Is the sun your friend or your enemy? The answer is: both. If that’s confusing, so is the news that’s coming from health experts.
Recent studies have found that many Americans are deficient in vitamin D, which is crucial to bone health and has many other health benefits. As a major source of vitamin D, sunlight is definitely your friend.
But skin cancer is the most common malignancy in this country with more than two million Americans being diagnosed each year. As the number one environmental risk factor for skin cancer, sunlight is pretty clearly your enemy.
Makers of sunscreen are among those insisting that the sun is your enemy. But so are the American Cancer Society and the Centers for Disease Control. CDC rules for skin cancer prevention, for example, sound a bit uncompromising.
• “The sun’s UV rays can damage your skin in as little as 15 minutes.”
• “UV rays from the sun can reach you on cloudy and hazy days, as well as bright and sunny days.”
• “Your best bet to protect your skin is to use sunscreen or wear protective clothing when you’re outside–even when you’re in the shade.”
Making the argument for sunlight as a source of vitamin D are many reputable medical experts. An article in the Harvard Health Letter [June, 2004], talked of “solar-phobes: people so concerned about getting skin cancer that they stay inside or cover every bit of skin.” Getting outside into the sun has physical and psychological benefits for all ages, the article argues.
Considering these opposing views, you can decide for yourself by learning some basic information about skin cancer and your potential risks.
Three Types of Skin Cancer
There are three basic types of skin cancer, named according to the cells that become cancerous.
BASAL CELL CARCINOMA is the most common type, accounting for about 75 percent of all cases. It is also the least serious, highly treatable and rarely spreading to distant organs. It starts in the lowest level of the epidermis, the outer layer of skin.
Most basal cell cancers occur on the face, neck or hands–areas most commonly exposed to the cumulative effects of sun exposure. Signs include: a red, irritated area of skin; a yellow or white area that resembles a scar; or a pink, pearly bump.
SQUAMOUS CELL CARCINOMA, the next most common type, also occurs usually on skin that has been exposed to sun, including the ears, lips and mouth as well as other areas of the body. In persons with dark skin, however, it may appear on places not exposed to the sun such as the legs and feet. It is more dangerous than basal cell carcinoma but less so than melanoma.
Symptoms include: a bump that changes to an open sore or becomes crusty; a bump that gets larger; or a sore that doesn’t heal. When left untreated, it can spread to other parts of the body but is rarely life threatening.
MELANOMA, the least common but most dangerous type of skin cancer, originates in the melanocytes, the pigment-producing cells of the skin. This cancer does spread and, if not treated in a timely manner, can be fatal.
In males, melanoma is commonly found on the head, neck or between the shoulders and hips. In women, the most common sites are the legs or between the shoulders and hips. In dark-skinned individuals, melanoma sometimes occurs under a finger or toe nail, on the palms of the hands or the soles of the feet.
Symptoms include a mole or freckle that changes in size, shape or appearance or a new spot that has an irregular outline and usually more than one color.
For all skin cancers, the number one risk factor is exposure to the ultraviolet rays of the sun. For basal cell carcinoma, cumulative exposure over a lifetime seems to be a major factor. For squamous cell, both cumulative and recent exposure have been linked to actinic keratoses–rough, scaley growths on sun-exposed skin that can be pre-cancerous.
For melanoma and even for some squamous cell carcinomas, cumulative exposure is less important than the amount of sun and the timing. A bad sunburn before your 20th birthday may be more dangerous than low levels of sun exposure over a lifetime.
Fair-skinned individuals from northern Europe living in sunny climes such as Australia or New Zealand are clearly at high risk for all skin cancers. And in Australia, doctors have made significant strides toward preventing skin cancers by taking a strong stand in favor of covering up.
The motto there is “slip, slap and slop.” Any time you go out in the sun, you should slip on some protective clothing, slap on a wide-brimmed hat and slop on generous quantities of sunscreen with an SPF of 15 or higher. The sunscreen should be broad spectrum, protecting against both UVA and UVB.
Clothing with a tight weave, covering both arms and legs, is recommended; a T-shirt has an SPF of less than 15; so slop on some sunscreen if that is all you’re wearing on the top.
A baseball cap leaves the neck and ears exposed. Either apply sunscreen to exposed areas or wear a wide-brimmed hat.
Sunscreen should be applied to dry skin 15 to 30 minutes before venturing outside and re-applied every two hours–more frequently if you’re sweating or swimming. It should be used every day and should not be used as an excuse for staying in the sun for extended periods. Deliberate tanning, in tanning booths or on the beach, should be avoided.
The principles are fairly straightforward, and, if you’re concerned about getting enough vitamin D, you can always take a supplement.
Vitamin D advocates don’t always agree. They point out that the association between skin cancer and sunlight are not as simple and straightforward as they seem. Genes also play a role; some individuals are more vulnerable than others. And exposure to toxic substances may be the trigger.
The choice is yours. You don’t have to be either a sun worshiper or a solar-phobe to take reasonable efforts to protect your skin from your friend and enemy, the sun.
REFERENCES:
EmilyAltman, M.D., “A response to the recent USPSTF updates on skin cancer prevention counseling guidelines,” Rash Decisions, January 9, 2012.
American Cancer Society, “Skin cancer prevention and early detection.”
Laurie Barclay, M.D., “USPSTF updates skin cancer prevention counseling guidelines,” Medscape Medical News, November 8, 2011.
“Benefits of moderate sun exposure,” Harvard Health Letter, June, 2004.
Centers for Disease Control, “Skin Cancer Prevention,” last updated July 16, 2012.
Lisa Fayed, “Types of skin cancer,” About.com, June 25, 2012.
Steven Fox, “Basal cell carcinoma: prior history biggest risk,” Medscape Medical News, July 27, 2012 (Journal of Investigative Dermatology, July 19, 2012).
Alan C. Geller, MPH, RN, et al, “Overcoming obstacles to skin cancer examinations and prevention counseling for high-risk patients: results of a national survey of primary care physicians,” Journal of the American Board of Family Medicine, 2004;17(6).
Kerry Grens, “Helping kids be more sun-safe is a challenge: study,” Reuters Health, September 14, 2012.
Larry Hand, “Sun-Protection behaviors improve with mailed materials,” Medscape Medical News September 27, 2012 (American Journal of Preventive Medicine, 2012).
Gina Kolata, “Mutations found in melanomas may shed light on how cancers grow,” New York Times, January 25,2013.
Norma MacReady, “USPSTF issues preliminary recommendations on skin cancer prevention,” Medscape Medical News, February 7, 2011 (Annals of Internal Medicine, February, 2011).
Mayo Clinic Staff, “Skin cancer,” MayoClinic.com, June 6, 2012.
“Misdiagnosis of skin cancer can be fatal,” Medscape Medical News, May 3, 2000.
National Cancer Institute, “What you need to know about melanoma and other skin cancers,” January 11, 2011.
Anthony I Reeder, “‘Prescribing sunshine’: a national, cross-sectional survey of 1,089 New Zealand general practitioners regarding their sun exposure and vitamin D perceptions, and advice provided to patients,” BMC Family Practice, 2012;13(85).
“Skin cancer prevention tips,” American Academy of Dermatology, SkinCancer.net.
03/04/2013
For more information, sample newsletters or to get on our mailing list contact:
Community Relations
West River Regional Medical Center
1000 Highway 12
Hettinger, ND 58639-753