An Ounce of Prevention

When it comes to skin cancer, the best defense is a good offense.

By Laurie Wertich

Who doesn’t love summer? The days are long, the nights are warm, the pace is carefree, and the sunshine is abundant. As the season approaches, visions of beach days may dance in your head—but before you spread your blanket on the sand, it’s important to make sure you’ve taken proper precautions to protect your skin and prevent skin cancer.

Skin cancer is the most common cancer in the United States, with more than 1 million new cases each year.1 About 90 percent of all skin cancer is caused by ultraviolet (UV) exposure from the sun.2 There is no healthy, safe way to tan; however, it’s not realistic to prevent all sun exposure. Here’s how to have fun in the sun—safely.

Wear Sunscreen The importance of sunscreen cannot be overstated. If there were one area in which to be an overachiever, this is it. Wear sunscreen every day: sunny days, cloudy days, hot days, cold days, summer days, winter days—every day. It’s your first line of defense against the sun. Choose wisely and apply carefully:

  • Broad spectrum. Choose a broad-spectrum sunscreen that protects against both types of ultraviolet rays: UVA and UVB. UVA rays are associated with wrinkling and aging, whereas UVB rays are associated with burning. Both types of rays cause skin damage.
  • High SPF. Choose a sunscreen with a sun protection factor (SPF) of 30 or higher (although the jury is still out on the added efficacy of anything over SFP 50).
  • Apply early and often.  Apply sunscreen 15 to 30 minutes before heading outside. Reapply at least every two hours, more often if you’re sweating or swimming. Even if you’re wearing water-resistant sunscreen, it’s imperative to reapply immediately upon exiting the water, as no sunscreen is truly waterproof.
  • Slather it on. This is no time to conserve. Dermatologists recommend applying at least 1 ounce of sunscreen to all exposed areas; this adds up to about the amount of a shot glass for your entire body.
  • Go white. Sunscreens with physical blockers such as zinc oxide and titanium dioxide protect against more rays. Another bonus is that these ingredients are associated with fewer allergic responses.

Not all sunscreen is created equal. To learn more about decoding labels and maximizing protection, see sidebar “The Proof Is in the Labeling.”

Limit Exposure The sun’s rays are strongest between 10 a.m. and 2 p.m. Stay inside or seek shade during this time of day to avoid overexposure.

Wear a Hat Wear a hat to shield yourself from the sun’s harsh rays. Choose your hat with safety in mind.

  • Wide brim. A wide-brimmed hat helps shade the face, head, neck, and ears. Baseball caps do not provide protection for the ears and the back of the neck.
  • Tight weave. A tightly woven fabric, such as canvas, provides the best protection from UV rays. Avoid straw hats that let sunlight through.

Make Shade If you’re planning a long day outside, consider creating your own shade. Beach umbrellas or portable shelters provide protection from both the heat and the harmful rays of the sun.

Wear Protective Clothing A rash-guard with sleeves may not be as sexy as a teeny-weeny bikini, but it provides a lot more protection. Cover up to protect that precious skin. Regular clothing offers some protection from the sun, but if you want to go the extra mile you can invest in sun-protective clothing that is rated with an ultraviolet protection factor (UPF). There are also several laundry aids on the market that offer wash-in UV protection: added to a load of laundry, it creates a UPF of 30 for every garment in the load and lasts for up to 20 washes.

REFERENCES

1. Cancer Facts and Figures 2011. American Cancer Society website. Available at: http://www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancer-facts-figures-2011. Accessed January 9, 2012.

2. Pleasance ED, Cheetham RK, Stephens PJ, et al. A comprehensive catalogue of somatic mutations from a human cancer genome. Nature. 2009;463:191-96.

3. FDA Sheds Light on Sunscreens. US Food and Drug Administration website. Available at: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm258416.htm. Accessed January 9, 2012.

Early Detection

When prevention falls short early detection is critical

Face it: no matter how diligent you are about prevention, there is always a risk of developing skin cancer. Skin cancer doesn’t discriminate—it affects people of all ages and nationalities. Most skin cancer is very treatable if caught early, so it’s important to learn to recognize the signs.

