The Triton


Yachting life requires vigilance in avoiding sun-damaged skin


This morning I am putting the finishing touches on this column, then getting ready to head out for fun in the sun on my boat. Although I really enjoy the feel of the sun, I also realize the dangers. So, today I will be wearing a big hat, long-sleeved T-shirt and lots of sunscreen.

I realize that the vast majority of my readers also spend a lot of time on the water and in the sun. For more information on harm the sun may cause, I contacted Dr. Joseph Francis, who is a board-certified dermatologist in Palm Beach County and a specially trained skin cancer surgeon practicing in Atlantis and Jupiter, Fla.  Dr. Francis is also an avid boater and fisherman.

“During my dermatology residency in Virginia,” Dr. Francis said, “we sometimes had patients bused in from neighboring states. Medical specialists can sometimes be scarce in rural areas. I can remember one particular patient who took an eight-hour bus ride because he was concerned about a spot on his neck that I could easily tell was benign. However, he did have a skin cancer on the bridge of his nose that he did not notice.  This is a recurring pattern now that I continue to see in private practice.”

Dr. Francis offers the following tips on how to identify skin lesions that may be concerning. He points out that this is in no way a substitute for regular visits to a dermatologist. His hope, he says, is that these tips may help you to identify skin lesions earlier or encourage you to see a local dermatologist certified by the American Board of Dermatology.

Dr. Francis’ 10 tips:

  1. Look for anything that appears and grows quickly.
  2. Look for a lesion that bleeds and doesn’t heal.
  3. Be suspicious of lesions in sun-exposed areas: scalp, ears, nose and lips.
  4. Basal cell carcinomas can often have a pearl-like appearance.
  5. If you’ve had something removed before, be aware of changes occurring around the scar such as redness, scaling and blood.
  6. Lots of patients with skin cancer tell me that they notice blood on their pillows or sheets.
  7. With pigmented lesions, such as moles and freckles, watch for: asymmetry, uneven or notched borders, diameter greater than a pencil eraser, or different shades of black, brown, tan, red, white or blue.
  8. Some advanced skin cancers can be very painful or itchy.
  9. Beware of hard painless lumps beneath the skin on your neck — they could be enlarged lymph nodes.
  10. Any pigmented lesion that you see changing over time should be shown to your doctor.  Changes include bleeding, itching, growing in width or height, and changing color.

Here are answers from Dr. Francis to frequently asked questions:

Q: What kind of sunscreen should I use?

A: First, it is important to understand the difference between sunscreen and sunblock. Take a look at the ingredients before using any product. Sunscreens contain chemicals that absorb UV radiation. Sunblocks (also confusingly called “physical sunscreens”) contain minerals such as titanium or zinc that block UV radiation from reaching the skin.

Sunblocks can offer broader UV protection than sunscreens. However, sunblocks are usually thicker and messier (think of the lifeguard with zinc oxide on the nose).  Newer sunblock formulations offer transparency with broad spectrum protection, which is usually what I recommend.

Watch out for the ingredient PABA, or para-aminobenzoic acid, which can stain clothing and cause allergic reactions.  I have also seen people who have developed horrible skin reactions to old or expired products.

I am also a big proponent of sun-protective clothing. When I am out on the water, I wear a hat that covers my ears and a long-sleeved, breathable, sun-protective shirt.  This allows me to be comfortable without having to worry about painful sunburns the next day and skin cancers in the future.

Q: Is SPF 100 better than SPF 15?

A: Technically, yes — but the actual difference is miniscule. The AAD recommendation is to  use a broad-spectrum sunscreen that is at least SPF 30 and to reapply it every 2 hours.

Q: Is the sun bad for my skin?

A: Lots of sun exposure can cause premature skin aging (sun spots, wrinkles, thinning of the skin, skin cancer). However, exposure to UV light can also be used to treat conditions like jaundice, psoriasis, atopic dermatitis, lichen planus, etc.  It is also how your body naturally produces Vitamin D. My opinion is that sun exposure is OK in moderation. 

Trained as an emergency medical technician, Keith Murray now owns The CPR School, which provides onboard CPR, AED and first-aid training as well as AED sales and service ( Comments are welcome at


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