Author: Laurel J. Finster, MPH

Author Affiliation: Stanford University, School of Medicine, Department of Epidemiology and Population Health

This blog offers a personal reflection on surfing, sun exposure, and the complex balance between the joy of an outdoor sport and the cancer risks associated with prolonged exposure to ultraviolet (UV) radiation. Through personal experience and medical insight, it explores how a passion for surfing became intertwined with skin cancer diagnosis, risk mitigation, and the ongoing practice of self-care.

Under the hot sun, the glassy, turquoise water looked clear enough to drink it. A 10-foot board was propelling into motion underneath me, finding a rhythm with the wave as if it knew something I didn’t. I stood up, and within seconds was swallowed by the whitewater like a wet rag. Still, at the age of 39, I was drawn in. 

Surfing, as I would come to understand, is both technical and expressionistic. It is scientific in the way that the wave’s break point peels along the wave crest, providing a brief opportunity to surf within the “wave pocket”. Waves can be read by their breaking patterns, shifting with tides, swell, and wind (1). Yet surfing is artistic, allowing each surfer to develop a distinctive style of how they flow on a wave, often bemoaned by surfers as “steeze”.

Unfortunately, my new obsession began the same year I was diagnosed with two stage 0 melanomas. I already had nine excisions from bad moles, but this new diagnosis meant something different… a more carefully examined relationship with sun exposure. I was advised to wear pants at the beach, gloves while driving, and a wide brimmed hat always, no exceptions. 

Research has linked ocean sports like surfing not only to the physical health benefits of physical activity (e.g.,  improvements in fitness, body composition, cardiovascular function, and Vitamin D intake) (2, 3), but to clinically significant gains in mental health outcomes  like reducing stress, anger, and depression (4, 5), and even mitigating symptoms of PTSD, especially among women and girls (6, 7). Unless you have experienced it, there is nothing quite like the post-surf zen. Author William Finnegan wrote in Barbarian Days: A Surfing Life, “What was consistent was a certain serenity that followed a rigorous session. It was physical, this postsurf mood, but it had a distinct emotionality too. Sometimes it was mild elation. Often it was a pleasant melancholy. After particularly intense tubes or wipeouts, I felt a charged and wild inclination to weep, which could last for hours.”

So, I began  my calculated risk era of surfing. With 17 years in health research, much of it in the cancer field,  I know the data– people who participate in outdoor sports experience high levels of ultraviolet radiation, and surfers can be 120x more likely to get skin cancer (8, 9). While honing my surf craft through attempts at rail grabs and nose riding, I kept up with my four-month skin checks. Then came another call: another melanoma and severely atypical mole. My dermatologist tone shifted, “you are too young to now have your 11th lesion of consequence, and too many biopsies to keep track of”. My body had enough scars to be its own case study. 

There is a certain wisdom that is gained anytime you surrender to life’s constant, unpredictable change, and the ocean provides ample opportunity to do so. During really tough surf sessions, I often question why I put myself in a situation that requires intense adaptability and resilience. During my doctors’ visits, I am reminded that cancer also demands these character traits. 

Turns out that calculating melanoma risk is not straightforward, and the diagnosis, classification, and management of cutaneous melanoma has undergone several transformations over the past decade (10, 12). After my first diagnosis, I underwent genetic testing to look for inherited melanoma mutations and fortunately, they were all negative. However, another mutation appeared in subunit A of succinate dehydrogenase enzyme (SDHA), a mutation linked to cancers of the nervous system (13). Could this be related to the melanoma? Unclear. But I underwent several hours of MRI testing.

With the third melanoma finding, I was reminded that I am two years overdue for my follow-up with the pituitary gland and adrenal gland disorders specialist. I made an appointment. 

 “Where have you been”? she asks. Well, working full-time, three young kids, gynecologic issues, quarterly dermatology visits, …She said SDHA mutations don’t wait for people, and the tone became more somber. When asked how I stay healthy, I proudly shared my devotion to surfing, expecting praise. Instead, she quipped, “You grow melanomas like mushrooms, someone like you should not be exposed to that much sun”. Ouch. 

I tried to explain what surfing meant to me but my eyes welled up with tears. Crying in a doctor’s office is always a very vulnerable few minutes, with constant scanning for the exit ramp to the conversation and visit. “Maybe you can try Pilates”, she suggests. I do practice Pilates, and it isn’t the same, but it is hard to convey that to someone who isn’t part of the tempestuous cult of surfing. 

It is quite the paradox: the activity that brings me the most joy and vitality, surfing, may pose the greatest risk to my health. Was it true that one day my immune system might give up on fighting these lesions as she suggested? I thought of my children. But now I share the lineup with them, and surfing makes me a better, happier mom. How can I give this up?

The facts are the facts. Cutaneous melanoma is increasing globally, particularly among white people, while people of color and those who experience poverty bear the burden of mortality and poor outcomes (10, 14-17).  The good news is that there is a lot of promise in emerging immunotherapies and targeted therapies for individuals with advanced disease (10, 11).  Evidence- based strategies for melanoma prevention are available, including avoiding sunburn and tanning beds and utilizing skin protective measures (e.g., sunscreen, protective clothing). But ultimately, avoiding prolonged exposure to UV radiation from the sun seems to be the best strategy available to us today (12). 

What does this mean for my amateur surfing career? Undecided. But the morning after my visit with the specialist, I paddled out earlier with the UV index in mind and a bucket hat. The lineup was quiet, my mood was solemn, and the waves caught that day felt sacred. Back on land, I made my follow-up appointment for more MRIs and ordered an even wider wide brimmed hat.

References

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