In the Know: Summer Sun and Skin Cancer
Summer is in full force which made us think of afternoons by the pool, weekend hikes and lots of SUN! And where there is sun, there is sunburn and the potential to develop skin cancer. So, with that in mind, and our annual Fight Cancer campaign in a few short months, we spoke with Dr. Audrey Fetch, a board-certified Dermatologist and fellow of the American Academy of Dermatology for the dos and don’ts this summer season.
What are the most common types of skin cancers?
The most common types of skin cancer are called non-melanoma skin cancer (NMSC), otherwise known as basal cell carcinoma or squamous cell carcinoma. It is estimated that over 5 million cases were diagnosed in 2012 alone,[i] and that 1 in 5 Americans will develop skin cancer in their lifetime. [ii] Most patients think of Melanoma when they think of skin cancer, however invasive melanoma comprises about only 1% of all skin cancer cases. [iii] Melanoma, however, is the most deadly.
What are the warning signs/what should you look out for?
Universal warning signs include changes in the size, shape, or color, the appearance of a new lesion, or a non-healing wound. NMSC often will present as a red scaly patch that fails to improve over time, open sores, small pink shiny bumps, or odd looking scars. Any non-healing wound or bump persisting longer then a few weeks should be evaluated by a board-certified dermatologist.
These lesions tend to occur predominantly on sun-exposed areas, however melanomas can occur anywhere- including the inside of the mouth, fingernails, the scalp, and the soles of the feet.
Many patients also think that melanomas only develop in existing moles, which is incorrect. A recent study published in August 2017 in the Journal of the American Academy of Dermatology found that only ~29% of melanomas arise from a pre-existing mole, and ~71% arise de novo. [iv]
The American Academy of Dermatology has a wonderful website (https://www.aad.org/public/spot-skin-cancer) with instructions on how to do a self-skin checks and how to check your partner.
And get this…research has shown that a woman is 9 times more likely than a man to diagnose a skin cancer on others![v]
What are the risk factors?
UV exposure (from both natural light and tanning beds), blistering sun burns as a child, having fair-skin with red/blonde hair and freckles, and a personal or family history of skin cancer, are all risk factors for skin cancer.
Certain patients with weakened immune systems, certain types of leukemia, or a history of organ transplants are particularly susceptible to developing more skin cancers, and skin cancers that can behave more aggressively.[vi]
We live in California where the sun shines almost year-round. How can we protect ourselves?
With SUNSCREEN!!! When looking for a sunscreen, the AAD recommends looking for the following labeling:
- Broad-spectrum protection: This means it has protection against both UVA and UVB rays.
- “I personally love products with mineralized zinc oxide or titanium dioxide. Unlike the old zinc products of the past, these newer nanoparticles go on smoothly and don't leave behind a white residue,” said Dr. Fetch.
- Minimum SPF of 30
Dr. Fetch recommends applying sunscreen 15-30 minutes before exposure and reapplied every 2 hours or after sweating. “UV radiation is strongest between 10am-4pm, so try and avoid being in direct sunlight at this time,” she said.
For the most protection, wear long sleeved tightly woven, darkly colored clothing or a wide brimmed hat when outdoors. Remember that sunscreen does not only protect against sunburns and skin cancer, but also prevents and slows signs of aging, such as age spots and wrinkles! [ix] [x]
How often should you have your doctor do a skin check?
“The AAD encourages everyone to perform monthly self-skin checks, and report to a board certified dermatologist for any concerning lesions. Patients with a history of skin cancer should have skin checks by a dermatologist every 6 months to 1 year,” she finished.
[i] Rogers HW, Weinstock MA, Feldman SR, Coldiron BM. Incidence Estimate of Nonmelanoma Skin Cancer (Keratinocyte Carcinomas) in the US Population, 2012. JAMA Dermatol. 2015;151(10):1081–1086. doi:10.1001/jamadermatol.2015.1187
[ii] Stern RS. Prevalence of a history of skin cancer in 2007: results of an incidence-based model. Arch Dermatol. 2010 Mar;146(3):279-82
[iii] American Cancer Society. “Cancer Facts and Figures: 2017”. https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2017.html Last accessed September October 12, 2017.
[iv] Pampena R, Kyrgidis A, Lallas A, Moscarella E, Argenziano G, Longo C. A
meta-analysis of nevus-associated melanoma: Prevalence and practical
implications. J Am Acad Dermatol. 2017 Aug 22. pii: S0190-9622(17)32051-0. doi:
[v] Avilés-Izquierdo JA et al. Who detects melanoma? Impact of detection patterns on characteristics and prognosis of patients with melanoma. Journal of the American Academy of Dermatology. 2016. 75 (5): 967-97
[vi] Bolognia, J., Jorizzo, J. L., & Schaffer, J. V. (2012). Dermatology. Philadelphia: Elsevier Saunders.
[vii] The International Agency for Research on Cancer Working Group. The association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: a systematic review. Int J Canc 2006; 120:1116-1122.
[viii] Green AC, Wallingford SC, McBride P. Childhood exposure to ultraviolet radiation and harmful skin effects: Epidemiological evidence. Progress in biophysics and molecular biology. 2011;107(3):349-355. doi:10.1016/j.pbiomolbio.2011.08.010.
[ix] Sambandan DR, Ratner D. Sunscreens: an overview and update. J Am Acad
Dermatol. 2011 Apr;64(4):748-58. doi: 10.1016/j.jaad.2010.01.005. Epub 2011 Feb
[x] Lim HW, Arellano-Mendoza MI, Stengel F. Current challenges in photoprotection.
J Am Acad Dermatol. 2017 Mar;76(3S1):S91-S99. doi: 10.1016/j.jaad.2016.09.040.
Epub 2016 Dec 27.