Who’s Got Your Back?

When it comes to lathering on sunscreen, until my late 20’s, I often neglected to protect my back. According to the American Academy of Dermatology (the Academy), I am like most people in this way. It is like most things in life – out of sight, out of mind. We may only see our backs to the shoulders, and we do not often see the backs of our legs.  These areas tend to bear much of the brunt of sunburns since they are out of mind – at least until you hop in a warm shower and feel the sting of your burned back and legs, or you see the diffuse lentigines (sun spots) on your shoulders.

This month, the Academy reminds us that melanoma most commonly occurs on the back with its “Who’s Got Your Back” campaign. The Academy’s 2015 online survey reveals that 37 percent of people rarely, if ever, apply sunscreen to their sun-exposed backs, and 43 percent rarely, or never, ask for someone’s help in lathering sunscreen to their backs.  These numbers are likely higher, as people tend to underestimate or understate behaviors perceived as negative, such as not asking for help.

Men surveyed were particularly reticent to wear sunscreen or to ask for application help. This does not surprise me. Sorry to stereotype, gentlemen, but it is not sexism if I’m discussing facts, right?!

What is the bottom line?

Think prevention.

We have to be more mindful and protective of body areas that may be hidden from our eyes but are not hidden from the sun. Like most behaviors, it sounds simple when we read it, but it is more difficult to practice or make a habit. When it comes to our backs, putting on sunscreen requires some stretching. Maybe start by asking for help from someone, anyone, in applying sunscreen to your back if you absolutely must be shirtless outside. Otherwise, your exposed back, with all the cumulative, chronic ultraviolet (UV) radiation or the short bursts of intense UV leading to acute burns, could grow a melanoma – a strange-looking, growing, and ultimately metastasizing (spreading to other organs) lesion. And the scariest part? If located in a hidden area like your back, it may go unnoticed and undiagnosed for a long time; sadly, in some cases, for too long.

Think early detection.

The Academy suggests that each of us designate a loved one (but I say even a neighbor if needed) to examine our backs at least monthly for suspicious lesions. Interestingly, the Academy found that spouses find about 16% of melanomas. I found this to be true in practice, as many of my patients would tell me they came in after a spouse or other relative noticed a strange mole.

Since working in dermatology, I have wised up and now try (*for the most part*) to practice what I preach. What is the downside to protecting the skin on our backs? Well, some may argue that it takes several extra minutes to lather on sunscreen, or it may cause embarrassment to ask someone for help for those hard-to-reach areas. I realize that we exist in a hurried culture and that time is of the essence. I also can appreciate that some may not be comfortable asking another person to apply sunscreen to his/her back. But let us consider the alternative. Nobody enjoys having, or hopes to get, a sunburn or a skin cancer, particularly a melanoma.

As I advise others, and remind myself, it is not worth being cavalier or dismissive when it comes to skin protection. But it is worth overcoming any shyness when it comes to asking for a hand with sunscreen application and getting (at least) an annual skin examination of your entire body (yes, even the private parts) by a reputable, thorough, and board-certified dermatologist. I love that the Academy suggests checking your birthday suit on your birthday, or even more frequently if advised. That has been my advice, too. It could save your life. And, like I would tell patients, when a dermatology provider performs a full skin examination, he/she is not paying attention to rolls, dimples, cellulite, or any other self-perceived flaws – or excesses. Speaking from experience, your provider is focused on detecting suspicious lesions, not checking you out.

Remember, though, that providers are patients, too, and they understand how uneasy skin checks can make people. As you sit uncomfortably and probably sweating – and if you are like me, trying to cover any exposed skin and your unmentionable parts with your ill-fitting gown – waiting for the provider, remind yourself, no judgment!  Again, the exam could save your life.