Hot reminders vs. sun exposure

Overexposure to the sun’s harmful ultraviolet (UV) rays not only can increase your risk of skin cancer, it can also cause premature aging of the skin.  As we accumulate sun exposure through the years, our skin ages in many ways.  We can divide these changes into color and texture.

Age-related skin changes

Many different color changes can occur due to chronic sun exposure:  Brown spots called solar lentigoes can form on the skin.  They’re commonly called “sun spots,” “liver spots,” or “age spots.”  In addition, a type of discoloration called poikiloderma can develop with chronic sun exposure. This is a mottling of red, brown, and white discoloration, often seen on the neck and upper chest.

Sun exposure also causes many skin texture changes, due to alterations in the elastin and collagen in our skin.  This leads to increased and deeper skin lines and is a major cause of fine lines and wrinkles on the face.  Breakdown of elastin and collagen can lead to the thinning of the skin, often seen on the hands and forearms.  If you wear a wristwatch, for instance, compare the skin underneath the watch (sun-protected) with the adjacent sun-exposed skin on your forearm. This can give you a good demonstration of the results of accumulated sun exposure.  Although many age-related changes in the skin are unavoidable, limiting additional exposure to the sun can help prevent further damage.

Types of skin cancer

Aside from cosmetic damage, the most dangerous consequence of too much unprotected skin exposure is skin cancer.  Research suggests that both non-melanoma skin cancer (NMSC) and the more deadly melanoma are on the rise.

The three types of skin cancer that are linked to sun exposure include two NMSCs that are less lethal than melanoma.  Of these, basal cell carcinoma (BCC) is the most common, and is thought to be caused by intermittent short-term sun exposure spread over many years.  The next most common type, squamous cell cancer (SCC), occurs most frequently on the skin that is continually exposed to sunlight over long periods of time.  Basal and squamous cell carcinomas account for 95 percent of all skin cancers. 

Basal cell carcinoma appears as a pearly/waxy bump or flat brown lesion.  It is the most easily treated form and is the least likely to spread.  Squamous cell carcinoma looks like a firm red pimple/nodule or scaly patch.  It is easily treated if detected early and is more likely to spread than basal cell carcinoma.  Melanoma may present as an existing mole that bleeds, itches, or changes shape or color, or as a large brownish patch, or smaller spot, with black, red or white speckles.  It is the most serious form and needs to be diagnosed early because later, it can be difficult to treat as it spreads easily (see photo). In examining your skin lesions, you may use the ABCDE rule as guide (see table).

Skin cancer typically develops on skin exposed to sun but can occur on other areas, too.  Most lesions occur in the sun-exposed areas of the face, arms, tops of the ears, and the backs of the neck and hands.  Men with thinning hair are more vulnerable to skin cancer on the exposed scalp.  And you don’t have to be outdoors to be exposed to the sun’s ultraviolet rays.  Even when you’re in the car, UVA rays can still come through your windows.  You’re at higher risk if you’re fair-skinned, as you have less protection pigment (melanin) in your skin.  Childhood sunburns also up your risk, as does family history of skin cancers, advanced age, and having a lot of moles or precancerous lesions called actinic keratoses.  These are scaly pink or brown patches that can develop on the face, arms, and hands of fair-skinned people (see photo).  Some two to 10 percent of actinic keratoses will develop into squamous cell skin cancer over 10 years.

The risk assessment should include a quick check on your medications.  Some can leave you more sensitive to sun.  These include commonly prescribed fluoroquinolone antibiotics and some blood pressure medications.

Prevention is vital

Whether you’re in the car or outside, protect your health with suncreen.  Experts recommend using suncreen with a sun protection factor (SPF) of at least 15.  However, most dermatologists prefer an SPF of 45 or 50 to ensure adequate protection, especially because people don’t tend to apply enough to attain the stated SPF.

Since skin cancer can develop almost anywhere, do a full-body skin exam at least once a month and have your spouse help with the exam.  If you note something that you may be concerned with, like a new mole or a changing mole, a red or pink spot or a bleeding area when you shave, see a dermatologist.  In general, look for anything that is new, that looks different from other things in your body, or anything that’s changing, growing, or bleeding. Also, anything that doesn’t heal in two weeks.

Have your doctor examine all of your skin, including your scalp, at least once a year after age 50.  Consider periodic exams by your dermatologist.  However, if you have no actinic keratoses or a personal family history of skin cancer, repeat exams with your dermatologist every three to five years.  If you’re fair-skinned, have a high sun exposure, or you have a history of actinic keratoses, see a dermatologist yearly or every six months if you’ve had skin cancer.  Skin checks can save your life.  With most of these cancers, if you catch them early and remove them, they’re cured!

Other measures for sun safety include wearing a wide-brimmed hat that covers your face, ears, and back of your neck, as well as loose-fitting long sleeves and long pants.  Avoid doing outdoor activities between 11 a.m. and 3 p.m. when the sun’s ultraviolet radiation is greatest.  Stay in the shade.  Watch out for reflection from water and sand.  And wear sunglasses with a UV coating and make sure the label states that they block 99-100 percent of UV rays.  The more sun exposure in your life, the higher your overall risk  for skin cancer.  In particular, repeated sunburns or blistering sunburns boost your lifetime risk.

The proper way to apply sunscreen

Choosing the right sun protection and applying it properly are not only the most important steps to protect yourself from the sun’s harmful rays, they’re also probably the most misunderstood.  Some think that a quick application of the tanning cream is sufficient and will last all day — it won’t. Between one-fourth and one-half of all people who apply sunscreen use inadequate amounts, which obviously limits the sunscreen’s effectiveness.  For example, if an SPF 16 sunscreen is put on too thin, it’s actually equal only to an SPF 2, or an SPF 80 would become an SPF 3.

It is also important to note that the effectiveness of sunscreens diminishes within a few hours, and that cloudy and overcast days aren’t safe as you may think.  Actually, 70 percent to 80 percent of ultraviolet radiation gets through clouds and will cause photo damage.

The best sun protection for your skin starts with a sunscreen with an SPF of 30 or higher.  About one ounce, approximately two tablespoonfuls, is needed for the average adult body.  About one quarter to one-third of a tablespoonful is right for the face.

Sunscreen should be applied to dry skin about 15 minutes before going out to the sun and should be reapplied every hour if you are in water or sweating heavily.  Reapply every two to three hours if not in the water or not sweating.  Reapply the sunscreen frequently even if the product you buy is supposedly formulated to be sweat- or water-resistant.  And remember, despite popular belief, there is no such thing as a “healthy tan,” because every tan is a response to skin damage.

Indeed, knowing how to help avoid all the effects of sun damage — from premature wrinkling of your skin to developing skin cancers — is no summer mystery.  A recent prospective study showed that regular sunscreen use significantly reduced the incidence of invasive melanomas.  It’s not always that a practice as simple as properly using sunscreen can prevent a potentially fatal illness!