Sun safety. Ultraviolet rays.

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1 Produced 2010 Next revision due 2012 Sun safety If you have been treated with radiotherapy or chemotherapy for Hodgkin lymphoma or non-hodgkin lymphoma you should always be careful in the sun. However, you can still enjoy summer activities and foreign holidays, providing you are sensible and take precautions to protect yourself. This also applies to those of you who have been diagnosed with lymphoma and are on watch and wait. Ultraviolet rays Ultraviolet (UV) rays in sunshine are potentially harmful, although they only form a small part of natural sunlight because the ozone layer in the atmosphere filters out the most damaging ones. The UV rays that will affect you consist of two main types: UVA and UVB. UVA rays are present throughout the whole year, with equal levels in summer and in winter. UVB rays are at their most intense during the summer, around midday, and at high altitude. The nearer to the equator that you travel, the more intense they become. While UVA rays penetrate the skin, lead to wrinkles and may cause skin cancer, UVB rays are responsible for sunburn and are strongly linked to the increased incidence of skin cancer. Therefore, care needs to be taken when you are exposed to the sun: to avoid sunburn in the short term and, in the long term, the increased risk of developing skin cancer. There is no such thing as a healthy tan. The presence of a suntan is evidence that the skin has been damaged. It is trying to protect itself from further UV damage and you from the increased risk of developing skin cancer. Everyone should take care in the sun. You are particularly vulnerable and at an increased risk of developing skin cancer from UV exposure if you have: fair skin red or blonde hair blue eyes a tendency to sunburn and freckling a history of treatment with radiotherapy or chemotherapy. 1

2 Some suggestions to protect your skin from the sun Avoid the sun between 11am and 3pm when the rays are at their strongest. Try to plan outdoor activities for early morning or late afternoon. Seek natural shade in the form of trees or other shelter. Take extra care when on a beach or skiing holiday because UV rays are reflected by sand, water and snow. Use a sunscreen with a sun protection factor of 15 or higher and choose one that protects against UVB and UVA rays. Sunscreen should be re-applied after swimming or sweating. Dress appropriately when in the sun and wear clothes that offer protection against its rays, such as a wide-brimmed hat, long-sleeved shirts and trousers. Sunscreens Do not become over reliant on sunscreens. They are only one of many steps you need to take to reduce exposure to the sun. There are two important criteria that should guide your choice when selecting a sunscreen: Sun protection factor (SPF) the higher the number, the better the protection against UVB. An SPF of 15 or greater is recommended. Star rating the ability to protect against UVA is indicated by a star rating 1-5. Sunblocks with the highest rating of 5 stars for UVA protection are recommended. Clothing Clothing is an important part of protecting yourself against the effects of the sun. On a hot day, no one wants to wear lots of clothing, and striking a balance between protection and comfort is the better option. You should choose loose fitting clothing which is comfortable. Long-sleeved shirts with collars and long trousers or skirts are ideal. A compromise of short-sleeved shirts, knee-length shorts or skirts provides far better protection than skimpy tops, tiny shorts or miniskirts. Any uncovered skin will require usage of an appropriate sunblock. 2

3 Remember the following tips: Colour dark colours provide better protection than light ones. Weave avoid lightly woven fabrics as they may allow rays through. Hold the fabric up against the light to make sure that you cannot see light through it. Sun protection factor some clothes now have a sun protection factor (British Standard 7914:1998). The higher the number, the better the sun protection. Hats - wearing a hat with a wide brim (at least 5cm) going right around is important. Baseball caps do not protect the whole face, neck or ears. Eye protection UV rays also damage the eye. Therefore, sunglasses should absorb at least 95% of UV radiation and carry the British Standard :1987. Sun safety and the effects of cancer treatments Radiotherapy Following radiotherapy, the skin may be inflamed and sore. If this is so, the skin should be protected from the sun. You should cover areas such as the neck with scarves and shirts with collars. After the soreness of radiotherapy has gone, the affected skin is more sensitive to the effects of UV rays. Therefore, you should continue, ideally forever, to take extra care to protect areas that have previously been treated with radiotherapy. If using sunblocks, bear in mind that some can irritate your skin after radiotherapy. Those containing titanium dioxide and zinc oxide are less of an irritant. You should buy a few small bottles to find the best sunblock for you. Chemotherapy Many chemotherapy drugs make the skin more sensitive to sunburn from UV rays. This is more likely to occur with dacarbazine (DTIC), vinblastine and methotrexate. After each treatment, you should be especially careful about exposure to the sun. Once the chemotherapy has been completed you will need to protect your skin forever; you are more likely to develop skin cancer as a result of exposure to UV rays. 3

4 Skin cancer what to look out for Taking sensible precautions will reduce your risk of skin cancer. Most people have more than one skin blemish at any time. If one of these appears different to the others then you should see your doctor. In particular you should look out for blemishes that: change in size, shape, colour or texture ulcerate or bleed become tender or painful. To put your mind at rest, skin cancers are very treatable and those identified early have a very high cure rate. Are fake tans safe? Fake tanning products stain the top layer of the skin. They are generally safe and there are no apparent reasons why people who have had lymphoma, chemotherapy or radiotherapy should not use them. However, the staining effect does not provide any extra protection to skin from the damaging effects of the sun. Therefore, people who use fake tan products should continue to protect their skin from the sun. Useful websites Sun protective clothing Supplier of sun protective clothing, particularly swimwear Supplier of sun protective clothing and related products Cancer Research UK information website containing facts and downloadable resources about sun safety Supplier of sun protective clothing and related products The websites listed above are outside the control of the Lymphoma Association. It cannot accept any responsibility for their content. 4

5 Further information We have the following information sheets which may be useful. What precautions should I take before I go abroad? Travel insurance Vaccinations and Immunisation Please call the helpline ( ) to obtain copies or look on our website. Acknowledgements The Lymphoma Association is grateful to Dr Jonathan Sowden, a consultant dermatologist in Wrexham Maelor Hospital for his help in writing this article. We would also like to thank our panel of volunteers who review our information. About our publications: The Lymphoma Association is committed to the provision of high quality information for people with lymphoma, their families and friends. We produce our information in accordance with nationally recognised guidelines. These include the DISCERN tool for information about treatments, the NHS Toolkit for producing patient information, and the Campaign for Plain English guidelines. Our publications are written by experienced medical writers, in close collaboration with medical advisors with expertise in the appropriate field. Textbooks and professional journals are consulted to ensure that information is as up to date as possible. References are provided where they have been used. Some publications are written by professionals themselves, acting on guidance provided by the Lymphoma Association. Our publications are reviewed every two years and updated as necessary. Our publications are reviewed by a panel of volunteers with experience of lymphoma. Publications are also reviewed by members of the Lymphoma Association helpline team, who have many years collective experience of supporting those with lymphoma. In some instances, our publications are funded by educational grants from pharmaceutical companies. These sponsors do not have any involvement in the content of a publication. They are not invited to see the content and have no editorial input. Lymphoma Association Views expressed in this publication are those of the contributors. The Lymphoma Association does not necessarily agree with or endorse the comments included here. 5