Do yourself a favor and don’t be like Capt. Butch Cox. That’s probably not something you’ve ever heard before about the longtime Prime Time skipper, who’s well-known for not just his fishing abilities, but also his friendly nature. So, when I say to not to be like him, it’s with an air of playfulness. While Cox has countless characteristics we all should be so lucky to emulate, there’s one particular area in his life that could use some improvement: sun protection. In that regard, Cox calls himself a bad boy. After numerous surgeries, his dermatologist would likely agree.
A First Brush with Cancer
Cox turned 71 in June and has been fishing professionally for 50 of those years. While working in Oregon Inlet on the Outer Banks of North Carolina, he eventually met someone who was looking to buy a boat and start his own fishing program. Together, the pair established an internationally renowned operation aboard the 57-foot Paul Mann Prime Time. For 24 years Cox manned the helm, fishing in world-class destinations such as North Carolina, Venezuela, Aruba, St. Thomas and the Dominican Republic. Since then, he’s gone on to run other programs, including DA Sea.
Like all fishermen, Cox has spent an immeasurable amount of time exposed to the elements and is no stranger to the sun. “While fishing, I would pretty much always wear a visor but never a shirt. And I definitely didn’t apply any sunscreen,” he admits. Decades of sun exposure would eventually catch up to him in the mid-1990s. Interestingly enough, it wasn’t a dermatologist, nurse or fellow fisherman who told him he had a problem.
“I had this bump, sort of like a pimple, on the side of my face that wouldn’t go away,” he says. “I’ve been a golfer my whole life, and one day on the course, a dentist saw the bump on my face and told me I ought to go get it checked out. I did, and it turned out to be cancerous.” That brush was the first of many. When I asked him how many surgeries he’s had since that first bout, he says, “Golly day—maybe around 10.” That’s 10 times Cox has had something cut from his face and neck. And while some skin cancers are often easy to treat, others—when left undetected—can result in much scarier outcomes.
The Common Types
According to the Skin Cancer Foundation, a nonprofit organization founded in 1979 to educate the public on prevention, detection and treatment, skin cancer is the most common form of cancer in the world, with 1 in 5 Americans expected to develop skin cancer by the age of 70. The Skin Cancer Foundation is an excellent source of information and provides a laundry list of other compelling statistics regarding various skin cancers. For example, every hour, more than two people die from skin cancer in the United States.
According to Dr. Kat Kesty, a board-certified dermatologist and owner of St. Petersburg Skin and Laser in St. Petersburg, Florida, the three most common types of skin cancer are basal cell carcinoma, squamous cell carcinoma and melanoma. “All three of these cancers are believed to be linked to sun exposure,” she says. The fundamental difference is the type of cell that has been affected. Melanoma occurs when melanocytes have been damaged, while basal cell and squamous cell carcinomas result from damaged basal and squamous cells, respectively.
Of the three skin cancers commonly seen in fishermen and others regularly exposed to the sun, melanoma is the most dangerous. According to the Skin Cancer Foundation, it is less common than basal cell carcinoma and squamous cell carcinoma, but melanoma is more dangerous because of its ability to rapidly spread to other organs if it is not treated at an early stage. Another alarming statistic, especially for those of us who have allowed ourselves to cook in the sun a number of times, is that your risk of developing melanoma doubles with a history of five or more sunburns. Fortunately, early detection and treatment results in an extremely high survival rate.
While melanoma is the most aggressive of the three skin cancers mentioned here, basal and squamous cell carcinoma, the kinds that Cox has had removed, are more common. All three of these skin cancers initially present in relatively similar ways. There are some differences in what the lesion might look like and where it might be likely to occur, but the bottom line is that you don’t need to know the differences to identify if you have a questionable site on your body. “The most common symptoms of skin cancer are any new growths or a spot that is changing, growing, bleeding, itching, or turning a different color,” Kesty explains. “The best thing to do if you have a spot that is concerning for skin cancer is to visit a board-certified dermatologist and have them look at it.”
