Preventing Skin Cancer

Sun and skin damage

About 9 in 10 non-melanoma skin cancers, 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 the risk. It is the ultraviolet (UV) radiation in the sunshine which does the damage. Skin cells that are damaged are at greater risk of becoming abnormal and cancerous.

Sun damage can also cause other skin problems to develop such as premature skin ageing and solar keratoses (actinic keratoses - benign warty growths on the skin).

All people of all ages should protect their skin, but it 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.

How can I protect skin from the sun?

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, canopies, etc, 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. Baseball caps are not so good as they shade the face but not the neck, lower face and ears. Young children should wear hats with neck protectors too.
• Wear loose baggy T-shirts (or even better - long sleeve tops) and baggy shorts. The material should be tightly woven which blocks sunlight.
• Wear wrap around sunglasses (your eyes can get sun damage too). Make sure the sunglasses are ones which protect against UV light.

Use a high factor sunscreen liberally

You should apply sunscreen of at least SPF 15 (SPF 30 for children or people with pale skin) which also has high UVA protection. Be sure to cover areas which are sometimes missed such as the lips, ears, around eyes, neck, scalp if hair is thinning, hands, and feet.

You should not think of sunscreen as an alternative to avoiding the sun or covering up. It is used in addition. No sunscreen is 100% effective and so it provides less protection than clothes or shade.

The SPF label shows the protection against UVB, which leads to sunburn and the damage that can cause skin cancer. It is also important to use a sunscreen with a high UVA protection. UVA can cause ageing effects of the skin and also potentially the damage that can cause skin cancer. Sunscreens with a high UVA protection will have a high number of stars (these range from 0 to 5).

Ideally:

• Apply 20-30 minutes before going out into the sun (it takes a short time to work).
• Re-apply frequently, at least every two hours, and always after swimming or towelling (even those that say they are waterproof).
• Re-apply to children even more often.
• Use a 'broad spectrum' sunscreen to protect against UVA and UVB.

Some facts that you might not realise:

• Sunscreens less than factor 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 packet). Most have a shelf-life of 2-3 years.
• 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 onto 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.
• 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 T-shirts) actually allow a lot of sunlight through. You need to wear tightly-woven clothes to protect from the suns rays. If you can see light through a fabric then damaging UV rays can get through too.
• The suns 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.
• Artificial tanning from sun-ray lamps and sun beds are just as damaging as sunshine - so avoid them. Studies have shown that women under the age of 35 who use sun beds could actually increase their risk of melanoma by as much as 75%.
• 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 exposure to UV 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 reflects a lot of sunlight, wear a hat, sunscreen, lip balm and sunglasses.

The UV index

The met office provide 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, the more care you should take of your skin when outside. See their website (given below) for details.

Sunshine and vitamin D

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. 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.

Some people suggest that there needs to be a balance. That is, avoid the damaging effects of the sun as described above - in particular avoid sunburn, the strong sun in the middle of the day and excessive sun exposure. However, some sun exposure is required to be healthy and obtain vitamin D.

Further help and information

SunSmart

Web: www.cancerresearchuk.org/sunsmart/
The UK's national skin cancer prevention campaign. Run by Cancer Research UK.

Solar UV index forecast for the UK

Web: www.metoffice.gov.uk/weather/uk/uk_forecast_uv.html
From the met office

Sun Awareness Sunscreen factsheet

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