5 Minutes with a Dermatologist

May is Skin Cancer Awareness Month, and we've been sharing information all month about skin cancer and sun safety. Many local dermatologists participated in our free skin cancer screening in April, including Dr. Chris Schach and Dr. Eric Stewart of Ozark Dermatology Clinic. We thought you might want to know the answers to a few questions we recently asked their staff - which also includes Dr. Kevin St. Clair, Dr. Robert Brown, and Physician's Assistants Robert Stevens and Joshua Matthews. Feel free to post your own questions in the comments section at the end of the post.

Question: How have your cases changed over the last 10 years with respect to the skin cancer you are seeing?

Answer: Overall, the rate of nonmelanoma skin cancer (primary basal cell and squamous cell carcinomas) has remained about the same. As the baby boomer generation continues to age, however, we are seeing an increased number of nonmelanoma skin cancer in that population. The main concerning change that we have seen is the increased rate of melanoma in younger and younger women. It is not unusual to see malignant melanoma now in women in their late 20s or early 30s. Hopefully, increased awareness of measures to take to prevent sunburn and minimize sun exposure will pay off over time with decreasing rates of all types of skin cancer.


Question: There has been a lot in the news about the danger of tanning beds. Is any indoor tanning safe? What about outdoor tanning - is any level of sun exposure okay?

Answer: There are many efforts underway at the state level to regulate tanning bed use and to prevent minors from using or abusing tanning beds. If the skin darkens in response to exposure to ultraviolet radiation, whether the source is sunlight or a tanning bed, this does result in damage to the skin. This not only increases skin cancer risk, but also the risk of premature aging of the skin. Despite advertising to the contrary by the tanning bed industry, there is no such thing as a "safe tan." There are only degrees of injury. The only tanning that would be considered safe is the spray-on variety where no ultraviolet radiation is used at all. Of course, it is not necessary to avoid sunlight - only avoid sunburn and minimize your overall exposure.

Question: What should we look for in a sunscreen?

Answer: As of June 2012*, the FDA is changing labeling requirements for sunscreen. The new guidelines will include a comment addressing whether or not the sunscreen is "broad spectrum". If the sunscreen product is broad spectrum, this will imply that it provides UVA protection in addition to UVB protection. The Sun Protection Factor, or SPF, which has been used to label sunscreens for many years, implies only the degree of protection against UVB radiation. If a product is considered broad spectrum, a 4-star labeling system will be employed to give consumers some idea of the degree of UVA protection the product provides, with 1 being relatively less protection, and 4 being the maximum.

Another new requirement will be labeling to indicate whether the product is water resistant for 40 minutes or water resistant for up to 80 minutes. Claims of being "waterproof" will no longer be allowed. In my opinion, the best overall sunscreens are titanium dioxide and zinc oxide, which are now available in small enough particles that the sunscreen can be rubbed in without leaving a white film.

*the new label requirements have been delayed by six months.

Question: If the sun is not out, do I need to wear sunscreen?

Answer: Yes, because even though it does not feel as warm and it is not as bright if it is a cloudy day, a significant proportion of ultraviolet radiation will penetrate through clouds and can still cause sunburn. In addition, quite a bit of ultraviolet radiation, especially UVA, can be reflected and scattered, and this is why many people have noticed that one can sunburn even standing under a tree or in a shaded area.

In the News: Sunscreens and Vaccines

May is Skin Cancer Awareness Month. Since we shared information recently on skin cancer awareness and prevention, we're sharing some related but unique information this week that has recently made the news.

New Sunscreen Labels

In 2009 the U.S. Food and Drug Administration approved new labeling for sunscreen products that will finally go into effect next month. There have always been guidelines in place, but they were adopted on a voluntary basis - which meant many companies didn't adopt them at all. Using terms such as "All Day Protection" and "Waterproof" were not only misleading, they were downright inaccurate. The new guidelines are mandatory.

Here are the major changes in labeling that will help consumers buy exactly what they need, and know exactly what they're getting:

Sunblocks: No product on the market today can completely shield your skin from the sun. For this reason, sunscreens will no longer be labeled as "sunblock".

