Doc’s Corner


Skin cancer statistics are scary, to put it mildly.
Each year there are more new cases of skin cancer than new cases of breast, prostate, lung and colon combined. One in every five Americans will develop skin cancer during their lifetime.
The underlying cause is well known: 90 percent of basal and squamous cell cancers and 86 percent of melanoma cases are linked to sun exposure, according to the Skin Cancer Foundation.
Living in beautiful, sunny Southern California, what’s a sun-loving person to do? The obvious response is to use sunscreen, but how much, how often and what type? Each of us have a different risk profile based upon skin type, prior exposure and even inherited genetic predisposition. This is because those with more pigmentation have more natural protection from the sun. However, people with darker skin can nonetheless get skin cancer. Most people have a UV radiation resistance-associated gene (UVRAG for short), that rushes in to repair as much of the damage as possible, while others lack this protection. We now know this gene plays a role in everyone’s odds of getting skin cancer. Skin damage can begin within 15 minutes of sun exposure. It is generally best to consider each of us to be at risk.
Wear sunblock whenever you’re outdoors, regardless of the weather and your skin tone. Apply an ounce of sunblock (about a shot glass) 30 minutes before going outdoors, as recommended by the American Cancer Society. As much as 40 percent of the sun’s UV rays reach the earth on overcast days.
And skin cancer doesn’t discriminate. Melanoma survival rates among African Americans tend to be significantly lower than white Americans, according to a recent study published in the Journal of the American Academy of Dermatology.
Reapply your sun block after getting wet or sweating. Waterproof sun block doesn’t exist. Yes, there were products labeled as waterproof but since they needed to be reapplied after getting wet or swimming, they’re really not waterproof. According to new FDA guidelines, if a sunblock is marketed as water resistant, it must be able to claim to protect you for 40 or 80 minutes after getting wet or sweating.
Not all sun blocks protect you from UVA and UVB rays. UVA rays age your skin, weaken the immune system and damage DNA. UVB rays are linked with skin cancer. Many sun blocks provide protection against UVB rays but not UVA. Only products labeled as broad spectrum can protect you from both because they have either zinc oxide (experts’ ingredient of choice), titanium oxide or three percent avobenzone with octocrylene in its ingredients.
Aerosol spray-on sun blocks often don’t provide the same level of protection as a lotion. It’s very difficult to gauge the amount of spray you’ve used and if you’re thoroughly covered. Inhaling fumes also is a concern.
Read sun block labels. Begin by checking the expiration date. Most sun blocks are only effective for two or three years. Next, check the SPF level. Many people are willing to spend a lot of money on sun blocks with high levels of SPF thinking they’ll get significantly more protection from UVB rays. That’s not quite accurate. A block with SPF 15 screens out about 93 percent of UVB rays; SPF 30 filters about 97 percent, SPF 50 protects 98 percent and SPF 100 blocks about 99 percent. Select a SPF level that best suits your needs and wallet. Usually use SPF 15-30 or higher, SPF 50 if fair skinned.

1 Broad Spectrum: It’s essential for your sunscreen to offer broad spectrum protection, which means that it offers effective protection against both UVA (ultraviolet A) and UVB (ultraviolet B) rays, the solar wavelengths proven to damage the skin. UVA rays penetrate the skin more deeply than UVB, and are the chief cause of wrinkles, sagging and other signs of aging. UVB rays damage the skin’s upper surface and are the main cause of sunburn. Both cause skin cancer.

2 Sun Protection Factor (SPF): SPF is a measure of how long a person can stay in the sun before its UVB rays start to burn the skin. Let’s say with no sunscreen, your skin starts to redden in 20 minutes. An SPF 30 will theoretically allow you to stay in the sun 30 times longer without getting burned. But keep in mind that SPF numbers are determined in a lab. In the real world, no matter what the SPF, sunscreens start to lose effectiveness over time, so it’s important to reapply every two hours and after swimming or heavy sweating. Also note that above SPF 50 the amount of additional sun protection is negligible. The Skin Cancer Foundation recommends always using a broad spectrum sunscreen with an SPF of 15 or higher – SPF 30 or higher for extended stays outdoors.

3 Water-resistant: The terms “water-resistant” and “sweat-resistant” indicate whether the sunscreen remains effective for 40 minutes or 80 minutes when you are swimming or sweating. Since no sunscreen is fully “waterproof” or “sweatproof,” the FDA prohibits these terms.

4 Active ingredients: This area of the label, often on the back of the bottle, lists the main ingredients in sunscreens that protect your skin against UV rays. There are two main types of active sunscreen ingredients: chemical and physical. Chemical ingredients such as avobenzone and benzophenone, work by absorbing UV, reducing its penetration into the skin, whereas physical ingredients such as titanium dioxide and zinc oxide stay on top of the skin and deflect UV rays. Many sunscreens available today combine chemical and physical ingredients.
Lastly, consider selecting a brand without vitamin A and forms of it such as retinyl palmitate, retinyl acetate, retinyl linoleate and retinol. The sun block industry uses this antioxidant to moisturize skin. But topical vitamin A has been linked to skin tumors and lesions when exposed to sunshine.
Of course, sunblock is not your only means of sun protection. Tightly woven, loosely fitted long shirts and pants can reduce up to 27 percent of your sunburn risk. If you spend a lot of time in the sun, consider investing in sun-protection clothing, sold at many sporting good and outdoor stores. Additionally, hats with two to three-inch brims, UV blocking sunglasses and contact lenses also can help. Whenever possible, avoid planning outdoor activities between 10 and 4 pm, when the sun is the strongest. And when outdoors, seek shade, whether it be a tree, umbrella or tent.
Be sure to scan your body each month to keep track of new or changing moles and lesions that should be reported to your doctor. If you’re concerned about vitamin D deficiency, talk to your physician. Sun exposure has long been touted to help prevent vitamin D deficiency; however, many experts no longer consider it to be the safest or most reliable source of vitamin D. Vitamin D supplementation is now readily available.
In Summary:

Seek the shade, especially between 10 AM and 4 PM.
Avoid sunburn.
Avoid tanning and UV tanning booths.
Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses.
Use a broad spectrum (UVA/UVB) sunscreen with an SPF of 15 or higher every day. For extended outdoor activity, use a water-resistant, broad spectrum (UVA/UVB) sunscreen with an SPF of 30 or higher.
Apply 1 ounce (2 tablespoons) of sunscreen to your entire body 30 minutes before going outside. Reapply every two hours or immediately after swimming or excessive sweating.
Keep newborns out of the sun. Sunscreens should be used on babies over the age of six months.
Examine your skin head-to-toe every month.
See your physician every year for a professional skin exam.
Nonsteroidal anti-inflammatory medications like aspirin, ibuprofen (Advil and Motrin) and naproxen (Aleve) make you extra-sensitive to the sun. If you use such medications for your aches and pains, be vigilant about protecting your skin. Be aware that some prescription medication, some antibiotics and others, may sensitize the skin to burn more readily.

Paul R. Block, MD, FACP, FCCP

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