With summer here (finally), we are seeing more and more people (and staff) with sun damaged skin. As Family Medicine providers we frequently see patients with skin lesions and skin cancers. In our Medical Laser and Rejuvenation practice many of the concerns we face – brown spots, premature wrinkles – are also related to sun damage. The goal of this blog is to give some facts about the problem, and what we can all do to lower our family’s and our own risk of skin cancer and skin damage.
Skin cancer is the most common form of cancer in the United States
and directly related to sun exposure.
More than 3.5 million skin cancers in over two million people are diagnosed annually. There are 3 common types of skin cancers: basal cell, squamous call and the most deadly, melanoma.
- A person’s risk for melanoma doubles if he or she has had more than five sunburns at any age.
- One or more blistering sunburns in childhood or adolescence more than double a person’s chances of developing melanoma later in life.
- The biggest jump in melanoma rates is for adolescents aged 15 to 19, especially girls. In the last 40 years the incidence of melanoma increased by 8X in young women and 4X in young men
- Of the seven most common cancers in the US, melanoma is the only one whose incidence is increasing. Between 2000 and 2009, incidence climbed 2% a year.
- The predictions are 80,000 cases of invasive melanoma will be diagnosed in 2013 with 10,000 deaths.
- Melanoma is the most common form of cancer for young adults 25-29 years old.
- This increase is linked to the common use of tanning booths in adolescents and young adults . Recent reports from the International Journal of Caner found that using tanning facilities before age 35 increases the risk of melanoma by 75 % Although there is legistation proposed to change the legal age for tanning in CT, presently it is legal for teens use tanning booths without parental consent at age 16.(I learned this from personal experience when I found a tanning pass on both my teen daughters key rings and learned that they actually did not need to lie about their age to get in.)
SUNSCREEN NOT A MAGIC BULLET
It seems a lopsided statistic that as sunscreen sales increase, so are the cases of skin cancer. As Rabin quotes in an article ( New York Times, Health & Science section on May 27, 2013 ) “Sunscreen is not a magic bullet,” said Dr. Steven Q. Wang, director of dermatologic surgery and dermatology at Memorial Sloan-Kettering Cancer Center and a spokesman for the Skin Cancer Foundation, “It’s just one of the defenses against the harmful effect of UV radiation, and that message gets lost.”
Many patients think that applying sun screen and going to beach, boating and other outdoor activities, exempts them from sun damage. Others tell me they “always use sunscreen” when they are on vacation, boat, etc. While we know that it is important to apply sunscreen on typical days when you will have exposure to sun, for the best protection, we recommend the “5 S’s“. The 5 S’s are a combination of sun protection measures The Australian Health Department uses as their slogan.
PRACTICE THE 5 S’s
- SLIP on some sun-protective clothing that covers as much skin as possible.
- SLOP on broad spectrum, water resistant SPF30+ sunscreen “broad spectrum protection”, meaning they protect against both UVA and UVB rays. Apply one ounce (2 tablespoons). Put it on 20 minutes before you go outdoors and every two hours afterwards. Sunscreen should never be used to extend the time you spend in the sun.
- SLAP on a hat – broad brim or legionnaire style – to protect your face, head, neck and ears.
- SEEK shade.
- SLIDE on some sunglasses. Yes, ultraviolet(UV) eye protection matters. UV radiation from the sun can damage not only the skin of your eyelid but also the cornea, lens and other parts of the eye. UV exposure also contributes to the development of certain types of cataracts and possibly macular degeneration. When you’re choosing sunglasses, look for UV-protection details on product labels. Choose sunglasses that block 99 to 100 percent of both UVA and UVB rays. Skip sunglasses that neglect to offer details about their UV protection. Keep in mind that the color and degree of darkness sunglasses provide have nothing to do with the sunglasses’ ability to block UV rays. Also, opt for wraparound sunglasses or close-fitting sunglasses with wide lenses that protect your eyes from every angle.
In addition to the 5 S’s, we recommend a few more precautions:
- Keep babies younger than 6 months out of the sun, period. If they must be outdoors, keep them completely covered and in the shade. Sunscreen should NOT be used on infants.
- Try to keep older children inside when the sun is harshest, from 10 a.m. to 2 p.m.
- Look for products with an SPF of 15 to 50, and that are labeled “broad spectrum protection,” meaning they protect against both UVA and UVB rays. Higher SPF values are misleading and the FDA has recommended capping SPA at 50. Advocates like Sonya Lunder, analyst for the Environmental Working Group, have criticized the F.D.A. for backing away from some of its own proposals, like putting in place a star system that would give consumers more information about UVA and UVB protection, capping the SPF values allowed on the market at 50, and banning sunscreen sprays, which may not work as well to prevent sunburn. Europe and Canada have tougher standards, Ms. Lunder said. “In the U.S., you can make a bad sunscreen and just not call it ‘broad spectrum,’ but still sell it,” she said. “In Europe, the pass-fail test is stronger, and it must protect against both UVA and UVB.” New York Times, Health & Science section on May 27, 2013
- Avoid sunscreen sprays. The FDA is requesting more studies on these products. The concern is twofold: that not enough sunscreen makes it onto the skin, and that the spray may be inhaled into the lungs.
- Labeling was changed recently to water resistant from water proof.
- Examine your skin and your families skin head-to-toe every month. Many cancers are in areas we don’t normally think of: feet, back, top of head. Ask your provider if you have any concerns
- See your physician every year for a professional skin exam.
- Take endorsements and seals of approval with a grain of salt. The Skin Cancer Foundation gives a “seal of recommendation” to sunscreens, but only if their manufacturer has donated $10,000 to become a member of the organization.
New York Times, Health & Science section on May 27, 2013
Skin Cancer Foundation/Skin Cancer Facts
Information provided on this website and in the Doctor’s Blog is for informational and educational purposes only. It is not intended as and does not substitute for medical advice. Please consult your health care professional for evaluation of your individual case.
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