A Visit with a Specialist
Champ Smith is a 58-year-old native of Charleston, South Carolina, who has spent his entire life on the water. He has been visiting his dermatologist, Dr. Marguerite Germain with Germain Dermatology in Charleston, multiple times per year since the mid-2000s. He’s worked as a mate and captain in locations such as St. Thomas, Cape Verde, Australia, the Azores, Venezuela and Costa Rica. Much like Cox’s experiences, Smith’s first brush with skin cancer started with a weird-looking pimple that wouldn’t go away. “I had this rough spot that was red and irritated on my cheek. I shave every day and knew something wasn’t right about it,” he says. As it turns out, Germain would go on to remove a golf-ball-size lesion from his cheek. Close to two decades later, Smith is now an old pro at dermatology visits. “I have everything circled with a magic marker when I go to the dermatologist now,” Smith says. “They burn off something every time, and I schedule appointments usually three or four times per year.”
Given advancements in technology and medicine, there are many ways to treat skin cancer depending on the type, the stage of the disease, and the location of the lesion. “Common treatments include surgery, cryotherapy and topical chemotherapy creams,” Kesty says. For more-advanced stages of melanoma, chemotherapy or radiation might be necessary. Germain added, “The most common treatment is a complete surgical excision of the affected area, leaving cancer-free margins.”
For basal cell carcinoma and squamous cell carcinoma, such an excision is usually accomplished with Mohs surgery. According to the Skin Cancer Foundation, the procedure is done in stages, all in one visit, while the patient waits between each stage. After removing a layer of tissue, the surgeon examines it under a microscope in an on-site lab. If any cancer cells remain, the surgeon knows the exact area where they are and removes another layer of tissue from that precise location, while sparing as much healthy tissue as possible. The doctor repeats this process until no cancer cells remain. Both Cox and Smith described the pain after these surgeries to be relatively minimal, unless the lesion occurred in an unusual location that took a while to heal. But in most cases, these surgeries are minimally invasive. After the procedure, patients typically wear a pressure bandage for a night or two and then switch over to an adhesive bandage until the sutures are ready to be removed.
Getting the Best Gear: Clothing and Sunscreen
Fortunately, while medical treatments have advanced over the years, so has the technology behind sun-protective clothing and sunscreens. Lightweight hooded performance shirts, neck gaiters or buffs, gloves, and hats are now widely available to fishermen these days. Such clothing options weren’t around for folks like Smith and Cox back in the day, at least not in the lightweight, moisture-wicking fabrics we now enjoy. When shopping for a shirt for yourself or for your fishing program, you’ll likely see references to its UPF rating. UPF, or ultraviolet protection factor, is a measure of the amount of UV radiation that a fabric allows to pass through and reach the skin. A fabric rated as UPF 50 stops 98 percent of the sun’s rays, allowing only one-fiftieth to pass through to your skin.
The Skin Cancer Foundation indicates that a fabric must have a UPF of 30 to qualify for its seal of recommendation. A UPF of 30 to 49 offers very good protection, while UPF 50-plus rates as excellent. When selecting your next performance shirt, consider evaluating the UPF rating. Fabrics with higher UPF ratings might be more expensive, but they are more protective. I think we’d all prefer to wear a long-sleeved performance shirt that is actually doing its job.
After dealing with multiple skin-cancer issues, both Cox and Smith cover up with UPF clothing when in the sun. Cox admits that he is still bad about applying sunscreen; Smith, on the other hand, has embraced it fully, using the recommended inorganic or mineral sunscreens to keep himself best protected from harmful rays.
