Skin Cancer: The Basics. Umass Medical School Division of Dermatology

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1 Skin Cancer: The Basics Mary E. Maloney MD Umass Medical School Division of Dermatology

2 Skin cancer Squamous cell carcinoma Melanoma Basal cell carcinoma

3 Ultraviolet light Outline Immediate and long term effects Ozone Tanning How to protect your skin Sunscreen for adults and kids Sunless tanners Vitamin D

4 Things that damage skin Ultraviolet light Smoking Increases wrinkling and fine line Increases risk for Squamous cell carcinoma

5 Ultraviolet (UV) light Sources of Ultraviolet light Natural sunlight Artificial i light (tanning booths, phototherapy booths)

6 Sunlight Sunlight consists of visible light (the light we see) and ultraviolet light (we can t see) Ultraviolet light is what causes Sunburns Suntans a mark of damage to the skin Other skin damage

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8 Ultraviolet light is divided into 3 parts UVA UVB UVC

9 The atmosphere blocks some UV Ozone layer damage increasing i UV gets to Earth

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13 UVA Photoaging i / wrinkles and tan Skin cancer UVB sunburn, b tan, and skin cancer UVC Filtered by ozone layer

14 Short-term affects of UV Sunburn Tanning Polymorphous light eruption ( sun allergy ) Flare of cold sores (herpes infection)

15 Sunburn Intense UV exposure causes burn of the skin Caused by UVB Severe cases can involve blisters Melanoma risk doubles with 5 or more sunburns

16 Tanning skin s s self defense UV light causes damage to the DNA in our cells Pigment (melanin) is made by the skin to help protect the DNA from further damage Increased melanin in the skin TAN Tan skin is not healthier, it is a direct result of skin damage

17 Chronic sun damage Wrinkles Pigment changes Brown spots (freckles, lentigenes, melasma) White spots Blackheads Telangiectasias

18 Photoaging and wrinkles Caused by UVA light UVA penetrates regular window glass

19 Skin cancer UV light exposure Damage to DNA in skin cells Growing cells develop mutations Cells become malignant (cancer)

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21 Who gets skin cancer Most at risk Fair skin Burns easily History of lots of sun exposure Family history of melanoma Risk increases as you get older Rates are increasing in young people

22 Tanning booths Provide an artificial ifiilsource of fuvlih light for the purpose of tanning Give UVA and UVB exposure Levels of UV radiation are NOT regulated Use of tanning booths continues to increase in adolescents

23 Tanning misconceptions Tanning booths are safe Tanning in a booth is safer than outdoors Getting a base tan will protect my skin A tan is healthy for the skin

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25 Tanning booths Tanning causes damage to the skin, just like burning Risk of skin cancer increased 15 percent higher risk of melanoma if ever used a tanning booth * 2.5x greater squamous cell carcinoma 1.5x greater basal cell carcinoma Accelerated skin aging * The Association of Use of Sunbeds with Cutaneous Malignant Melanoma and Other Skin Cancers: A Systematic Review," International Journal of Cancer 120, no. 5 (2006): ).

26 Sun protection Sun avoidance Sun protective clothing Sunscreen

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28 Playing safe in the sun Peak UV times are 10 am to 4 pm, with the greatest risk from 12 to 2pm Try to plan outdoor activities for early morning or late afternoon if possible Seek shade Wear a hat with a broad brim, made of dense weave material Wear UV protected t sunglasses

29 Sunscreen Something applied to the skin to help protect it from UV light Come in gels, lotions, creams, sprays, sticks Added to chapstick and makeup

30 Important sunscreen info SPF Ingredients does it block UVB and UVA?

31 What is SPF? Sun protection factor Measures how much longer it will take to sunburn than without sunscreen An SPF of 15 = 15 times longer before a faint sunburn occurs It measures only UVB protection (UVB causes sunburns) Does not tell you about UVA protection

32 How does sunsreen work? Sunscreen can have either: Physical blockers Block both UVA and UVB Chemical absorbers Can protect from UVA, UVB or both They protect the skin differently

33 Physical blockers protect the skin by reflecting UV light Include: Zinc oxide Titanium dioxide Can give a white appearance Newer formulas have smaller particles that are more cosmetically pleasing

34 Chemical absorbers soak up UV light Many different types Can protect against UVB, UVA or both depending on the ingredient

35 UVA Certain ingredients block UVA well Physical blockers Titanium dioxide Zinc oxide Chemical absorbers Avobenzone (Parsol 1789) Mexoryl

36 Labels can be misleading!

37 Check the active ingredients

38 How to select a good sunscreen SPF of 30 or greater Broad spectrum sunscreen that blocks UVA too Fits with your activities iti Waterproof /sweatproof for swimming, athletics Oil free for areas prone to breakouts (face) Formula you like Gel, lotion, spray, stick

39 Two common questions I use high SPF sunscreen why do I still burn? Is it true that anything over SPF 15 doesn t make a difference?

40 The true SPF depends on how much you apply Most people use less sunscreen than needed Thickness of application affects SPF You need to apply 2 mg/cm² That means that: An average 150 pound adult needs 1 oz to cover the entire body 1/3 teaspoon to cover the face Stokes R. How well are sunscreen users protected? Photodermatol Photoimmunol Photomed. 1997;13:

41 Most people get tbetween 20-50% of the SPF on the label SPF 15 SPF 3 to 7.5 SPF 30 SPF 6 to 15 Using too little sunscreen can give a false sense of security Underprotection and increased exposure Underprotection and increased exposure are a risk

42 Use enough Apply evenly

43 How to apply sunscreen Apply minutes before going outdoors Apply liberally, ll rub in well and evenly Re-apply After swimming, toweling dry, sweating After every 2 hours outdoors

44 Infants and dthe sun Babies less than 6 months old should get as little sun as possible Protect infants with: Hat with wide brim or bonnet Long sleeves and pants Cover stroller Sit in shady spot or under an umbrella

45 Sunscreen for infants and children Sunscreen should be used on infants over 6 months of age Apply liberally If a rash develops with 1 sunscreen, try switching to another one or ask your doctor for guidance You can test with a small amount applied to the inside of the arm a few days ahead of time to see if a rash develops

46 Sunless tanners Are safe How they work DHA, dyes the top layer of skin Provides only SPF 2-4 Some have higher SPF but that only last 2 hours, not duration of color change Use with sunscreen!

47 Has the damage been done? It s never too late! You can always prevent additional sun damage Careful sun protection at any point will decrease the risk of sun damage down the line and may give the skin a chance to heal

48 Vitamin D Controversial topic Vitamin D and disease prevention Vitamin D and the sun How much sun do we need? Where should we get our Vitamin D?

49 Vitamin D production SKIN Pre-Vit D3 Vit D3 CIRCULATION GI TRACT FOOD / VITAMINS liver kidneys Active Vit D

50 Conclusions UV light can cause immediate and long term damage to the skin Skin cancer rates are increasing Prevention is key! Seek the shade, especially between 10 A.M. and 4 P.M. Do not burn Avoid tanning and UV tanning booths Use a sunscreen with an SPF of or higher every day. Apply 1 ounce (2 tablespoons) of sunscreen to your entire body 30 minutes before going outside. Reapply every two hours Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses Keep newborns out of the sun. Use sunscreen on babies over the age of six months.

51 How much sun do we need? Vitamin D is made in the skin with the help of UVB Only a little UVB is needed A fair-skinned person needs only a few minutes In Worcester in June, 5 minutes is all you need More exposure only increases UVB damage without adding more vitamin i D Most people p get enough UV exposure with normal activities