Preventing Skin Cancer

The most important way to prevent skin cancer is to protect your skin from the harmful effects of the sun's rays. This leaflet gives tips on how to protect your skin from the most damaging ultraviolet rays. There are separate, more detailed leaflets on the different types of skin cancer, called 'Cancer of the Skin - An Overview', 'Cancer of the Skin - Non-melanoma' and 'Cancer of the Skin - Melanoma'. One of the most important things is to protect children's skins from the sun. The skin of a child is more sensitive to sun damage which can lead to skin cancer in later life.

About 9 in 10 non-melanoma skin cancers (this includes basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), and about 6 in 10 melanoma skin cancers (the most serious form of skin cancer) are thought to be caused by excessive exposure to the sun. In particular, episodes of sunburn greatly increase your risk of developing skin cancer.

It is the ultraviolet (UV) radiation in the sunshine which does the damage. There are two types of UV radiation - UVA and UVB (see later). Skin cells that are damaged are at greater risk of becoming abnormal and cancerous.

Sun damage can also cause other skin problems to develop. For example, premature skin ageing (wrinkles, loss of elasticity, etc) and solar keratoses (also called actinic keratoses - roughened growths on the skin that are noncancerous).

All people of all ages should protect their skin, but it is even more vital to protect children. Although skin cancer is rare in children, the amount of sun exposure during childhood is thought to increase the risk of developing skin cancer in adult life. Therefore, take extra care with children, and keep babies out of the sun completely.

If you have pale skin, red or fair hair, and freckles, you have the type of skin which burns most easily. This puts you at increased risk of sun-related skin damage and you should take extra care to protect your skin - NEVER allow yourself to burn. Skin cancers, especially melanoma, are uncommon in nonwhite skin types.

Avoid the sun as much as possible when the sun is strong

In the UK, stay in the shade or indoors as much as possible between 11 am and 3 pm in the summer months (May to September). This applies all year round in hotter countries nearer to the equator. This middle time of the day is when the sun's rays are the strongest. Trees, umbrellas and canopies can all provide good shade.

Cover up

Cover up the body as much as possible when you are out in the sunshine:

  • Wear wide-brimmed hats with a brim that goes all around the hat to protect the face and neck. These are the areas most commonly affected by sun damage. Men, in particular, seem most likely to develop skin cancers on their necks, shoulders and backs (women tend to get skin cancers more on their legs and arms). Baseball caps are not as effective, as they shade the face but not the neck, lower face and ears (unless you buy one with a cotton neck protector). Young children should wear hats with neck protectors too.
  • Wear loose baggy T-shirts (or even better - long-sleeved tops) and baggy shorts. The material should be tightly woven to block out sunlight.
  • Wear wrap-around sunglasses (your eyes can get sun damage too). Make sure the sunglasses conform to the European Standard, indicated by the CE mark (or equivalent) and are labelled as providing protection against UV light.

Use a high-factor sunscreen liberally

You should apply sunscreen of at least sun protection factor (SPF) 15 (SPF 30 for children or people with pale skin) which also has high UVA protection. SPF gives a guide to how much sun protection is afforded by a particular sunscreen. The higher the SPF, the greater the protection. The SPF label shows the protection against UVB, which leads to sunburn and the damage that can cause skin cancer.

It is also important that your high SPF sunscreen should also have a high level of UVA protection. UVA can cause ageing effects of the skin and also potentially the damage that can cause skin cancer. Sunscreens with high UVA protection will have a high number of stars (these range from 0 to 5).

Be sure to cover areas which are sometimes missed, such as the lips, ears, around the eyes, neck, scalp (particularly if you are bald or have thinning hair), backs of hands and tops of feet.

You should not think of sunscreen as an alternative to avoiding the sun or covering up. It is used in addition. Sunscreens should not be used to allow you to remain in the sun for longer - use them only to give yourself greater protection. No sunscreen is 100% effective and so it provides less protection than clothes or shade. Ideally:

