Skin Cancer: Questions & Answers

The two most common kinds of skin cancer are basal cell carcinoma and squamous cell carcinoma. (Carcinoma is cancer that begins in the cells that cover or line an organ.) Basal cell carcinoma accounts for more than 90 percent of all skin cancers in the United States. It is a slow-growing cancer that seldom spreads to other parts of the body.Another type of cancer that occurs in the skin is melanoma, which begins in the melanocytes. Although anyone can get skin cancer, the risk is greatest for people who have fair skin that freckles easily–often those with red or blond hair and blue or light-colored eyes.

Ultraviolet (UV) radiation from the sun is the main cause of skin cancer. Artificial sources of UV radiation, such as sunlamps and tanning booths, can also cause skin cancer.

The risk of developing skin cancer is affected by where a person lives. People who live in areas that get high levels of UV radiation from the sun are more likely to get skin cancer. In the United States, for example, skin cancer is more common in Texas than it is in Minnesota, where the sun is not as strong. Worldwide, the highest rates of skin cancer are found in South Africa and Australia, areas that receive high amounts of UV radiation.

In addition, skin cancer is related to lifetime exposure to UV radiation. Most skin cancers appear after age 50, but the sun’s damaging effects begin at an early age. Therefore, protection should start in childhood to prevent skin cancer later in life.

Questions & Answers

Q: When Do I need to protect myself from sun exposure?
A: Protection from sun exposure is important all year round, not just during the summer or at the beach. Any time the sun’s ultraviolet (UV) rays are able to reach the earth, you need to protect yourself from excessive sun exposure.

UV rays can cause skin damage during any season or temperature. Relatively speaking, the hours between 10 a.m. and 4 p.m. during daylight savings time (9 a.m. – 3 p.m. during standard time) are the most hazardous for UV exposure in the continental United States. UV radiation is the greatest during the late spring and early summer in North America.

Remember: UV rays reach you on cloudy and hazy days, as well as on bright and sunny days. UV rays will also reflect off any surface like water, cement, sand, and snow.

Q: How can I protect myself from the sun’s UV rays?
A: When possible, avoid outdoor activities during midday, when the sun’s rays are strongest.This usually means the hours between 10 a.m. and 4 p.m.

You can also wear protective clothing,such as a wide-brimmed hat, long-sleeved shirt, and long pants.For eye protection, wear wraparound sunglasses that provide 100 percent UV ray protection. And always wear a broad-spectrum (protection against both UVA and UVB rays) sunscreen and lipscreen with at least SPF 15.

Remember to reapply as indicated by the manufacturer’s directions. Also, check the sunscreen’s expiration date. Sunscreen without an expiration date has a shelf life of no more than three years. Exposure to extreme temperatures can shorten the expiration date or shelf life of sunscreen.

Q: What does a suntan indicate? Why does the skin tan when exposed to the sun?
A: The penetration of UV rays to the skin’s inner layer results in the production of more melanin. That melanin eventually moves toward the outer layers of the skin and becomes visible as a tan.

A suntan is not an indicator of good health. Some physicians consider the skin’s tanning a response to injury because it appears after the sun’s UV rays have killed some cells and damaged others.

Q: Does it matter what kind of sunscreen I use?
A: Sunscreens come in a variety of forms such as lotions, gels, and sprays, so there are plentyof different options. There are also sunscreens made for specific purposes, such as the scalp, sensitive skin, and for use on babies. Regardless of the type of sunscreen you choose, be sure that you use one that blocks both UVA and UVB rays and that it offers at least SPF 15.

Q: What does a sunscreen’s SPF rating mean?
A: Sunscreens are assigned a Sun Protection Factor (SPF) number according to their effectiveness in offering protection from UV rays. Higher numbers indicate more protection. As a rule of thumb, you should always use a sunscreen with at least SPF 15.

Q: Do sunscreens need to be reapplied during the course of a day?
A: You should follow the manufacturer’s directions regarding reapplication or you risk not getting the protection that you might think you are getting. Though recently developed sunscreens are more resistant to loss through sweating and getting wet than previous sunscreens were, you should still reapply frequently, especially during peak sun hours or after swimming or sweating.

