“No matter what your age, no matter what your level of sun damage, it’s never too late to take care of your skin. Start protecting it now,” said Catherine Pisano, a Mohs micrographic surgeon and cutaneous oncologist at Harvard Medical School.
Here’s what the experts have to say about protecting your skin this summer:
How common is sun damage?
“It’s extremely common,” said Mary L. Stevenson, associate professor in the Ronald O. Perelman Department of Dermatology at New York University Grossman School of Medicine. “Two different ranges of light wavelengths cause different types of skin damage.”
Ultraviolet A (UVA) rays cause premature aging of the skin, but ultraviolet B (UVB) rays can cause “DNA damage that turns normal cells into precancerous or cancerous cells,” Pisano said. Since “the damage can take years to show up,” a sunburn you got in your 20s can turn into skin cancer in your 50s.
The environment can also stress our skin, said Shadi Kourosh, associate professor of dermatology at Harvard Medical School.
“We are learning more and more about the role of other factors, such as visible light, infrared radiation (heat) and pollution, in the development of skin cancer,” Kourosh said. “… There is evidence that air pollutants from smog and wildfires can corrode the skin barrier and damage DNA.”
How common is skin cancer?
According to the American Academy of Dermatology, 9,500 cases of skin cancer are diagnosed every day in the United States, making it the most common cancer in the country.
“Basal cell carcinoma is the most common, followed by squamous cell carcinoma and melanoma,” Stevenson said. According to the American Cancer Society, more than 8,000 people in the United States are expected to die from melanoma this year.
Squamous cell and basal cell cancers occur in the outermost layer of the skin, while melanoma starts in cells called melanocytes, which can penetrate the deeper layers of the skin, making it the most deadly.
“The five-year survival rate for basal cell carcinoma is close to 100 percent,” said Stacy P. Salob, clinical assistant professor at Weill Cornell Medical College. “However, if basal cell carcinoma is left untreated, it can grow and ulcerate, which can be painful, become infected, and destroy nerves, fascia, or cartilage. Squamous cell carcinoma is also curable if caught early. Only about 2 percent of cases metastasize, but that’s when it becomes dangerous. The five-year survival rate is 40 percent.”
“If melanoma is detected early, the five-year survival rate is over 99 percent. But if melanoma spreads to the lymph nodes, according to the Skin Cancer Foundation, only 74 percent of patients survive, and if it metastasizes to another organ, the survival rate drops to 35 percent.”
How to prevent skin cancer?
“You can’t really eliminate the risk of skin cancer,” said Jeremy Brauer, associate clinical professor of dermatology at NYU Langone Health. “But you can reduce your risk by practicing sun protection behaviors. This includes applying a broad-spectrum UVA/UVB sunscreen appropriately, wearing clothing (with UV protection factor) including hats and sunglasses, seeking shade, and planning outdoor activities before 10 a.m. or after 4 p.m. whenever possible.”
“Adopting more sun protection behaviors now is extremely effective in reducing the sun damage you already have, as well as preventing further sun damage,” Pisano said.
In a recent study, the Environmental Working Group, a nonprofit advocacy and research organization, said that only 25 percent of sunscreens on the market met the group’s standards for safety and effectiveness. The organization also released a list of the best sunscreens, all of which contain titanium dioxide and zinc oxide, making them “mineral” sunscreens.
Tell me about sunscreens available in Europe and Asia, but not in the United States.
“In the United States, we have relatively few ingredients that can block UVA rays. Europe and Asia have a number of excellent ingredients that block UVA rays effectively,” Salob said, adding that many American sunscreens work well.
In the United States, the Food and Drug Administration (FDA) regulates sunscreens as over-the-counter drugs, a lengthy process. Bemotrizinol, a broad-spectrum UV-filtering ingredient found in many European and Asian sunscreens, is among the sunscreen ingredients awaiting FDA approval for sale on the U.S. market.
Are there any new treatments for people with sun-damaged skin? What are their side effects and when are they used?
People with a history of multiple skin cancers or precancerous lesions called actinic keratoses may be prescribed topical creams (such as fluorouracil, often combined with Calcipotriene, which helps treat and shrink precancerous cells, or photodynamic therapy (PDT), Stevenson said. PDT consists of a solution that is applied to the skin and then activated by light.
“The treatments create a robust immune response to DNA damage and reduce the risk of skin cancer from those damaged cells. Neither is a one-time treatment,” Pisano said. “You’ll probably need to do it about once a year as a maintenance treatment. Fluorouracil is applied at home and photodynamic therapy is used.” (East) in-office treatment, so the patient can decide what is best for them.
While these treatments are FDA-approved for precancerous spots (also called solar keratoses), Salob said they are also sometimes used to treat “superficial skin cancers. Imiquimod, another topical, is FDA-approved for basal cell carcinomas as well as solar keratoses. It stimulates the immune system to treat the area affected by skin cancer.”
A laser treatment known as fractional resurfacing (or Fraxel) can reduce precancerous changes and lower the risk of developing certain cancers.
With these new treatments, can people be sure they can avoid skin cancer?
Treatments are effective, but they’re not enough. “Even with these treatments, it’s still possible to develop skin cancer, so it’s important to have your skin checked regularly by a board-certified dermatologist,” Pisano said.
When should you see a doctor about a skin problem?
“Any type of pimple, bug bite or red bump that doesn’t go away within four to six weeks, as well as anything that itches, hurts, bleeds or increases in size, should be seen by a dermatologist,” Pisano said.
The American Academy of Dermatology recommends the ABCDE method to help detect melanoma, the deadliest form of skin cancer. Here are some things to look for:
ASymmetry: One half of a spot on the skin does not match the other half.
Border: Its border is not smooth, but rather jagged and irregular.
VScolor: The color of a stain is uneven, with shades of brown, black, gray, red, or white.
DDiameter: A spot on the skin is larger than the tip of a pencil eraser (6 mm).
Eevolving: a spot is new or changing — melanomas grow and change over time.