SPF level: A sun protection factor (SPF) of 15 or more means the product lowers the risk of skin cancer and aging. For SPFs from 2-14, this is not the case. Those products prevent sunburn at best. Sunscreen labels will have to be clear about how much SPF they provide - and whether they actually reduce your risk of developing skin cancer and curb visible aging or just prevent sunburns. The highest level of SPF allowed with the new guidelines will be 50.

One common misunderstandings that lingers today is that the higher the SPF number on a bottle of sunscreen, the better. In truth, a product with a number above 30 really doesn't add enough additional protection to make it worthwhile. That said - you should always choose a sunscreen with an SPF of at least 15.

Broad Spectrum: To be labeled "broad spectrum," sunscreens must provide equal protection against the sun's two types of radiation: UVB and UVA. Both types can lead to cancer - but UVA gives you more wrinkles and UVB causes sunburns.

"Waterproof" and "sweatproof" claims will disappear . Sunscreens can only say how long they offer water resistant protection. And, the company marketing the products must be able to back up their claims with text results.

Instant protection: Sunscreens can't say they provide "instant protection" or protect skin for more than two hours unless the FDA approves the claims for the specific sunscreen in question.

There is a 2-2-2 rule that goes hand in hand with these new requirements, even though it's been around a while:

2 tablespoons. Use at least this much sunscreen on each part of your body.This is about the size of a golf ball. Rub it in until it disappears.
2 hours. That’s how often you should reapply it. Evaluate and apply more often if you're involved in active water activities such as skiing.
2 years. That’s how long you should keep it. The ingredients lose their effectiveness after 2 years. Be sure to check expiration dates if you find overstock sunscreens for sale at thrift stores.

Melanoma Vaccine

Recently, The Mayo Clinic announced that their researchers are working on a melanoma vaccine to combat skin cancer. Melanoma is the most deadly form of skin cancer, with the major risk factor being exposure to UV light. Incidence rates continue to rise, with the largest increase being seen in young women.

The research has been done on mice, using a genetic combination of human DNA from melanoma cells and a cousin of the rabies virus. In early studies, 60 percent of the mice with tumors were cured in fewer than three months with minimal side effects. Human clinical trials related to this research aren't anticipated for a few more years, but the results look very promising. More information on this research can be found in the story originally shared by Mayo Clinic here.

Here Comes the Sun!

We've harped about this a bit lately, but we really can't say it enough...

Wear sunscreen!!! 

If you don't believe us, check out this article from the Food and Drug Administration. It covers subjects like the cancer risk associated with tanning (and other risks), tanning for children and teens, and presents a brief story of one woman who was a sun worshiper and now - 25 scars later - regrets it.

Most disturbing is the review of 19 studies done over the course of 25 years that found evidence of:

• an association between indoor tanning and two types of skin cancer: squamous cell carcinoma and melanoma
• an association between UV-emitting tanning devices and cancer of the eye (ocular melanoma)
• both UV-A and UV-B rays causing DNA damage, which can lead to skin cancer in laboratory animals and humans
• the risk of melanoma of the skin increasing by 75 percent when tanning bed use started before age 35

According to the article, "Of the more than 68,000 people in the United States who will learn they have melanoma this year, one out of eight will die from it, according to National Cancer Institute estimates. In addition, the American Academy of Dermatology reports that melanoma is the second most common cancer in women 20 to 29 years old."

Some other things to think about...
Sunburns and sun damage (i.e. tanning) can occur when it's overcast outside, in fall and winter, and even through some clothing. The best way to protect yourself is to wear a broad spectrum sunscreen every time you are outside or in a vehicle - car windows don't have SPF ratings! - or to avoid the sun's rays completely by finding shade if you have to be outside.

Many kinds of lotion and make-up brands are adding sunscreen to their products, and a wide-brimmed hat (with or without a bow) will protect your face if you have sensitive skin.

Be sure to ask your child's daycare provider if they apply sunscreen when they take the kids outside. If they don't do it as a rule, be sure to let them know that your child needs it! Send a little bottle with his/her name on it if you have to. For some great info on sun safety for kids (and their parents!), check out this site.

It's easy to do, but you have to get into the habit. We watch what we eat, and try to get enough exercise, but our bodies can be healthy and still develop skin cancer. Care for your skin as seriously as you care for your other organs - you'll be glad you did.