TORONTO - When Virginia Disimino hears people talk about soaking up some sun to produce vitamin D - or worse, that tanning beds are the optimal way to acquire the nutrient - she despairs that years of warnings about skin cancer still aren't sinking in.
Disimino is well aware of the need for vitamin D, but she knows from experience that catching too many rays isn't the way to go.
Ten years ago, while getting a pregnancy test for what would be her first child, she asked her doctor to check out what she thought was a stubborn patch of eczema on her upper arm.
It turned out the bicoloured, irregularly shaped spot wasn't eczema at all - but malignant melanoma.
"I was completely shocked and caught off guard by it," recalls Disimino, 40, of Woodbridge, Ont., northwest of Toronto. "The doctor said: 'This is the worst form of skin cancer, you can never go in the sun again."'
"I'm not a very emotional person, but I lost it."
Although her arm bears a roughly 12-centimetre scar where the cancerous lesion was removed, Disimino knows she was one of the lucky ones: the melanoma was caught before it had spread to other parts of her body and she didn't need other treatments that could have harmed her growing fetus.
But others aren't so fortunate. About 4,600 Canadians will be diagnosed this year with the disease and about 900 will die.
"Melanoma rates have been continuing to rise over the last 10 years, much faster in males than in females," said Heather Chappell, senior manager of cancer control policy for the Canadian Cancer Society.
As well, almost 70,000 cases of squamous and basal cell carcinomas will be diagnosed this year - making skin cancer, in terms of sheer numbers, the most common cancer of all to affect Canadians.
While rarely fatal, said Chappell, squamous and basal cell cancers "increase the risks of developing melanoma, and the surgery to remove them can be quite disfiguring and painful."
Yet all three types of skin cancer are preventable by avoiding excess time in the sun and steering clear of tanning beds, which experts deem particularly unsafe.
But with recent studies suggesting that vitamin D appears to reduce the risk of some other cancers, there is confusion over how much sun a person needs for good health and how much sun is too much.
"That's a very tricky question because everybody's different," concedes Toronto dermatologist Dr. Cheryl Rosen.
"Everybody has a different skin colour, not everybody burns, not everybody tans well, lots of people have a lot more pigment to start with," says Rosen, national director of the Canadian Dermatology Association.
"So your individual time you can spend out in the sun, depending on what time of year it is and what time of day it is, really is variable."
Chappell says the cancer society's sun safety advice hasn't changed despite new vitamin D recommendations.
"So we're still recommending that Canadians protect themselves from the sun when the sun's rays are strong. We're talking a UV index of three or higher that people should consider sun protection methods."
That means avoiding sunlight, particularly between 11 a.m. and 4 p.m., by seeking shade, wearing long-sleeved clothing, a wide-brimmed hat and sunscreen or sunblock with a minimum SPF15 rating. Babies under a year old should have no direct sun at all.
The cancer society advises that no more than five minutes a day of unprotected sun exposure will replenish vitamin D stocks for light-skinned people; those with darker skin that doesn't absorb UV rays as readily and the elderly should take a vitamin D supplement of 1,000 IUs a day as well. (In winter, everyone should take the supplement.)
"You definitely don't need a tan to (get) vitamin D," says Chappell. "That's overexposure. So any time your skin's turning a different colour, a tan or a burn, you're causing skin damage and that's not the amount you need for vitamin D."
Tanning beds, she and other experts agree, are a definite no-no.
"Most tanning beds have an intensity five times the strength of the strongest midday sun, so it's a very high intensity," warns Chappell. "Secondly, there are not good regulations with the type of bulbs in the tanning beds. They may or may not have UVB being emitted - and that's what makes your skin produce vitamin D."
Kristen Sanderson found out the hard way what overexposure to UV rays can do. A self-described "obsessive tanner," the 21-year-old recalls getting lots of sun as a child and teen - and two years of almost daily 20-minute "baking" sessions while working at a tanning salon.
"I liked having that healthy glow - or supposedly healthy glow - and it almost became an obsession. The darker I got, the lighter I thought I was," says the Vancouver travel consultant of her time using tanning beds. "You read the sign that says, 'This may cause skin cancer' and you slather up and you go in anyway."
Sanderson says she never worried about skin cancer, thinking the disease was something that happened only to people her mother's age or older.
But at just 18, Sanderson was told a dark, oddly shaped mole on her back was potentially fatal malignant melanoma.
She lost a chunk of flesh from her back, which now bears a lengthy scar, as well as some lymph nodes under her arm. Like Disimino, she was lucky: the cancer hadn't spread.
Now she protects herself in the sun and wouldn't go near a tanning bed.
"I think no matter what age you are you have to be careful because you never know if it's going to happen to you. Don't think that just because you're 18 or 19 or 20 years old that you're not going to get something that someone that's 40 or 50 can get."
Disimino, too, remains hyper vigilant about avoiding sun exposure, always wearing a hat, long sleeves and pants and slapping sunscreen on any exposed skin.
It is a protective behaviour she has also instilled in her three young children, knowing that it's the cumulative exposure to sunlight beginning in childhood that can add up to skin cancer later in life.
"Some things seem so random that you can't control it," she says. "If you look at skin cancer, which is the one you're most likely to get, it's something that's so within our control."
"As a parent, when I look at the kids I want to make sure that I at least eliminate that from being a worry that they're going to have in the prime of their life."
