With sandy blond hair and light skin, Julie Moppin always freckled or burned in sunlight. But she still tried to tan. Now, decades later, her sunspots are attacking her.
In five years, dermatologists have cut 40 current or potential cancers from her flesh, including two melanomas -- the worst kind. Every three months, she returns half expecting more surgery.
"It gets real old," she said. But she knows the alternative is worse.
"My dad passed away last year from melanoma," Moppin said.
Moppin has both of the biggest causes of skin cancer -- a personal past of sun abuse and a family history of skin cancer. But even Americans who aren't so genetically at risk are getting skin cancer in record numbers.
William James, president of the American Academy of Dermatology Association, said statistics show skin cancer now afflicts more Americans than all other cancers combined.
"Skin cancer has sort of reached epidemic proportions," said dermatologist Glen Goldstein, founder of the Dermatology and Skin Cancer Center in Leawood, Kan.
Nationwide, non-melanoma skin cancer cases have shot up from 1 million in 1987 to 3.5 million in 2009, Goldstein said. The Centers for Disease Control and Prevention statistics show melanoma also has risen since 1986 by an average 3.1 percent each year.
To meet the growing need for skin cancer care, Goldstein expanded his skin cancer treatment in the Kansas City area to include nine more doctors and three sites. His practice, which treated 300 skin cancer patients in 1988, now treats 6,000 to 9,000 a year and up to 20 melanomas a month.
"Our skin cancers have gone up every year since I've been in practice," Goldstein said. "We're diagnosing more melanomas all the time."
Kansas and Missouri have two of the 10 highest state death rates from melanoma, according to a 2010 SunWise publication from the Environmental Protection Agency. The SunWise education program teaches children and their caregivers how to protect themselves from overexposure to the sun.
Goldstein said the main reason for the deaths is people aren't vigilant enough in checking for skin cancer. They should watch more for moles and spots that bleed, scab, change color or don't heal within six weeks. If they find one, they need to see a doctor as soon as possible.
"They're all 100 percent curable if you catch them early enough," he said.
The skin cancer increase itself has multiple causes, James said. People don't wear sunscreen and protective clothing as often as they should. They expose themselves too much at midday -- from 10 a.m. to 2 p.m. -- when UV radiation levels are the highest. They also are using tanning booths more.
UV radiation levels overall are higher, too. The United States has on average 4 percent more exposure to UV radiation than it had 30 years ago, said Jay Herman, a UV radiation researcher for NASA and the University of Maryland. Pollution from 1979 to 2000 caused the increase by depleting of the higher, upper-level ozone.
On average, the Midwest has more exposure to UV radiation than eastern coastal areas of similar latitude because of less cloud cover.
Usually, skin cancers form on younger people who have suffered severe sunburns at an early age, Goldstein said. The average age of non-melanoma skin cancer has dropped from 70 in the mid-1980s to 55 in 2009.
Moppin said most of her sun exposure has come from outdoors -- burns from family trips to the beach or to the Lake of the Ozarks.
Melanomas, which traditionally form before age 45, are showing up more commonly -- and sometimes, fatally -- among 20-year-olds.
"We hate it," Goldstein said, referring to the young patients who have died from the disease. "Every time we come across one, we know if we would have caught it earlier, we would have avoided that outcome."
Artificial tanning is another cause for alarm. Skin Cancer Foundation statistics show a 75 percent greater chance people will get melanoma if they are exposed to tanning booths in childhood. Goldstein said that even more telling are the locations of the cancers he finds. He is increasingly treating cancers in locations that, in public, would be covered by clothing and are "definitely attributed to tanning salons."
The Patient Protection and Affordable Care Act, which President Barack Obama signed into law on March 23, included a new nationwide 10 percent tax to discourage indoor tanning.
Two days after the tax passed, tanning salons took another blow. The Food and Drug Administration advisory committee panel suggested even more deterrents specifically aimed at teenagers. The proposed restrictions included outright bans, higher restrictions for people prone to skin cancer, parental consent forms and intensified warnings and education.
The Indoor Tanning Association has since reacted to the new tax, which takes effect in July, by claiming on its website that such a statute is unfair to small business and ignores the positive effects of indoor tanning, such as vitamin D.
But James said the dangers of artificial tanning had grown too severe to ignore. Of the 1 million Americans who used tanning booths in 2009, he said, 70 percent of them were young women ages 16 to 29.
Elizabeth Vinyard said she began tanning in salons five years ago. Only 15 then, she was a sophomore at Oak Grove High School, and her homecoming dance was looming. She has since graduated from high school and dances have long passed. But just this year, she bought a yearlong membership for two tans each week.
Vinyard said that she has heard of the dangers, but she thinks they're overestimated. At least for now, she said, the benefit of bronze skin far outweighs any risk.
"Being a college student especially," she said, "it feels like you're accepted."
James said the efforts to raise awareness about skin cancer have improved some, but the country still has a long way to go.
Moppin is determined to pass that awareness onto her 11-year-old son, Mitchell. Youth baseball is just beginning, and she hasstocked up on sunscreen .
"With the sun, a lot of people, especially a lot of young people, think it's not going to happen to them," Moppin said. "They're invincible."
Of course, Moppin thoughtthat too at one point. Forty surgeries later, she knows better.
"I'm just thankful there's a lot more awareness now than there used to be," she said. "When I was young, we didn't have any warnings."