Q: What kinds of clothing best protect my skin from UV rays?
A: Clothing that covers your skin protects against the sun’s UV rays. Loose-fitting long-sleeved shirts and long pants made from tightly woven fabric offer the best protection. A wet t-shirt offers you much less UV protection than does a dry one.

If wearing this type of clothing isn’t practical, at least try to wear a t-shirt or a beach cover-up. Keep in mind, however, that a typical t-shirt actually has an SPF rating substantially lower than the recommended SPF 15, so double-up on protection by using sunscreen with at least SPF 15 (and UVA and UVB protection) and staying in the shade when you can.

Q: It gets so hot here in the summer, there’s no way I could be comfortable in long pants and along-sleeved shirt. So, what else can I do to protect my skin?
A: Protecting yourself from the sun’s UV rays doesn’t have to be a major chore; it’s just a matter of knowing your options and using them. Wearing a dry t-shirt is a good start, but it is not enough if you are going to be outside for more than a few minutes.

If you can’t wear long pants and a long-sleeved shirt, you can boost your protection by seeking shade whenever possible and by always wearing sunscreen with at least SPF 15.

Q: Will a hat help protect my skin? Are there recommended styles for the best protection?
A: Hats can help shield your skin from the sun’s UV rays. Choose a hat that provides shade for all of your head and neck. For the most protection, wear a hat with a brim all the way around that shades your face, ears, and the back of your neck.

If you choose to wear a baseball cap, you should also protect your ears and the back of your neck by wearing clothing that covers those areas, using sunscreen with at least SPF 15, or by staying in the shade. The amount of shade offered by a particular hat appears to be its most important prevention characteristic. If a darker hat is an option, though, it may offer even more UV protection.

Q: Are sunglasses an important part of my sun protection plan?
A: Yes. Sunglasses protect your eyes from UV rays and reduce the risk of cataracts. They also protect the tender skin around your eyes from sun exposure.

Q: What type of sunglasses best protects my eyes from UV rays?
A: Sunglasses that block both UVA and UVB rays offer the best protection. The majority of sunglasses sold in the United States, regardless of cost, meet this standard. Wrap-around sunglasses work best because they block UV rays from sneaking in from the side.

Q: Is there any particular time I should try to stay in the shade?
A: The sun’s UV rays are strongest and do the most damage during midday, so it’s best to avoid direct exposure between 10:00 a.m. and 4:00 p.m. You can reduce your risk of skin damage and skin cancer by seeking shade under an umbrella, tree, or other shelter before you need relief from the sun.

Q: I work outdoors all summer and can’t stay in the shade. What can I do to protect my skin?
A: If you can’t avoid the sun, you can protect your skin by wearing a wide-brimmed hat, wraparound sunglasses that block both UVA and UVB rays, long-sleeved shirt, and long pants.

You can also wear a sunscreen and lipscreen with at least SPF 15 and UVA and UVB protection and reapply according to the manufacturer’s directions. When you can, take your breaks and your lunch in the shade.

Q: If I stay in the shade, should I still use sunscreen and wear a hat?
A: UV rays can reflect off virtually any surface (including sand, snow and concrete) and can reach you in the shade. Your best bet to protect your skin and lips is to use sunscreen or wear protective clothing when you’re outside — even when you’re in the shade.

Skin Self-Exam

You can improve your chances of finding skin cancer promptly by performing a simple skin self-exam regularly.

The best time to do this self-exam is after a shower or bath. You should check your skin in a well-lighted room using a full-length mirror and a hand-held mirror. It’s best to begin by learning where your birthmarks, moles, and blemishes are and what they usually look like. Check for anything new–a change in the size, texture, or color of a mole, or a sore that does not heal. Check all areas, including the back, the scalp, between the buttocks, and the genital area.

1. Look at the front and back of your body in the mirror, then raise your arms and look at the left and right sides.

2.Bend your elbows and look carefully at your palms; forearms, including the undersides; and the upper arms.

3. Examine the back and front of your legs. Also look between your buttocks and around your genital area.

4. Sit and closely examine your feet, including the soles and the spaces between the toes.

5. Look at your face, neck, and scalp. You may want to use a comb or a blow dryer to move hair so that you can see better.

By checking your skin regularly, you will become familiar with what is normal. If you find anything unusual, see your doctor right away. Remember, the earlier skin cancer is found, the better the chance for cure.