  • Apply sunscreen 20-30 minutes before going out into the sun (it takes a short time to soak into the skin and work).
  • Re-apply frequently, at least every two hours, and always after swimming, towelling yourself dry or excessive sweating (even those that are labelled waterproof).
  • Re-apply to children even more often.
  • Sunscreens with an SPF of less than 15 do not give much protection. Always use factor 15 or above.
  • Sunscreens can go off and not work after a time. Therefore, do not use out-of-date sunscreen (see the use by date on the bottle). Most have a shelf-life of 2-3 years.
  • Being kept in the sun can cause deterioration of the active protective ingredients in sunscreen. Be wary of buying bottles of sunscreen that have been kept on a shelf in direct sunlight or outside in hot countries. Try to keep your sunscreen somewhere cool and shaded.
  • Some experts think that the increased use of sunscreen lotions and creams may give a false sense of security. This may encourage people to go into the sun more and, as a result, cause an increase in your risk of developing skin cancers. It has to be emphasised that sunscreen only partially protects your skin. Using sunscreen does not mean that you can sunbathe for long periods without harm. If you tan then you have done some damage to your skin.
  • Reflected light can damage too. On sunny days, even if you are in the shade, sun can reflect on to your skin. Sand, water, concrete and snow are good reflectors of sunlight.
  • Wet clothes let through more UV light than dry clothes. Take spare clothes with you if you expect to get wet.
  • You can burn in the water. Even if you are swimming in a pool or snorkelling in the sea, you can still get burnt.
  • Clouds may give a false sense of security. Most of the UV radiation from sunshine still comes through thin cloud. Thick cloud provides some protection, but you still need protection when there is thin cloud.
  • Many clothes worn in hot weather (such as thin shirts) actually allow a lot of sunlight through. You should wear tightly-woven clothes to protect from the sun's rays. If you can see light through a fabric then damaging UV rays can get through too.
  • The sun's rays are more powerful at higher altitudes. It may be cooler up a mountain but you will need more skin protection.
  • Fair-skinned people who sunburn easily are at particularly high risk of developing skin cancer and should be most careful about protecting their skin.
  • There is no such thing as a healthy tan. A tan is the skin's response to the sun's damaging rays and is therefore an indicator of sun damage.
  • Artificial tanning from sunray lamps and sunbeds is just as damaging as sunshine - so avoid them. Studies have shown that women under the age of 35 who use sunbeds could actually increase their risk of melanoma by as much as 75%.
  • Fake tan from a bottle is safer than a natural tan because no sun exposure is required. Remember that fake tan is not a sunscreen and, if you plan to go out in the sun, you will need to apply another product. Some fake tans are bronzers that simply stain the skin and can be washed off. Other products contain a chemical that reacts with the skin to give a tanned colour. We don't yet know the long-term effects of these chemicals, but at the moment we know they are safer than tanning in the sun or under a sunbed.
  • It's not the heat that does the damage but the UV radiation in sunlight, which is present all year. You can get a lot of UV exposure doing winter sports, such as skiing, as it is often done in sunny weather and at high altitudes. In particular, when out in ice and snow which reflect a lot of sunlight, wear a hat, sunscreen, lip balm containing an SPF, and sunglasses.

The Met Office provides information called the Solar UV Index with their weather forecasts. The index is given as a figure in a triangle over the maps they use when giving forecasts. Basically, the higher the index (from 1 to 10), the greater the risk from the sun, and the more care you should take of your skin when outside. See their website (given below) for details.

Vitamin D is vital for good health. Vitamin D is made in the skin with the help of sunlight. Sunlight is actually the main source of vitamin D, as there is very little found in the foods that we eat.

This means that to be healthy you need a certain amount of sun exposure. There is concern that some people may go to the extreme of avoiding the sun altogether and then become deficient in vitamin D. The aim is to enjoy the sun sensibly, so as to make enough vitamin D, whilst not increasing the risk of skin cancer.

It is estimated that, to prevent deficiency of vitamin D, we need 2-3 sun exposures per week in the summer months (April to September). Each exposure should last 20-30 minutes and be to bare arms and face. It needs to occur in direct sunlight and not through a window. It is not the same as suntanning and sunburn should be avoided at all costs. (See separate leaflet called 'Vitamin D Deficiency' for more information.)

It is recommended that fair-skinned people who avoid the sun rigorously to reduce the risk of melanoma should consider supplementing their intake of vitamin D as long as there are no medical contra-indications.

SunSmart

Web: www.sunsmart.org.uk
Run by Cancer Research UK, the UK's national skin cancer prevention campaign.

Solar UV Index forecast for the UK

Web: http://www.metoffice.gov.uk/public/weather/forecast/?tab=map&map=MaxUVIndex
The Met Office is the UK's National Weather Service.

Sun Awareness Sunscreen factsheet

Web: www.bad.org.uk/site/734/default.aspx
From the British Association of Dermatologists.

Original Author:
Dr Tim Kenny
Current Version:
Peer Reviewer:
Dr Tim Kenny
Last Checked:
18/11/2011
Document ID:
4850 (v41)
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