SPF, or sun protection factor, is a measure of the time it takes for skin exposed to UV rays to burn. Theoretically, if used correctly, a sunscreen with SPF 30 should keep you protected 30 times longer than if you weren’t wearing sunscreen at all. Of course, there are many caveats with that, and it’s important to reapply often. “For the areas of the skin that are not covered by UPF clothing, a mineral sunscreen with SPF 50 or greater is ideal,” Kesty recommends. “Mineral sunscreens contain the ingredients titanium dioxide and zinc oxide. It used to be that mineral sunscreens left a white cast, however, newer products are on the market with sheer formulas that are more cosmetically elegant and easier for my patients to use,” she says. “I recommend to apply sunscreen at home at least 15 minutes before going out in the sun, sweating or swimming. Reapplying sunscreen at least every two hours is also important for optimal sun protection.”
Never Too Young to Start
These clothing and sunscreen recommendations don’t just apply to those who have had skin-cancer issues already. All fishermen—regardless of age—should consider using the same products. I know that none of this is sexy or fun, but neither are gaping, fleshy wounds that require you to visit a plastic surgeon or wrinkles that make you look more raisin than human. Or, more important, neither is chemotherapy. Thomas Henry Key, a 21-year-old mate who works for Capt. Ryan Riggs aboard Outlier, has been an avid angler since he was too little to retain memories. Key has spent enough time in the industry to have heard the horror stories. “It seems like any time I talk to someone from the older generation, they have at least had one encounter or scare with sun-exposure-related issues,” he says. “Just hearing their stories at the dermatologist alone has scared me enough to want to be much more conscious of sun protection.”
Key is known for covering up on the water. Of course, there are days when he might not wear a wide-brimmed hat or be fully lathered in zinc oxide, but he does a good job of keeping himself protected. “I am a big fan of using mineral sunscreens,” he says. “I apply a thick coat first thing in the morning and keep reapplying throughout the day. A motto I use for myself regarding sunscreen is that if you can’t see it, it isn’t working, so I use that mindset to ensure that I am protected.”
If you have already intelligently incorporated sun protection into your routine, keep it up. When I ask Cox if he has anything else he’d like to share with others regarding skin cancer and sun protection, he simply says, “Take better care of yourself than I have.”
Think about having to continually visit a dermatologist to cut chunks out of your face or hands. Don’t let the stories of these legendary fishermen fall on deaf ears. “The effects of the sun are cumulative over your entire lifetime,” Germain warns. “The skin remembers every second you’ve spent in the sun from the time you were born. That is why sun protection and developing smart habits are so important.”
And if you’re a young person trying to come up in this industry and the health risks aren’t enough to persuade your sense of immortality, consider how the sun affects your fishing ability. “I was bad about not wearing sunscreen for much of my teenage years,” Key says, “but I quickly realized how much energy the sun drains out of you throughout the day. That can really affect how you work and perform over multiple days of fishing. Being well-protected conserves my overall energy levels and enables me to perform my best, day in and day out. I would hate to be in a situation later in life where my health requires me to limit my sun exposure.” It’s all pretty simple: Protect yourself now, and you’ll be fishing for a lot longer than you would if you don’t.
You are never too young—or too old—to practice good preventive-medicine habits; protect yourself from the sun all year long. The best prevention is to avoid prolonged sun exposure; however, if you must be in the sun, Dr. Marguerite Germain offers the following tips for keeping yourself protected:
- Wear sun-protective clothing, including a hat with a 3-inch brim, and wraparound sunglasses to protect the eyes.
- Apply and reapply an adequate quantity (a golf-ball-size amount) of at least SPF 30 sunscreen at least every two hours. Don’t forget tops of feet and backs of hands and ears.
- Everyone should be extra careful about sun protection at the beach, pool, or on a boat because there is reflection of dangerous sun rays from the water, sand, and concrete.
If you’re concerned about sunscreen’s potential ill effects to yourself or coral reefs based on information you’ve seen in the news, avoid sunscreens with oxybenzone and octinoxate in the ingredients.
Everyone should start seeing a dermatologist in early childhood to get properly screened for sun damage and evaluated for any potentially dangerous moles. Annual visits to the dermatologist for a full-body skin screening is recommended for all ages.