“It’s a good thing you came in today,” says my San Francisco-based dermatologist, Dr. Alison Lyke, as she carefully carved a worrisome mole out of my left shin. “These things have the potential to turn into something bad; too many athletes like you wait too long.”
Over the last seven years, I’ve gradually increased my training volume for long-distance running and triathlon races. My health concerns have predominately been stress fractures and heart conditions. Stress fractures because they are a topic of conversation during every group run that I’ve ever participated in, and heart conditions because of the all-too-often sensationalist media coverage about the supposed deleterious effects of “too much exercise.”
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But my skin? It was afterthought at best. And even then, my dermatological concerns generally centered on controlling sweat-induced acne.
This all changed when my good friend, professional triathlete Doug MacLean, was diagnosed with skin cancer. Suddenly the risk became real. Just a few days later, Dr. Lyke was removing that dark, dime-sized spot from my shin and educating me on skin cancer in the process.
“It’s important for people to realize that skin cancer can start as a new spot on the skin, or that an existing mole can turn into skin cancer,” explains Dr. Lyke. “That’s why you need to check your skin every few months for new or changing spots.”
Yet so many athletes (myself included, which is particularly embarrassing given my background in public health) are cavalier about moles for various reasons, including:
1. Moles tend to be slow-growing and asymptomatic. They certainly don’t affect performance immediately like soft-tissue or bone injuries do.
2. Training-related skin cancer gets little-to-no coverage in the media. This is unfortunate given that melanoma, the most dangerous type of skin cancer, is the fifth most common cancer, directly related to sun exposure, and kills far more young people than training-induced heart attacks.
3. Endurance athletes are busy and tired from hours of training in addition to work, family, and other commitments. Remembering to do a comprehensive self-examination—let alone scheduling an appointment, driving to the doctor, parking and waiting—can be a real hassle.
But this mindset needs to change. When it comes to taking your moles seriously, it’s always too early—until it’s too late.
According the American Academy of Dermatology (AAD), athletes training outdoors should protect as much of their skin as possible with clothing. For those areas of skin still exposed to the sun, the AAD suggests applying sweat-proof sunscreen with an SPF of at least 30. In addition to these basics, the AAD recommends regular self-examinations and has published a simple worksheet to help guide them. The worksheet covers the ABCDEs of skin cancer: you should check moles for Asymmetry, Border irregularities, Color variance, Diameters greater than a pencil eraser and Evolution (or change in a mole) over time. The guide also details how to see often overlooked body parts using a mirror.
You can access and print the worksheet here. I have it hanging in my bathroom and set an alert on my iPhone for “skin self-examination” on the first weekend of every month. I urge you to do the same.
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Still, Dr. Lyke recommends athletes who spend significant time training outdoors see their health care provider annually for a full-body evaluation. A physician can access places that are hard to see on your own (even with the help of a mirror) and spot subtle irregularities. But most important is “letting your doctor know if you notice new or changing spots on your skin,” she says, “since it is best to diagnose and treat these things early.”
Thankfully, Doug MacLean now calls himself a cancer survivor—but he would still prefer to not have that title. The surgery, physical pain and psychological angst he endured negatively affected far more than his endurance sports career.
“Melanoma, like many cancers, is largely about awareness and early detection. If your vigilant, and catch it early, it’s an inconvenience, albeit a terrifying and life-changing one,” says MacLean. “But if you’re not vigilant, and don’t catch it early, it can turn into one of the most aggressive and deadliest cancers there is. I was lucky to catch it early. My friend Gavin was not so lucky. He didn’t catch it early, and he died before his 33rd birthday.”
Regardless of your past history and rationale, starting now, treat your skin seriously. Cover up. Apply sunscreen. Self-examine monthly. See your dermatologist annually. It may seem like an additional hassle, but in the larger scheme of things, taking these steps is a no brainer. Not only can they extend your running career, they can extend your life.
About the Author:
Brad Stulberg works in population health and is a freelance writer covering health and performance. You can follow him on Twitter @Bstulberg.