Get ready .... here comes the sun

Though long strides in skin-cancer awareness, research and prevention have been made, harmful UV rays will remain a constant on golf courses this spring and summer, so be prepared

Despite huge leaps in sun prevention awareness, it might be fair to say that golfers devote more time selecting what club to hit than taking simple precautions against the big glowing wheel in the sky.

After all, it's easy to take for granted the sport’s outdoor arena, though seismic shifts in recognizing dangers have been made during the past 25 years. And it’s almost silly to think that bygone eras fixated more on the dangers of lightning strikes than a killer sun – not to minimize lightning, by any means.

At the 1975 Western Open, four players – most notably headlined by Lee Trevino – were struck. At the 1991 U.S. Open at Hazeltine National Golf Club, a spectator died from a lightning strike. Both incidents helped usher in new processes to protect players and spectators.

All the while, golfers of those same eras likely spent more time perfecting a golden tan than lathering up with sunblock. At least until studies indicating precipitous rises in various skin cancers started popping up. The World Health Organization put out research findings in the early 1980s, as did the Skin Cancer Foundation, which was established in 1979. These studies became watershed moments for the golf industry, much like the lightning catastrophes.

Rest assured, not all skin cancers are deadly. There are three types of cancers doctors look for: basal cell carcinoma (the most common and most treatable because it rarely metastasizes), squamous cell carcinoma and melanoma. Precancerous growths, called actinic keratosis, can evolve into squamous cell carcinoma if left untreated.

Skin cancer has been around since the 5th century BC when Hippocrates first recorded melanoma. Perhaps French physician Rene Theophile Hyacinthe Laënnec, credited for distinguishing melanoma as separate from other skin cancers in the early 1800s, has always been rolling over in his grave.  

With more studies being released, golf officials took notice the way prairie dogs jump-yip. Danger was clearly in the air.

In 2010, six-time PGA Tour winner Rory Sabbatini was treated for squamous cell carcinoma, the second most common skin cancer. Sabbatini has said that while his cancer did not reach the melanoma stage, it was "serious enough that it scared me pretty well." / Photo: Golffile | Peter Muhly

The Skin Cancer Foundation, in particular, found that that nonmelanoma skin cancer, the most treatable, shot up by 77 percent between 1994-2014. Today, more than one in five Americans will be diagnosed with some form of skin cancer in their lifetimes. Skin cancer is a disease that affects more than 3.5 million people in the U.S., according to the American Cancer Society (ACS).

Longtime pro and broadcaster Andy North famously penned a story for the U.S. Golf Association’s Golf Journal about his 1991 skin cancer experience, thought to be collateral damage from long sun exposure days on the course in the 1970s and 1980s. North underwent five operations to cut out a large basal cell carcinoma that bore into his left cheek and later required surgery to fix the remnants of a quarter-sized hole. The doctor had removed most of his left nostril. Since then, he has had multiple lesions taken off and has helped raise monies and awareness for research.

“I was really lucky,” said North at the U.S. Open in 2002. “It could have been much worse. I wish I knew then about all the ultraviolet (UV) dangers that I didn’t really take seriously then, but few of us really did or really knew about it.”

North is just one of many professional golfers who have been victimized by the sun. The list has been growing. Then 33, Rory Sabbatini saw a doctor in 2010 for removal of a squamous cell carcinoma, the second most common skin cancer behind basal cell carcinoma.

Australian Adam Scott spoke about his basal cell carcinoma in 2011 when he was only 31. Also in 2011, compatriot Aron Price made headlines when he had three nonmelanoma cancers removed, followed by a fourth that turned out to be melanoma — the deadliest and rarest form of skin cancer. Australia holds the dubious claim as having the highest skin cancer rates in the world.

In 2014, Jimmy Walker had a Mohs micrographic surgery done on his face that excised a basal cell carcinoma. That followed having a spot removed from his lip in 2004.

“Just one of the hazards of being outside,” Walker said.

Jimmy Walker, a 2014 U.S. Ryder Cup team member and 2016 PGA Champion, calls skin cancer 'just one of the hazards of being outside.' In 2004, Walker had a spot removed from his lip. In 2014, Walker had basal cell carcinoma excised from his face / Photo: Golffile | Eoin Clarke

Most definitely. Skin cancer doesn’t discriminate against professionals. Nor does it discriminate against gender or color.

According to a March 2020 study released by the Skin Cancer Foundation, recreational golfers are at a high risk of developing skin cancer every hour while on the course. It’s likely they receive 3.5 to 5.4 times the amount of UV radiation exposure needed to cause a sunburn. More than that, those water and bunker traps are hazards in more ways than one. Water and sand can reflect UV radiation so that the skin absorbs it twice.

“That’s a serious amount of skin-damaging rays,” wrote Sajeve S. Thomas, medical oncologist at Orlando Health UF Health Cancer Center, in a blog about skin cancer prevention. He should know. Florida boasts more than 1,200 courses under an unforgiving sun — the same sun that causes cancer by damaging cell DNA.

It was estimated by the Skin Cancer Foundation that golfers — notably professionals — receive 217 times the amount of UV radiation needed to cause a sunburn over the course of the year. Just one sunburn alone as a child more than doubles the chances of developing melanoma late in life. The more someone burns, says the Skin Cancer Foundation, the greater the risk of skin cancer.

Melanoma makes up about 1 percent of all skin cancers in the U.S., but it causes the most deaths, according to Cancer.net. If not caught early enough, it can metastasize quickly.

Skin cancer doesn’t just affect males. As of this year, melanoma is the second most common form of cancer in females between 15 and 29 years old. Its incidence is increasing faster in females between those ages than in males of the same group, according to the American Melanoma Foundation.

This is not all doom and gloom. Data show strides are being made. The ACS estimated that roughly 6,800 people are expected to die from melanoma this year, a decrease from the 9,710 estimate the ACS made in 2014 and 7,320 last year.

In the mid-2000s, the U.S. Golf Association created campaigns around sun protection and prevention. The PGA and R&A followed.

What to do? Before heading out to play a round, the ACS recommends the “Slip, Slop, Slap and Wrap” rule. In other words, slip on a shirt, slop on sunscreen, slap on a hat and wrap on those sunglasses. Dr. Thomas recommends putting on a wide-brim hat and sunglasses with 100 percent UV protection. Additionally, he suggests wearing protective clothing to minimize sun exposure.

Moreover, scheduling early and later tee times — to avoid the sun’s most intense rays — can make a difference. Seek shade when possible and apply at least SPF 30-plus broad-spectrum sunscreen every two hours. Keep in mind, too, that 80 percent of the sun’s UV radiation can penetrate clouds, so the same rules apply on cloudy days.

These days, Walker liberally applies SPF lotion 70 to his face several times, admitting he probably overdoes it. But the scares had him take notice. The same with Sabbatini.

“It’s easy for golfers to think of sun protection as an afterthought,” said Sabbatini at Torrey Pines during the 2008 U.S. Open. “We’re out here every day, on the range, on the course, always exposed. In my case, the ‘afterthought’ became very real.”

Sign up to receive the Morning Read newsletter, along with Where To Golf Next and The Equipment Insider.