and the next day you had a melanoma growing on you, you’d stop going to the beach,” he said. “It’s harder to convey the threat because it takes years to materialize.”
The Association of Volleyball Professionals is trying to help get the word out about skin cancer. In March, they entered a partnership with the Skin Cancer Foundation to spread awareness within the volleyball world about the threats of skin cancer and remove some of the stigma surrounding protection.
“Teaming with the Skin Cancer Foundation is a natural fit for our athletes,” said Donald Sun, managing partner of AVP. “They are out all day practicing and competing. This is what AVP should stand for. And not just for the players, but for the fans and the staff, too.”
The Skin Cancer Foundation and AVP are producing public service announcements starring volleyball stars which will be shown at tournaments as well as online. The PSAs remind people about safe sunscreen and clothing practices.
“Once the Skin Cancer Foundation has a team ready, they will join us on tour, as well,” said Sun.
THE GOOD NEWS
Despite the rising incidence of skin cancer, a positive trend has also emerged: due to early detection, mortality associated with skin cancer is down.
According to the American Cancer Society, the overall five-year survival rate for patients whose melanoma is detected early, before the tumor has spread to regional lymph nodes or other organs, is about 98 percent in the U.S. The survival rate falls to 62 percent when the disease reaches the lymph nodes, and 15 percent when the disease metastasizes to distant organs.
The Skin Cancer Foundation asserts that, while skin cancer is the most common cancer in the U.S., it is also easiest to cure if diagnosed and treated early. They recommend self examinations monthly to track any changes in the skin, especially changes in moles and birthmarks or an open sore that does not heal within three weeks.
Doctors are also making headway in curing skin cancers that were not detected early. Last month, scientists in England revealed a new treatment that was successful in trials on patients with melanoma that cannot be removed or has spread to other parts of the body.
The drug, IMCgp100, operates by binding itself to protein antigens on the surface of the cancer cells. Further trials are now taking place in the United Kingdom and the U.S.
May has been deemed National Skin Cancer Awareness Month. The Skin Cancer Foundation urges people of all ages to perform a self examination or visit a dermatologist for a professional skin check.
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