The best skin sleuth is you. You know your skin better than anyone, and if you learn to pay attention, you’ll be the first to recognize changes in your skin. The American Academy of Dermatology offers a free, downloadable body mole map on its website (www.aad.org). One of the best ways to set yourself up for successful early detection is to use this mole map to perform an initial self-exam. To perform the exam, get naked and examine your body front and back and left and right. Don’t forget those hard-to-reach areas, such as between the toes or behind the ears. Use a hand mirror or a partner to examine tricky areas. Record your moles on the body mole map, which will become a handy tool for tracking any future changes.

Tracking Skin Changes

Stay familiar with your skin so that you can quickly catch any changes. Here’s what you want to watch for:

  • New moles or changes in your skin
  • Sores that don’t heal after two to three months
  • Small raised, red areas that bleed after a minor injury
  • Oozing or crusted areas of skin
  • Swelling
  • Change in sensation (itching, tenderness, or pain)

Staying familiar with your skin is an important first step in the early detection of skin cancer, but it’s important to remember that it is possible for skin cancer to develop without these characteristics and it’s also possible for a non-cancerous skin change to have all of these characteristics. In addition to monitoring your skin regularly, you may benefit from annual skin exams by a dermatologist, particularly if you have a family or personal history of skin cancer. The American Academy of Dermatology partners with dermatologists across the United States to offer free skin cancer screenings in an effort to improve the rates of early detection.

The Proof Is in the Labeling

For the first time in more than three decades the US Food and Drug Administration (FDA) has released new SPF guidelines, which will take effect this summer.3 The new regulations are twofold: they establish standards for testing the effectiveness of sunscreen products, and they require labeling that accurately reflects these test results.

Here’s what you need to know:

  • Broad spectrum means broad spectrum. Products labeled “broad spectrum” will have to pass a test proving that they protect against both UVA and UVB rays. In the past some products labeled as broad spectrum did not protect against UVA rays. Beginning in summer 2012, you can rest assured that any sunscreen labeled as broad spectrum has passed the test and does indeed provide broad-spectrum protection.
  • Water resistance will be clearly spelled out. Labels on water-resistant sunscreens must specify either 40 or 80 minutes of protection. Sunscreens that are not water resistant will be clearly labeled as such.
  • Health claims. Only sunscreens with an SPF of 15 or higher can have labels that claim that they protect against skin cancer. Sunscreens with the broad-spectrum designation can claim to protect against sun-related premature skin aging.
  • The no-no’s. The FDA has cracked down on many false and misleading claims. Manufacturers cannot claim that their sunscreens “block” the sun or that they are “waterproof” or “sweatproof.” They also cannot claim that their products prevent skin cancer or aging. Finally, they cannot claim that their sunscreen lasts more than two hours unless proof has been submitted and approved by the FDA.
  • Drug facts. Sunscreen labels will now have a “drug facts” box just like that found on over-the-counter medications. The box will contain appropriate safety warnings. For example: Sunscreen products that are not broad spectrum or that are broad spectrum with SPF values from 2 to14 will be labeled with a warning that reads, “Skin Cancer/Skin Aging Alert: Spending time in the sun increases your risk of skin cancer and early skin aging. This product has been shown only to help prevent sunburn, not skin cancer or early skin aging.”

In the Pipeline

The new guidelines are a huge step toward consumer protection and education, but the FDA is not finished establishing the ground rules. There are still two issues under evaluation:

  • SPF limits. There is a proposed rule to limit the maximum SPF value on sunscreen labeling to “SPF 50+” because there is no convincing data that anything beyond SPF 50 is more effective. Manufacturers are being given time to submit data.
  • Data request. There is a data request for information regarding the safety and the effectiveness of spray-on sunscreens. There is concern that people use too little sunscreen when it is in spray form and that there may be dangers associated with inhaling the spray formulas. The FDA is asking manufacturers to prove the effectiveness of these products.

What the New Guidelines Mean for You
The new FDA guidelines will take the guesswork out of choosing sunscreen. Now you can be confident that the products you choose have been adequately tested and are labeled to accurately reflect the level of protection they’ll provide.

This ABCDE guideline is an excellent tool for detecting changes in moles and can be useful for detecting melanoma, the most deadly type of skin cancer:

Asymmetry: One half of a mole is unlike the other half.

Border: The mole has an irregular or jagged border.

Color: The mole varies in color, with shades of tan, brown, or black or even white, red, and blue.

Diameter: The mole is larger than 6 millimeters in diameter, which is the equivalent of a pencil eraser.

Evolving: The mole is changing in size, shape, or color.

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